Hot flushes, brain fog, and night sweats are all hallmark symptoms of the menopause that many women know to expect. But research has found that menopause can impact women’s health in other ways that may come as a surprise – including heart health.
According to the British Heart Foundation (BHF), before menopause, women generally have a lower risk of heart disease than men. But after menopause, the risk increases. In fact, over 3.6 million women are currently living with heart disease, and it’s the leading cause of death of women in the UK – statistics that can be overwhelming to learn.
But understanding the link between menopause and heart health can be empowering. Here, we’ll explore what the research says, and consider practical steps you can take to help reduce your risk of heart disease.
Note: If you’re experiencing chest pain or discomfort (such as pressure, tightness, or squeezing) that doesn’t go away and/or is accompanied by feeling unwell, call 999 as soon as possible. It could be a sign of a heart attack.
What’s the link between menopause and heart disease?
Menopause occurs when the ovaries stop producing as much of the hormone oestrogen and don’t release an egg each month. Levels of other hormones, like progesterone and testosterone, also drop – a natural process that every woman will experience, though the timing and intensity can vary greatly from person to person.
Many women experience significant changes as a result of these hormones shifting during menopause, including symptoms like hot flushes, insomnia, and brain fog that can be disruptive to daily life. However, alongside these more familiar physical symptoms, menopause can also result in other changes that may not be immediately noticeable but can impact heart disease risk.
Understanding these less obvious changes can help you feel more prepared and in control of your health journey. We’ll cover some of these below.
Note: While menopause can play a role in the development of heart disease, experts are keen to emphasise that many heart issues associated with menopause can also be linked with general ageing.
High cholesterol
High cholesterol is a significant risk factor for heart disease, linked with one in every five heart and circulatory disease (CVD) deaths in the UK.
For many women going through menopause, cholesterol levels may change in ways they weren’t expecting. Menopause has been associated with a progressive increase in total cholesterol – particularly LDL (bad) cholesterol. This study, for example, found that total cholesterol levels tend to peak in women between the ages of 55 and 65, about 10 years later than men.
This shift is likely linked with the natural reduction in oestrogen that occurs during menopause. Oestrogen does so much more than we might realise – among other things, it helps regulate cholesterol and keep blood vessels healthy. When oestrogen levels fall, fat can begin to build up in arteries, causing them to become narrower, and increasing the risk of stroke, heart attack, and heart disease.
If this feels like concerning news, you’re not alone in being unaware of this connection. Despite these findings, research suggests a general lack of awareness of the link between menopause and cholesterol. A recent survey found that only one in four women associate menopause with high cholesterol, which means that three-quarters of women may be experiencing these symptoms without understanding why.
High blood pressure
High blood pressure is the leading modifiable risk factor for CVD in the UK, linked with around 50% of heart attacks and strokes.
There’s evidence that menopause can contribute to high blood pressure. Take this study, for example, which found that women had a higher risk of developing high blood pressure after age 45 than men. This is likely due to oestrogen’s role in blood vessel health.
The more reassuring news is that blood pressure is something that is usually possible to control – we’ll cover more on this later.
Weight gain
Most of us won’t be surprised by the link between excess body weight in around one in nine CVD deaths in the UK.
Interestingly, before age 45 obesity is more common among men than in women. But after age 45, the trend reverses, suggesting a link with menopause.
Many women also report frustrating changes in fat storage and distribution within their first year of menopause. Experts have also confirmed a shift in where women tend to store fat during and after menopause – from the hips to the waist – and women with larger waists may be at a greater risk of heart disease.
While experts are currently unsure exactly why menopause affects weight and fat distribution, it’s believed that hormones are largely responsible. Links have been made to the continued production of male sex hormones like testosterone (post-menopausal ovaries still produce male sex hormones), as well as changes in leptin (a hormone that regulates appetite and fat storage) and thyroid function.
Diabetes
According to the BHF, adults with diabetes are two to three times more likely to develop CVD than those without the condition, and for women, the picture becomes even more complex. Research suggests that diabetic women face a greater risk of death from heart disease than men with the condition.
One 20-year study found that women with diabetes were 3.3 times more likely to die from heart disease than women without diabetes, while the risk for diabetic men was only 1.7 times that of non-diabetic men. Other research has also noted a four-fold increase in heart disease risk among women 10 years after the menopause.
While these findings might feel alarming, understanding the connection means you can have more informed conversations with your doctor about your individual risk. Experts believe that menopause-related changes in insulin production and insulin sensitivity may play a role in this increased risk.
Does early menopause further increase heart disease risk?
According to the BHF, if you have early menopause, your risk of developing heart disease is higher. This is because your oestrogen levels begin to drop at an earlier age.
For example, this study found that women with early menopause (45 and younger) experienced more issues later in life than those who went through menopause around 50.
