Many women dread the transition to menopause. Hearing the discontented experiences of friends, mothers and other women before them, it is assumed that menopause will be this dreadful rollercoaster ride that could last 5, 8 or up to 12 years! Due to the decline in protective estrogen, heart disease risk begins to climb during this time. Post menopause, women’s risk catches up with that of men’s risk. Because of this, there is a lot of messaging encouraging menopausal women to adopt a heart disease prevention program. But I’m here to tell you not to wait that long.
We do know that the earlier women start a heart disease prevention plan, the better they will fair post menopause in reducing their risk of heart disease. And if you have officially celebrated the end of your menstrual cycle, there is no time like the present to take deliberate action to prevent your risk of a heart attack.
If you’re approaching perimenopause the timing couldn’t be more crucial to take strategic action. Here’s why…
Estrogen causes fat distribution pattern in breasts, buttocks and thighs. The decline in estrogen during menopause causes more weight gain around the middle instead of the hips and buttocks. Central obesity can lead to low grade chronic inflammation, insulin resistance and type II diabetes
Estrogen, along with collagen and elastin, help support normal distensibility of blood vessels and protects the delicate lining of arteries called the endothelium. A decrease in estrogen, along with decline in collagen and elastin production can affect blood vessel health, contributing to arterial stiffness, reduced arterial dilation, and high blood pressure.
Estrogen plays a role in upregulating LDL receptors in the liver to take up circulating cholesterol. A proposed mechanism contributing to changes in lipids is the down regulation of LDL receptors in the liver causing less uptake from the blood stream. Central adiposity associated with menopause may also contribute to the dyslipidemia as well.
Post menopausal women compared to pre-menopausal women tend to experience changes in their lipid profiles including higher total cholesterol, LDL, apolipoprotein B, and a decrease in HDL function. 
Menopause is a significant risk factor for sleep apnea. In fact, your risk may even double post menopause. Untreated sleep apnea can lead to high blood pressure, poor glucose regulation, disturbances in heart rhythm and overall cardiovascular disease risk.
If you are having ongoing unrefreshing sleep despite 7-9 hours, waking with headaches, snore, having significant daytime fatigues, it is worth a conversation with your doctor about testing. A quick quiz you can do to help determine your potential risk is the SLEEP BANG quiz. Click here to take the quiz.
Women who have more severe vasomotor symptoms (hot flashes, night sweats) are at a higher risk for coronary heart disease compared to those with less severe symptoms. VMS have been associated with a less favorable cardiovascular risk profile and surrogate CVD endpoints such as higher cholesterol, triglycerides, LDL-C, BMI, systolic blood pressure, diastolic blood pressure, and insulin resistance, have been found in women with VMS compared to asymptomatic women.
What can be empowering to know is that even though you may be postmenopausal there are many evidence-based strategies you can implement that can reduce your risk.
So, ladies, what do you say we put prevention—and ourselves—first? Approach menopause with confidence.
If you’re with me, start having a discussion with your health care provider about what strategies you can implement now so you can enjoy the next decades without fear of a heart attack. It’s simpler than you might think. Also know that if you struggle with the symptoms of hormonal changes - night sweats, hot flashes, headaches, cramping, heavy periods, mood changes...there is help for you, you don't need to suffer.
 Sharma, J., McAlister, J., Aggarwal, N., et al. Evaluation and management of blood lipids through a woman's life cycle. American Journal of Preventive Cardiology, 10 (2022). https://doi.org/10.1016/j.ajpc.2022.100333.
 Thompson, C., Legault, J., Moullec, G. et al. A portrait of obstructive sleep apnea risk factors in 27,210 middle-aged and older adults in the Canadian Longitudinal Study on Aging. Sci Rep 12, 5127 (2022). https://doi.org/10.1038/s41598-022-08164-6
Disclaimer: The information presented on this site does not constitute medical advice and does not replace the advice from your doctor. Always consult a qualified health care professional when changing or beginning a new health plan.
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