You’ve heard about the hot flashes. You may know that menopause can lead to anxiety, brain fog, sleep issues, weight gain, a drop in sexual satisfaction, and a laundry list of other surprising symptoms. But did you know that the change of life can also cause a change of heart?
Menopause may lead to a heightened risk of heart disease, according to the International Menopause Society (IMS). This year, the IMS has devoted World Menopause Day to the theme of cardiovascular disease to bring awareness to this dangerous link.
“It is well-documented that before menopause, women experience lower rates of heart disease versus men, partly due to the multi-factorial effects of ovarian hormones. However, this so-called ‘female advantage’ disappears by age 65,” says Lifeforce Physician Dr. Regina Druz, MD, MBA, FACC, ABIM Board Certified in Cardiovascular Disease.
So, how can you regain your edge and protect your ticker before, during, and after menopause? We consulted experts and dug into the latest research to get to the heart of the matter.
What You Need to Know About Cardiovascular Disease
Cardiovascular disease is not just one disease — it refers to a broad range of disorders that impact the heart and blood vessels. One of the most common is coronary artery disease, a blockage or spasm of the arteries bringing blood to your heart. This can lead to chest pain, shortness of breath, and eventually a heart attack if left untreated, according to a new pamphlet from the IMS.
The heartbreaking news is that cardiovascular disease remains the number one cause of death among women. According to the World Heart Federation, more than a third (35%) of deaths in women each year are due to heart disease. That’s more than all cancers combined, and 13 times more than deaths resulting from breast cancer.
What You Need to Know About Menopause
Menopause is defined as not having a period for one full year. The average age of natural menopause in the U.S. is 51, and the eight to 10 years preceding it are considered perimenopause.
The hormonal changes in perimenopause and menopause can wreak on your sleep, sexual wellness, cognition, body composition, and more. (Read all about what to expect here.) Yet, this transition period is also an opportunity to make positive changes in your life and wellness journey.
A new white paper released by the IMS says, “The menopause transition can be considered a portal to the second half of life, and as such, provides an opportunity to reassess lifestyle, recognize ongoing and potential health concerns, and encourage a proactive approach to future well-being, particularly cardiovascular well-being.” (More on how to get proactive below!)
How Does Menopause Impact Heart Health?
There are several factors that link heart health and menopause. One of the biggest, unsurprisingly, is hormone fluctuation. In perimenopause and menopause, levels of estrogen, progesterone, and testosterone drop dramatically. As hormone levels go down, cardiovascular risk goes up.
“The cardiovascular system is controlled by the autonomic nervous system, which requires estrogen to function properly,” explains Lifeforce Physician Dr. Susan Grabowski, DO. “Blood vessels have estrogen receptors, and estrogen helps maintain healthy tissue. Women will lose elasticity of blood vessels after menopause. Estrogen also facilitates production of nitric oxide, which keeps the vessels open and flexible. Additionally, estrogen contributes to favorable lipid (cholesterol) profiles and is anti-inflammatory. A drop in estrogen during perimenopause and menopause will therefore adversely affect heart health and lead to an increased risk.”
Progesterone has also been shown to promote the widening and relaxation of blood vessels, which leads to better blood pressure, according to Dr. Grabowski.
While androgens like testosterone are known as ‘male hormones,’ they are also crucial for women’s heart health. “DHEA — a precursor to testosterone — can reduce inflammation and improve stress resiliency by decreasing cortisol, and optimal testosterone levels contribute to cardiovascular health,” Dr. Grabowski says. According to a 2023 review study, androgens help keep blood vessels smooth and open, enhancing vascular function.
As if that’s not enough, hormone imbalances have more sneaky side effects. “In perimenopause and menopause, there is a disruption in the cyclic secretion of estrogen and progesterone, preceded by a drop in testosterone. The disruption in cyclical hormonal production leads to relative imbalance, often with estrogen dominance, even though absolute estrogen levels may be lower than during the reproductive years,” explains Dr. Druz. “These factors lead to increased accumulation of internal (visceral) fat, emergence of insulin resistance, and dyslipidemia (the imbalance of HDL cholesterol, LDL cholesterol, and triglycerides).” All of these factors can contribute to a more acute heart health risk during menopause.
Does Hormone Replacement Therapy Help or Hurt Your Heart?
So, if low hormone levels lead to heart problems, is hormone replacement therapy the solution?
The short answer: It can be if it’s started early. “As long as HRT is initiated within 10 years of menopause, it is associated with a reduced risk of cardiac events. Depending on the study, risk reduction of cardiac events is from 30-50%,” Dr. Grabowski says.
