If you’re going through early menopause, there’s quite a bit that you should be aware of where heart disease is concerned.
So let’s get to the, um, heart of the matter…
Heart disease is the number one killer of American women — responsible for about 36% of deaths. And virtually every study of premature and early menopause makes a very bold statement:
Take a look at the numbers: According to one study, women who go through menopause before age 35 may have a two to threefold higher risk of heart disease. Likewise, women who have their ovaries removed before age 35 may have a sevenfold higher risk (1).
If you’re older than 35 but still younger than 40, your risk is a only bit lower — about twice the chance of developing heart disease. In fact, whether you’ve gone through a surgical or natural premature menopause, you’re at a higher risk of heart disease than women who have gone through menopause at the average age.
These are startling figures to say the least — and one of the key reasons it’s so important to take charge of your heart health as soon as possible.
Are You At an Even Higher Risk for Heart Disease? Other Risk Factors To Know:
As with so many things that affect you when you’re coping with an early menopause or premature ovarian failure (POF), the reason for this increased risk appears to be lower amounts of estrogen. There have been a number of research studies exploring this link between estrogen and heart disease, however the results have not been completely conclusive. It’s a confusing scenario, to be sure…
Most recently, the Women’s Health Initiative Study (the WHI) halted the arm of the study in which “normal” menopausal women (women aged 50 to 79) were taking Prempro hormone therapy (conjugated equine estrogen and medroxyprogesterone acetate) due to an increase in heart attack and stroke.
In the above case, it appeared that the synthetic progestin (Provera) was the problem where the increase in heart problems was concerned, as those women in another arm of the study who were on estrogen alone didn’t show this same marked increase in cardiac events.
Another study (the HERS study) found that post-menopausal women (women of “normal” menopausal age — that is, older women) with a history of heart disease actually increased their risks of having heart problems for the first two years of hormone replacement therapy (HRT), but after this, the risk diminished.
It’s possible that, in these women, a gene defect causes estrogen receptors to stop working — and so keeps arterial cells from responding to estrogen. This could explain why HRT doesn’t appear to have the same effect on heart disease in women who already have coronary heart disease.
According to a number of studies, it appears that estrogen decreases LDL (low-density lipoprotein — the “bad” cholesterol) and increases HDL (high-density lipoprotein — the “good” cholesterol). This keeps atherosclerotic plaque from sticking to arteries. It also reduces one form of LDL cholesterol called LP(a) , which can cause stroke if high (2).
Estrogen also appears to help keep your homocysteine levels low. Homocysteine is an amino acid that, at elevated levels, affects the arterial linings and appears to be connected with an increase in heart disease and stroke. Finally, it may help to keep your blood vessels elastic, so they can expand when necessary to allow for increased blood flow.
But when you have an estrogen deficiency, your cardiovascular system starts working less smoothly… literally. When your circulating cholesterol changes to higher levels of the “bad” cholesterol and lower levels of the “good” cholesterol, the platelets in your blood get sticky. They build up on your artery walls, clogging them up, and interfering with blood flow. This can lead to heart attack or heart disease in general.
In addition, the lower estrogen makes your blood vessels more rigid and more likely to constrict. As a result, you can wind up with high blood pressure — which also can result in heart disease.
It’s not a great scenario… but it doesn’t have to happen. Premature menopause doesn’t necessarily equal heart disease. The key is getting heart-smart now to identify strategies with your doctor that can lower your risk!
Heart Helpers: What You Can Do To Tackle Heart Disease
Okay, so that’s all the bad news. But premature menopause won’t necessarily lead to heart disease. You can fight back — and, with due care, improve the odds of keeping your heart healthy. Here are some steps that could help your heart:
Consider replacing the estrogen you’ve lost
When it comes to fighting heart disease, estrogen itself appears to be on your side. Yes, there has been a longstanding debate over the pros and cons of estrogen replacement therapy and some concern over the findings of different research studies. This has made the issue a major source of controversy and contention between the different viewpoints.
The official position of the National Institute for Health and Care Excellence (NICE) is that HRT has no effect on the risk of dying from heart disease. In addition, HRT is not routinely prescribed for heart disease prevention in normal age post-menopausal women.
The key point to illustrate here is just that: age. Most women become post-menopausal in their 50s, and the circumstances of a “normal” menopause are entirely different to those faced by women experiencing early menopause or premature ovarian failure (POF).
