When you think of cardiovascular disease, you may conjure an image of an overweight middle-aged man, but the truth is that cardiovascular disease (CVD) affects women too.
Heart health and menopause are connected. Menopause itself does not cause cardiovascular disease (such as heart disease and stroke), but certain risk factors increase around the time of menopause.
Oestrogen levels: The hormone oestrogen affects almost every tissue and organ in the body in some way – and that includes our heart and general cardiovascular health. As women age, oestrogen levels deplete during perimenopause and menopause. This can result in narrowing arteries, stiffer and less elastic blood vessels, and changes to the walls of the blood vessels, which make it more likely for plaque to form. These changes can also lead to increased blood pressure, damaging the blood vessels. These changes can elevate the risk of stroke, heart disease, and more.
Other hormones: It’s not just oestrogen that plays a part. There also tends to be a disruption of other hormones including progesterone, testosterone, thyroid hormone and precursor hormones such as DHEA and pregnenolone. Progesterone lowers blood pressure and dilates the blood vessels. It’s important not to confuse progesterone with progestins or progestogens which resemble progesterone but are not molecularly identical to progesterone. Progestins are implicated in many of the studies which show an increase in strokes and heart attacks. An example is Provera (progestin) and Premarin (horse oestrogen). Sadly, progesterone and progestins have been used interchangeably, leading to a great deal of confusion and scaremongering in both laypeople and doctors. The recent reversal of NHS guidelines in regards to HRT is a welcome nod to this decades-old fear that so many women have of HRT. In addition, it is important that we mention how having an active metabolism (thyroid), the ability to build muscle,drive, and motivation (testosterone), and a general sense of wellbeing with a better ability to handle stress (precursor hormones), is extremely important as we get older.
Hot flushes and night sweats: Interesting recent research from The University of Queensland about the link between hot flushes and heart health suggests that women who experience hot flushes and night sweats after menopause are 70% more likely to have a cardiovascular disease like angina, strokes and heart attacks.
Timing of menopause: Many studies suggest a link between the time a woman reaches menopause and CVD risk. Indeed, early menopause (before the age of 40) has been linked to increased risk (see this study in The Lancet). Interestingly, recent research also highlights that black women are three times more likely to experience early menopause and as such, have depleted levels of oestrogen, progesterone and testosterone earlier than others.
Visceral fat: Visceral fat is the kind of fat that builds up in the belly area and around your organs. The University of Pittsburgh has released recent findings showing how women who have accelerated accumulation of abdominal fat at menopause are at a greater risk of cardiovascular disease.
Dr Harpal Bains explains: “Women we see in the clinic initially often seek HRT (hormone replacement therapy) for the purpose of symptom relief from the more obvious signs of menopause. They may have hot flushes, night sweats, insomnia, and mood swings that are driving them around the bend. But the effect oestrogen – or the lack thereof – has on the body goes much deeper than that. Oestrogen is essential for maintaining bone health, brain health, skin health and also cardiovascular health. I always say that women who get menopausal symptoms bad enough to seek help are in many ways much better off as they are putting protective measures in place sooner rather than later. Symptom relief is a ‘nice to have’. Bone, brain and cardiovascular protection should be a ‘must have’.
“On a more personal note, I recently reached menopause and I didn’t have many symptoms. I feel lucky to be doing this for a living as otherwise, I would simply have chosen not to replace my hormones, thinking of myself as one of the ‘lucky’ ones with very few symptoms. Now I know that I am doing all I can to protect my health for the future. And the icing on the cake is that apparently I had more symptoms that I realised as they crept up on me so gradually. I’m much calmer, happier, energetic and my skin is so much better.”
Women who take HRT for ten years following menopause have fewer heart attack and heart failure cases. We prefer to use bioidentical HRT to tailor the exact doses to what your body needs. Bioidentical hormones are identical in makeup to those produced in the body, rather than the synthetic ones used with traditional HRT. With these, we tend to find patients report fewer side effects, especially as we are able to tweak the delivery method, for example: creams, gels, lozenges, oral, pessaries and more. We are also able to adjust the dose as your body gets used to having these hormones again.
“There are many well-known benefits to bioidentical hormone replacement therapy – relief from the symptoms of menopause like hot flushes, but some of the hidden long-term benefits are, in my view, some of the most important. These benefits usually include better cardiovascular health and protection from osteoporosis, which is closely linked to the reduction in oestrogen that happens at menopause. BHRT is a chance to be proactive and do something that can protect you against future health conditions.” explains Dr Bains.
“Research shows that replacing oestrogen using HRT helps protect against heart disease when started in the earlier years of menopause. It helps maintain cholesterol levels, reducing the risk of plaque build-up in the arteries. It is for this reason that I prefer patients to remain on bioidentical HRT long term, beyond the ‘symptomatic’ menopause.”
And it’s not just oestrogen that plays a vital role in the body for women. Testosterone, often considered a male hormone, can help with weight control. It helps build more muscle and, as such, helps women to burn more calories. This can be beneficial for addressing and managing the issue of visceral fat. Although testosterone is not available for women with traditional HRT, one of the benefits of using bioidentical hormones is that we can offer it here in the clinic.
And of course, let’s not forget what most of our patients tell us – BHRT helps with overall improved zest and energy, which translates into a happier, more active person.
At Harpal Clinic, we take a holistic approach to managing menopause, addressing all hormone depletions (not just oestrogen) and replenishing them in precise amounts tailored to your body’s individual needs. We look at stress, lifestyle, nutrition, and more, considering all aspects of your life. We will address issues at their root to ensure you can have an improved quality of life long-term.