However, there are caveats to be aware of. “Those who started on HRT after 10 years of menopause had a slightly increased risk, particularly in the first year of therapy,” Dr. Grabowski says. She also notes that “these benefits do not last if HRT is stopped, and the benefit to vascular health diminishes over time to become the same as those never on HRT.”
Another important distinction is the type of hormones. “Older randomized trials actually showed increased risk of cardiovascular events with HRT. However, these studies were done on older women with oral estrogen and synthetic progestin,” says Dr. Druz. “Later research recognized that synthetic progestin may have contributed to the harmful effects. It is very different from bioidentical progesterone, which is molecularly identical to the type our ovaries make.” (At Lifeforce, we prescribe bioidentical progesterone.)
5 Heart-Healthy Tips to Get Proactive Now
Take heart: In addition to hormone optimization, there are other steps you can take to proactively protect your cardiac health. “Hormones alone are not sufficient prevention of atherosclerosis in postmenopausal women,” Dr. Grabowski says.
Both experts and the International Menopause Society’s guidelines say that lifestyle shifts can make a big impact. In fact, research from Harvard University found that women in their 50s who engaged in “low-risk lifestyle factors” — such as not smoking, limiting alcohol, and maintaining a healthy diet — lived 14 years longer on average than women with less healthy habits.
Here are five places to start for a healthier heart:
1. Check Your Biomarkers
Knowledge is power, so you want to know your baseline biomarker levels and keep close tabs on these numbers. Dr. Grabowski suggests a hormone panel that tests for estradiol, progesterone, DHEA, and testosterone (free and total). In addition, she recommends measuring heart health biomarkers, including an advanced lipid panel, lipoprotein(a), ApoB, homocysteine, A1c, and hs-CRP. The Lifeforce Diagnostic tests all these biomarkers and more, so it’s a great jumping off point. (In honor or National Menopause Day, get $250 off your first diagnostic HERE.)
2. Exercise Regularly
“At least 150 minutes per week of exercise is key to heart health protection,” Dr. Grabowski says. That’s just 20 minutes a day. The American Heart Association suggests that even a 20-minute brisk stroll daily can help people maintain cardiovascular health.
An even bigger flex: Strength training in particular has been shown to boost testosterone and balance estradiol, which enhances heart health during menopause. Resistance training can also improve your overall body composition and reduce visceral fat.
3. Eat Heart Smart
Dr. Druz says to opt for “a diet with phytonutrients and natural, unprocessed foods.” Dr. Grabowski is a fan of the Mediterranean diet, which emphasizes vegetables, fruits, whole grains, beans, and legumes and limits added sugars, sugary beverages, sodium, refined carbohydrates, saturated fats, and fatty or processed meats. Research shows that the Mediterranean diet can reduce your risk of cardiovascular disease by up to 25%.
Load up your grocery cart with fresh produce, seafood, nuts, seeds, legumes, and healthy fats like extra virgin olive oil and avocados.
4. Manage Your Sleep & Stress
“At least seven hours of sleep at night and building stress resilience are essential for women in perimenopause and menopause,” Dr. Druz says. This may sound counterintuitive because menopause actually disrupts deep sleep and contributes to anxiety. Research has shown that hormone optimization can improve sleep quality and help regulate emotional processing.
Additionally, you can support your sleep by making your bedroom a cooler temperature, powering down your devices at least two hours before bed, getting regular exercise, and soaking in the sunshine at least once a day. You can also optimize your sleep with Lifeforce’s Peak Rest™️. (Get more tips for your best rest here.)
For extra support from your smartphone, check out eight mental health apps for stress and sleep here.
5. Consider a Statin
Cholesterol is a major player in cardiovascular disease risk. Studies show that high levels of LDL (aka “bad cholesterol”) is associated with a 50% to 80% increased risk of death from heart disease.
Statins are a type of medication that help reduce LDL and total cholesterol, and may raise HDL (“good cholesterol”). Learn more about statins here and talk to your doctor to find out if they’re right for you.
In honor of World Menopause Day, we are offering $250 off the Lifeforce Diagnostic. The first step toward balancing your hormones and optimizing your health is knowing your levels. Our at-home blood test measures 40+ biomarkers, including comprehensive panels for hormone balance and metabolic health.
This article was medically reviewed by:
Regina S. Druz, MD, MBA, FACC, ABIM Board Certified in Cardiovascular Disease, Institute for Functional Medicine Certified Practitioner
Susan Grabowski, DO, ABAARM Board Certified in Anti-Aging and Regenerative Medicine