Going through menopause can be challenging at any age, but particularly if it starts early, as you may feel like you’re navigating this alone while your peers haven’t experienced it. It’s normal to feel upset, isolated, or unsure where to turn for support – you’re certainly not alone in feeling this way.
If you’d like to speak to someone about your experience, the Daisy Network is a charity offering support to women navigating early menopause. The Balance app also provides helpful tips for early menopause symptoms, and is available to download on the Rock My Menopause website.
4 steps to help reduce the risk of heart disease
Research suggests that after menopause, women may be more at risk of heart disease.
However, while certain risk factors can’t be controlled, there’s encouraging news: the World Health Organization (WHO) estimates that around 80% of heart disease cases could be prevented by diet and lifestyle changes. This means you have more power over your heart health than you might realise.
We’ll cover some of the main ways to reduce your risk of heart disease, focusing on practical steps that can fit into your daily life. For more in depth reading, you might also like to read our article: 11 healthy heart tips.
Note: If you’re concerned about your heart health, it’s important to make an appointment with your GP.
1. Build heart-protective habits into your daily routine
Staying active and eating a healthy, balanced diet are among the best things you can do to improve your heart health. Even small changes can make a meaningful difference.
We know from research that things like regular exercise, eating more fibre, and cutting down on salt and saturated fat are linked with lower cholesterol, blood pressure, and healthy weight maintenance – all of which play a role in heart disease.
Statistics also show just how effective these everyday choices can be. For example, research suggests that a 10% reduction in LDL cholesterol can reduce CVD risk by up to 20%. And, according to the BHF, being physically active can reduce your risk of developing CVD by as much as 35%.
To learn more, you might be interested in our articles: 5 tips to help lower cholesterol, 10 natural ways to lower blood pressure, and 10 creative ways to get fit and have fun.
2. Quit smoking
The BHF estimates that at least 15,000 CVD-related deaths could be prevented each year in the UK if people quit smoking. This is because, among other things, smoking can damage blood vessel walls and cause a build-up of plaque in the arteries.
Luckily, research shows that once you quit, some of the benefits are almost immediate as the body begins to repair itself. If you’d like help with quitting smoking, you might find our article, 7 tips for quitting smoking, useful.
3. Have regular health checks
Having regular health checks is important for keeping an eye on health and diagnosing conditions early.
When it comes to heart health and menopause, this may be particularly important as experts say symptoms of heart disease can manifest differently in men and women. Specifically, women are less likely to present well-recognised symptoms, which can further increase the risk of conditions going undiagnosed.
To learn more, check out our article: 11 important health checks for over 50s.
Note: If inherited heart conditions run in your family, it’s important to get tested.
4. Take steps to manage diabetes
We know from research that diabetes is a risk factor for heart disease, so it’s important to take steps to manage your symptoms if you have the condition – or to get tested for diabetes if you think you might have it.
For guidance with this, you might like to read our guides to type 1 diabetes and type 2 diabetes.
What about hormone replacement therapy (HRT)?
Hormone replacement therapy (HRT) is a treatment used to help women manage symptoms of menopause. HRT works by replacing the hormones in your body that decline during menopause, including oestrogen.
Many women find HRT useful for managing symptoms like hot flushes, mood swings, and vaginal changes. However, there’s still debate over its benefits for heart health.
On the one hand, there’s evidence that HRT may help to reduce the risk of stroke, heart attack, and heart disease by replacing hormones in the body that help to protect the heart. Some research has also linked HRT with lower cholesterol. However, conflicting research suggests that some types of HRT may actually have the opposite effect. And another study found no HRT benefits for heart health and actually noted a slight increase in stroke and thrombosis (blood clotting) risk.
It’s possible that the age at which women start HRT, and the way in which HRT is administered, can make a difference.
Specifically, research suggests the earlier HRT is started, the more effective it is at reducing the risk of heart disease. In line with current research, the BHF recommends beginning HRT within 10 years of starting menopause, and before the age of 60. Other research suggests that HRT tablets may slightly increase the risk of blood clots and stroke, compared to HRT patches or gels. However, again, the risk remains low for women under 60.
According to the BHF, while the benefits usually outweigh any potential risks for many people, it’s important to make the right decision for you.
To help you decide, it can be useful to discuss options with your GP or read up on the benefits and risks of HRT from trusted sources. The BHF has more information about HRT and heart health on their website, including whether HRT is suitable for those living with a heart condition or who have an increased risk of stroke or heart attack.
Final thoughts…
Research suggests that menopause can increase the risk of heart disease. However, while some changes are out of our control, experts say that healthy lifestyle changes can make all the difference when it comes to reducing your risk.
For further reading, head over to our menopause section. Here, you’ll find information on everything from managing menopause in the workplace to other menopause-related health changes.
Were you aware of the link between menopause and heart health? Are you taking any steps to improve your heart health? We’d be interested to hear from you in the comments below.
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