The Oestrogen Effect: Menopause and Cardiovascular Health

Menopause is defined as 12 months post the last menstrual period. The years before and after menopause form part of the menopause transition known as peri-menopause and post-menopause. Menopause occurs due to ovarian aging and decline, characterised by decreased oestrogen levels. The decrease in oestrogen levels can be associated with a number of symptoms of menopause transition that you may be familiar with, including hot flushes, night sweats, mood changes, poor sleep, decreased libido and vaginal dryness. However, you may not be aware that menopause is also associated with changes in women’s cardiovascular health and risk factors.

Cardiovascular disease is the leading cause of death for women. Cardiovascular disease includes heart disease and stroke. There can be gender differences in the presentation of heart disease. For example, women may present with different symptoms of a heart attack. There is also a difference in the development and progression of cardiovascular risks in women, and a number of these differences are related to the menopause transition. There is a higher risk of heart disease in post-menopausal women than in pre-menopausal. It appears that oestrogen has a protective effect on the cardiovascular system, and this is associated with lower blood pressure, lower LDL cholesterol (the “bad” cholesterol) and higher HDL cholesterol (the “good” cholesterol).

There are unique situations related to menopause that can increase the risk of cardiovascular disease further. These are reaching menopause before the age of 45 years and surgical menopause due to both ovaries being removed before the age of 50.

Some menopause signs and symptoms increase the risk of cardiovascular disease. Vasomotor symptoms, that is, hot flushes and night sweats, disordered sleep and central distribution of fat tissue, are associated with an increase in cardiovascular disease.

Menopause hormone therapy (the new name for hormone replacement therapy) commenced within 10 years of menopause for the management of menopause symptoms may provide a reduced risk of mortality and potentially some protection from cardiovascular disease. However, the evidence does not suggest a benefit for commencing menopause hormone therapy for the sole purpose of prevention of cardiovascular disease.

The menopause transition can be an important time to take measures to decrease the risk of cardiovascular disease, such as making positive lifestyle choices, ceasing smoking, trying to be more active and move your body, trying to eat a well-balanced diet, trying to maintain or achieve a healthy weight and developing good sleep habits.

So, on World Menopause Day 2023, consider your cardiovascular health and arrange for an assessment of your cardiovascular risk. One of our Family Medicine doctors or one of our Lifestyle Medicine Board Certified Doctors can organise an in-depth assessment and management plan to improve your cardiovascular health through the menopause transition.

“ Cardiovascular risk represents a lifetime of choices and experiences, but menopause offers the opportunity of a single point in time to step back, take stock, and do all you can toward promoting future cardiovascular health for the rest of your life.” Professor Cynthia Stuenkel.

Dr Jacqueline Dukino

IMC Camden

Dr Jacqueline Dukino is a graduate of the University of Sydney with experience working in General Practices in Australia and Shanghai. Dr Jacqueline is passionate about women’s health and dedicated to offering advice and support for women navigating menopause.

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