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Beyond Hot Flushes: The Surprising Impact of Menopause on Heart Health

Updated: Nov 8, 2023

One in three women dies as a result of cardiovascular disease 💔.

About ten years after menopause, cardiovascular disease (CVD) becomes women's leading cause of death, even overtaking breast cancer. While this is later in life than men, don't let that lull you into a false sense of security. These risks often go under diagnosed and are generally underestimated.

Women must be made aware of this hidden health hazard.

Hormones and Heart Health

Menopause is more than just the cessation of menstrual cycles; it brings about hormonal changes that influence the heart.

Declining levels of oestrogen and, to a lesser extent, progesterone —can significantly impact cardiovascular diseases like coronary artery disease, heart failure, and stroke.

Let's make it clear: menopause does not cause cardiovascular disease.

However, during the menopause transition, women experience many body changes, including some that can impact their cardiovascular health.


How Reduced Oestrogen Levels Impact Your Heart Health

Oestrogen has many beneficial effects. Its vasodilatory properties aid blood flow, help regulate lipid levels, and have anti-inflammatory effects, all of which contribute to heart health. When these levels drop during menopause, cardiovascular issues can arise.

  • Hypertension: The Silent Danger

One of the critical aspects influenced by declining oestrogen levels is blood pressure. Oestrogen promotes vasodilation, meaning it helps your blood vessels expand, facilitating smoother blood flow. Without sufficient oestrogen, the opposite effect occurs (vasoconstriction), combined with arterial stiffness, ultimately resulting in higher blood pressure. This increases the risk of hypertension—a leading cause of CVD.

Although not as crucial as oestrogen, progesterone also has a vasodilatory and anti-inflammatory effect. So, its reduction also has an impact.

  • Lipid Disorders: The Bad and the Ugly

Oestrogen helps maintain a healthy balance between 'good' (HDL) and 'bad' (LDL) cholesterol. It also keeps triglyceride levels in check. When oestrogen levels drop, we often see an unfavourable shift: increased levels of LDL and triglycerides and decreased HDL.

This imbalance is a significant risk factor for atherosclerosis, where fatty deposits build up in arteries, raising the risk of cardiovascular events like heart attacks. Often, after menopause cholesterol levels can go up by 10-15%.

Oestrogen also has an anti-inflammatory effect – so in its absence or decline, the cholesterol deposits that occur become more problematic.

  • Diabetes: The Unseen Culprit

Oestrogen is also instrumental in regulating glucose metabolism and insulin sensitivity. As oestrogen levels fall, insulin resistance can increase, setting the stage for Type 2 diabetes. This condition significantly raises your risk of CVD. With a 3.3 times higher likelihood of dying from CVD, diabetic menopausal women must be particularly cautious.

  • Obesity: The Weighty Issue

Menopause often brings weight gain, particularly around the abdomen. Oestrogen's decline plays a role in this change in fat distribution, leading to central adiposity or an 'apple-shaped' body, which is closely related to cardiovascular risk.

Your waist size is important; anything equal to or over 80cm has a greater association with CVD.


Beyond Oestrogen: Unmasking the Hidden Factors Impacting Cardiovascular Disease in Menopausal Women

In addition to hormonal shifts, menopausal women face a myriad of lifestyle and emotional changes that could contribute to increased cardiovascular disease (CVD) risks. This includes sleeping issues, hot flashes, mental health, smoking, physical activity, and stress.

  • Sleep Disorders

Sleeping problems like insomnia are common during menopause and can be linked to an increased risk of hypertension and heart disease. Lack of quality sleep often leads to an imbalance in stress hormones, causing strain on the cardiovascular system over time.

  • Hot Flashes

While hot flashes may seem unrelated to heart issues, studies have shown that severe hot flashes can be a marker for vascular dysfunction (problems with blood vessels), a precursor to CVD. Therefore, if you are experiencing frequent and intense hot flashes, discussing your cardiovascular risk factors with a healthcare provider might be wise.

  • Mental Health: Anxiety and Depression

Menopause can be an emotionally turbulent time, with many women experiencing increased levels of anxiety and depression. These emotional states can lead to the release of stress hormones that put additional strain on the heart. Mental health should be considered part of a comprehensive approach to managing CVD risk in menopausal women.

  • Smoking

If you're a smoker going through menopause, your risk of developing CVD is substantially higher than that of non-smokers. Smoking has been shown to counteract the protective effects that oestrogen once provided your heart.

  • Physical Inactivity

Exercise plays a pivotal role in maintaining cardiovascular health. The metabolic changes that occur during menopause often lead to weight gain and increased fat deposition around the abdomen, which are risk factors for heart disease.

