Heart disease is the No 1 cause of death after menopause , accounts for 37% of death compared with 3% from breast cancer .
Post menopausal women have a 2- 6 fold increase in heart disease compared with premenopausal women. Women who have an early menopause under age 45 have a higher risk of heart disease.
Life style intervention
Perimenopause and menopause is the golden age to prevent heart disease by lifestyle measures such as optimising weight, exercising, reducing smoking, alcohol intake and eating a healthy diet. This should ideally be started 10 years before menopause but its never too late.
Maintain a healthy weight by reducing intake of saturated fats especially animal fat, red meat and reducing simple carbohydrates such as bread, potatoes, pasta, crisps, sweet treats and processed food . Eating complex carbohydrates like plant based foods, fruits , vegetables , grains, beans, lentils, nuts , seeds, legumes, sweet potatoes keep you full for longer.
Lack of estrogen during Menopause matters predisposes to Risk factors for heart disease .
Weight gain during perimenopause and menopause is mainly around mid-portion and this predisposes to Metabolic Syndrome ( obesity, hypertension, Diabetes, High Cholesterol)
Benefits of HRT: Estrogen is good for our blood vessels, heart function and prevents atherosclerosis and thickening of arterial lining.
HRT prevents Diabetes, lowers Cholesterol and redistributes fat . It also reduces blood pressure by opening up/dilating blood vessels.
Timing Hypothesis: There is good evidence that estrogen if started within 10 years of menopause protects women from heart disease and reduces death from heart disease and stroke.
Some women suffer chest pain , ie angina due to vasospasm (spasm of blood vessels) and investigations like coronary angiography are negative with no obvious obstruction of coronary arteries. This chest pain responds well to HRT.
There are many women who missed out on starting HRT 10-20 years back and are now in their 60s still suffering from menopausal symptoms . Will HRT prevent heart disease in these women?
Ans: Evidence from randomised controlled trials have shown that HRT is not likely to benefit by preventing heart disease when started more than 10 years after menopause but will not be harmful. There was no increase in heart attacks or stroke in these women and it help prevent osteoporosis
In each case treatment needs to be visualised after weighing up benefits and risks . Starting low dose Estrdiol patches/gel and Micronised progesterone capsule which is body identical HRT similar to our own hormones from the ovary does affect clotting and has a lower risk of blood clots compared with other synthetic hormones.
