It is important to take a holistic approach when managing the menopause. Women experiencing the menopause need to be viewed in context of their medical history, social and personal circumstances.
At a molecular level, oestrogen receptors are found widely within the human body. They are present in the tissues of the female reproductive tract, breast, bone, brain, kidney, heart, lungs, liver, bowel, skin, salivary gland and endothelial cells. As women approach the menopause, these receptors are less activated due to the declining levels of oestrogen. This then results in a spectrum of menopausal symptoms, which can vary from person to person.
One important role of oestrogen is in its protection given to the heart. Oestrogen controls cholesterol levels by reducing the formation of cholesterol plaques within arteries and preventing them from becoming narrow or blocked. This process of atherosclerosis increases a person’s overall risk of heart disease, heart attacks and strokes. This risk is greater in women around the menopause and therefore needs to be assessed and managed appropriately.
We approach this by measuring and managing the following, if needed:
- Blood pressure – Taking an average of morning and evening readings over a week at home is recommended. Blood pressure targets vary according to your medical history, but usually an average 135/85 is acceptable.
- Cholesterol / Blood Lipid levels – A blood test can check these levels and your risk calculated according to your medical history.
- Sugar levels (HbA1c) – A blood test can check this level.
- Weight – Changes in the menopause typically affect women with weight gain around their abdomen or tummy area. There can also be increased amount of fat around the heart. Calculating the body mass index (BMI) can help women identify their healthy weight range. https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/
A well-balanced diet, regular physical activity, smoking cessation and alcohol reduction are recommended for patients as a starting point to managing overall cardiovascular disease risk.
See links below:
https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating
https://www.bhf.org.uk/informationsupport/support/healthy-living/staying-active
Further treatment and support is offered to ensure such risk factors are thoroughly managed before hormone replacement treatment (HRT) is considered.
Hormone replacement therapy can be prescribed to help improve symptoms associated with the menopause which impact on the woman’s quality of life. There is some evidence to suggest that HRT can reduce risk of cardiovascular disease, and that starting it within 10 years of the menopause (ie a year of no periods) and ideally, before the age of 60 could help to reduce this risk.
Useful Resources:
https://www.womens-health-concern.org/2021/03/hrt-and-heart-disease/
https://www.menopausematters.co.uk/cvd.php
https://www.womens-health-concern.org/wp-content/uploads/2022/12/11-WHC-FACTSHEET-HRT-BenefitsRisks-NOV2022-B.pdf