  • Stress Management

Stress and menopause often go hand-in-hand due to hormonal fluctuations, life changes, and symptom-related discomfort. Chronic stress has been linked to heart disease and can exacerbate other risk factors like hypertension.

  • Early Menopause and Surgical Menopause

There is an association between menopausal type and timing in CVD risk prediction. Early and surgical menopause can significantly increase a woman's risk of developing cardiovascular disease (CVD), primarily because these forms of menopause result in a more abrupt decline in the protective effects of estrogen. Therefore, early intervention and lifestyle modifications are even more crucial.

The Takeaway

While the hormonal changes of menopause are significant, they are just one piece of a larger puzzle. Understanding the multifaceted nature of CVD risks during menopause can empower you to take a more comprehensive approach to your health. Taking care of your heart involves more than just keeping an eye on oestrogen levels.


Positive actions that can be taken to support your heart health.

Simple Steps, Big Impact

Here are ten prevention tips to reduce cardiovascular disease's impact during menopause.

  1. Regular Exercise

Reduced physical activity during this period is common. However, consistent physical activity is one of the best ways to combat cardiovascular risks. Aim for at least 30 minutes of moderate exercise most days of the week. This will not only help manage weight but will also reduce stress, another contributing factor to CVD.

2. Maintain a Healthy Weight

Weight gain is common during menopause; excess weight can lead to diabetes and hypertension. Keep an eye on your waistline, as abdominal fat is particularly dangerous regarding cardiovascular risk.

3. Eat a Balanced Diet and limit sugar and processed foods.

While some may find this advice to be a no-brainer, for others, it might not be as intuitive. I'll release a detailed post next week to delve deeper into how diet affects heart health.

In the meantime, consider focusing on a diet abundant in fruits, vegetables, whole grains, and lean proteins to help regulate cholesterol and blood pressure. The Mediterranean diet, rich in beneficial fats like olive oil and nuts, is a great place to start. And remember the detrimental impact of excess sugar; it's a primary culprit in weight gain and a significant risk factor for CVD. Aim to reduce consumption of sugary beverages, sweets, and processed foods high in sugar and salt.

4. Moderate Alcohol Consumption

While the occasional glass of red wine may have some heart benefits, excessive drinking can lead to various health problems, including high blood pressure and irregular heartbeats.

5. Quit Smoking

If you smoke, now is the time to quit. Smoking is a significant risk factor for developing CVD and can accelerate the negative cardiovascular changes during menopause. Kicking this habit is crucial, not just for heart health but for overall well-being.

6. Prioritise Sleep

Poor sleep can contribute to problems like hypertension and is common during menopause due to symptoms like hot flashes. Therefore, maintaining a consistent sleep schedule is crucial for heart health. Aim for 7-9 hours of quality sleep per night.

7. Control Blood Pressure

Keep tabs on your blood pressure. If it starts to climb, lifestyle changes and possibly medication are essential.

Elevated blood pressure is a leading risk factor for heart disease and stroke.

8. Manage Stress

High-stress levels can contribute to heart disease. Stress management techniques such as mindfulness and deep-breathing exercises can be valuable additions to your heart health toolkit.

9. Be aware and have Regular Medical Check-ups

Have regular doctor visits. Screenings for cholesterol levels, blood pressure, and other cardiovascular risk factors are crucial during menopause. Your healthcare provider can offer targeted advice and early intervention if needed.

Heart disease risk goes up the longer some of these issues remain untreated.

Signs to Watch For

Women's symptoms of cardiovascular disease can differ from men's. Look out for upper abdominal pressure, jaw and neck pain, extreme fatigue, and shortness of breath.

10. Consider HRT, especially if under 60 and within 10 years of post-menopausal.

The exception to this is if you have experienced early menopause, then the 10 year 'cut-off' does not apply.


Menopause often coincides with a potentially stressful and busy time in women's lives, and they often put their own health aside, foregoing exercise and healthy food and missing routine health care such as cholesterol checks.

Healthy habits during this period are vital – Don't underestimate the impact of small, consistent, healthy lifestyle choices. You don't have to run marathons or adopt a vegan diet—make heart-healthy decisions most of the time - a bit more thoughtfulness about diet can make a huge difference to support you in the next decade and beyond.

If you are worried, for whatever reasons, please talk to a healthcare professional.

I'm here to support you throughout your journey. Feel free to reach out if you need guidance, help staying consistent, or are concerned about other issues you might be facing.

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