As with so much of the reporting surrounding menopause and large HRT studies, discussion has been focused around women in their 50s (and beyond) and the risks vs benefits scenario that they face. For those of us going through early menopause or POF: the guidelines are clear — the benefits of HRT in symptom management and disease-risk reduction outweigh any drawbacks.
In further good news, the results of various studies have shown a heart-protecting effect for HRT: replacing estrogen results in a lower risk of heart disease — as much as 50 percent if used for ten years or longer, with smaller improvements observed when used for lesser time periods (3, 4, 5).
Researchers believe that one way in which estrogen protects your heart is by reversing the rise in the “bad” LDL cholesterol after menopause. According to one recent study of women taking estrogen, LDL declined 13.5 percent while HDL (the “good” cholesterol) increased 22.5 percent (6).
Other studies have also shown that estrogen lowers fibrinogen, a blood-clotting factor and helps your blood vessels respond well to overloading through stress or exercise (7).
There are a few negatives to take into consideration however: If you take estrogen and a progestin (a synthetic progesterone such as the widely prescribed Provera), the progestin may block the benefits of estrogen. In addition, according to a number of studies, oral estrogen may increase your level of triglycerides (a type of fat in your blood that may be linked to heart disease), and can increase your risk of blood clots (6).
However, most doctors — even those who have argued against the use of HRT for normal menopausal women — believe that women in premature menopause would benefit from the use of HRT to prevent heart disease… at least until they reach the age of 50, the age at which their bodies would “normally” have experienced an estrogen drop.
To restate a point that I keep saying again and again: The key thing to remember here is that, unlike women who are taking estrogen in their 50s, when you’re in premature menopause, you’re taking it in your 20s, 30s or 40s — the years in which your body would have had this estrogen anyway under normal circumstances.
You’re replacing what the average woman your age has — and so, regaining the protection against heart disease conferred by estrogen that you usually would have had at this age.
If you can’t — or won’t — take HRT, you can still get the benefit of estrogen through alternative methods
First, you can replace estrogen by upping your intake of phytoestrogens, chemicals found naturally in certain foods, such as soy, that imitate estrogen. One study found that phytoestrogens appear to be as effective in preventing stroke as Premarin (a commonly prescribed conjugated estrogen) in post-menopausal monkeys.
The study was part of a program funded by the National Heart Lung and Blood Institute that is exploring the benefits of soy phytoestrogens. Clearly, much more research is needed before firm conclusions can be drawn, however.
You can get soy and other phytoestrogens through your diet, or by taking supplements such as soy isoflavones or ground flaxseed.
You also can look into taking tamoxifen or raloxifene. Both are so-called “designer-estrogens” or SERMs (selective estrogen receptor modulator). These seem to offer some cardiovascular benefits; however, they appear to be less effective than regular estrogen. Evidence suggests they may be able to decrease levels of the “bad” LDL cholesterol.
However, they don’t appear to have any significant effect on levels of the “good” HDL cholesterol, whereas estrogen appears to raise HDL. Even so, some prevention is better than none — so raloxifene or tamoxifen may make sense for you if you are unable to take estrogen. Again, talking these issues through with your doctor is always the best course of action.
Take Regular Exercise
You’ve heard it before: Regular exercise is good for your heart. It keeps your blood pressure down, increases the level of good cholesterol in your blood, helps you cope with stress, keeps your weight under control, and helps prevent diabetes… and these are only the benefits connected to your heart!
It also keeps your lungs working well, tones your muscles, and builds bone. Quite a list of positives!
Thirty minutes a day appears to give you the best chance of enjoying these health benefits. The good news is that, contrary to what was believed in the past, you don’t have to get those thirty minutes of exercise at one time.
As long as you get your heart rate up for a total of thirty minutes, you’re getting the protection you need. Walk upstairs instead of taking an elevator or escalator. Park farther from the mall and walk a few extra yards. Just get active!
Start eating for your heart’s sake
• Opt for a diet rich in heart-friendly foods. In particular, try to include sources of Omega-3 fats, such as those in fatty fishes like salmon.
• Also, try to eat foods high in Vitamin E (such as nuts and whole grains), which are believed to help lower the “bad” cholesterol, LDL.
• Up your fiber intake. It’s a good idea to get about 25 to 35 grams of fiber a day — to help reduce cholesterol, protect against diabetes, and keep blood sugar levels stable.
• Finally, try to cut down on sugar and empty calories. You’ve probably heard this advice before, but for good reason: It works!