What does your heart do?
Your heart is figuratively, and physiologically, a powerful organ. Many people believe that your heart is your life force, your essence and your happiness.
It is, in many ways, your most precious organ. It is somewhere you hold your family and friends, something you give away to your partner, and a place to hold all of your love.
It is also literally the body’s main transport system, and vital for living.
The heart is a small cone shaped organ, about the size of a small closed fist, and one of the strongest muscles in the body. Physiologically speaking, it is the hearts’ job to pump blood to almost all areas of the body, ensuring that oxygen, nutrients and toxins are both available and expelled appropriately.
The heart can be simply and correctly described as a pump but the heart is not an ordinary pump. Your heart has the amazing ability to cope with demands. A healthy heart has the ability to increase its function and intensity during exercise, slow down and remain consistent during sleep, and work overtime, long term, when building a baby.
Your heart, along with your blood vessels, make up the transport system that is vital for living. This system is called the cardiovascular system.
How does menopause affect your heart?
Menopause is a time of life when you are no longer able to procreate. It is signified by the retirement of the ovaries, and the significant cessation of sex hormone production (specifically oestrogen and progesterone). Unfortunately, menopause is also a time of increased cardiovascular disease.
The jury is still out (and investigating) when identifying the exact cause of this increase, however, lack of sex hormones, aging, and prior risk factors are the key suspects(1).
There is significant evidence to suggest that the lack of sex hormones play a large role in the increased risk of cardiovascular disease (CVD). Sex hormones (created by the ovaries) are not only thought to be protective and appear to have a positive effect on your cholesterol profile, but observational studies have shown that cardiovascular disease in women tends to develop 10 years later than that in men, typically after menopause. The menopausal change in sex hormone levels has been linked with an increase in the total cholesterol and LDL-cholesterol (often termed ‘bad cholesterol’), increasing your risk of cardiovascular complications(2).
Similar to this, it has been found that blood pressure is typically lower in women prior to menopause, compared to post menopause. After menopause, the statistics of women with high blood pressure increases to levels similar, or higher, than age-matched men. A 2009 study showed that approximately 75% women over 60 years old have high blood pressure(3). The common denominator in all these scenarios are the hormone levels.
Whilst high cholesterol is an important factor in potential heart and cardiovascular complications, high blood pressure or diabetes, and their combination has a greater importance in determining cardiovascular risk in women(4).
Does HRT affect your heart?
Bio-identical Hormone Replacement Therapy (BHRT) involves biologically identical hormone supplementation. This essentially means that by taking BHRT, you are supplementing your internal hormone levels with a structurally identical external source.
The theory behind maintaining your hormone levels at a pre-menopause state for a longer period of time in order to reduce your cardiovascular risk is a well-intentioned theory. The logistics behind this thought is laced with many additional benefits including mood, energy and anti-aging. However, if we stand back, we can see that by doing this we are essentially trying to cheat aging. Menopause is a natural process, and does not need to be avoided.
Observational studies have suggested that hormone replacement therapy decreases the risk of cardiovascular disease and reduces deaths in postmenopausal women with heart disease. However, large scale clinical trials are showing unfavourable and inconsistent results. The controversy over the risks and benefits of hormone replacement therapy in the prevention of cardiovascular disease continues, with most of the debate focused on the details (age of menopause, age of HRT use, duration of replacement, dosage and form of oestrogen used, etc.). An additional factor to consider is synthetic hormone replacement therapy, versus bio-identical hormone replacement therapy.
A 2010 study of bio-identical hormone use in menopausal women showed the absence of complications that traditionally develop in those on synthetic HRT(5). An observational study of over 70,000 women has shown a link between synthetic oestrogen and synthetic progesterone with an increased risk of stroke(6). Further to this, a more recent study of over 18,000 women on synthetic HRT confirmed that synthetic HRT use did not confer cardiac protection, and may increase the risk of CVD among generally healthy postmenopausal women(7).
The Australian Menopause Centre continues to utilise only bio-identical hormone replacement therapy, as it is considered to be the more natural, and thought to be a safer option than standard synthetic HRT. More and more studies are showing that there is a sizable difference between synthetic HRT and micronized, or bio-identical HRT, with regards to heart health and cardiovascular impact(8).
Whilst it is known that premenopausal oestrogen is a ‘cardiovascular protector’, we do not recommend starting BHRT for the primary purpose of protecting your heart. The cardiovascular benefits should be considered ‘perks’.
Oral, synthetic oestrogen, which the Australian Menopause does not use, is controversially linked to an increased risk of blood clots.
For otherwise healthy women, heart health should not be a concerning factor when considering bio-identical hormone replacement therapy.
What are the risk factors for cardiovascular disease?
Your cardiovascular system is made up of your heart, blood, arteries and veins, however there are many factors associated with CVD.
Major risk factors associated with cardiovascular disease that cannot be modified include ageing, genetic predisposition, gender and ethnicity.
Modifiable factors associated with an increased risk of CVD include:
- Tobacco smoking
- Sedentary lifestyle
- Poor diet (high sugar, high trans fat)
- Excessive alcohol consumption
- Overweight or obesity
- High blood pressure
- High cholesterol
- Type 2 diabetes
You will not necessarily develop cardiovascular disease if you have a risk factor, however the more risk factors you have, the greater your likelihood of developing heart or cardiovascular issues.
Modify your risk factors now so that you can reduce your risk of heart disease or stroke.
How can you identify if you have any heart issues?
The most common and most dangerous cardiovascular issues observed in Australia is heart attack, and stroke. Unfortunately, both of these conditions are medical emergencies, and often there is little to no warning that it is about to happen. Learn to recognise the signs and act fast.
Heart Attack Warning Signs:
Warning signs may not be what you think. They can vary from person to person and may not always be sudden or severe. Like men, women’s most common symptom of a heart attack is chest pain or discomfort. But women are somewhere more likely to experience some of the other common symptoms:
- Chest pain; uncomfortable pressure, squeezing, fullness, or pain
- Shortness of breath
- Back pain
- Jaw pain
- Arm pain
- Cold sweat
- Light headedness
Act fast, call 000.
Stroke Warning Signs:
A stroke is a medical emergency. If any of these symptoms appear, don’t delay, get medical help immediately.
- Sudden numbness or weakness of the face, arm or leg – especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing with one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
You should never wait more than 5 minutes to call 000.
F – face drooping
A – arm weakness
S – speech difficulty
T – time to call 000
At the Australian Menopause Centre, we have a team of doctors, naturopaths and clinical assistants. If you are concerned about your risk of heart disease, contact us to secure an appointment.
Written by Samantha Mainland
- Matthews KA, Crawford SL, Chae CU, Everson-Rose SA, Sowers MF, Sternfeld B, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? Journal of the American College of Cardiology. 2009;54(25):2366-73.
- de Kat AC, Dam V, Onland-Moret NC, Eijkemans MJ, Broekmans FJ, van der Schouw YT. Unraveling the associations of age and menopause with cardiovascular risk factors in a large population-based study. BMC medicine. 2017;15(1):2.
- Barton M, Meyer MR. Postmenopausal hypertension: mechanisms and therapy. Hypertension (Dallas, Tex : 1979). 2009;54(1):11-8.
- Gorodeski GI. Update on cardiovascular disease in post-menopausal women. Best practice & research Clinical obstetrics & gynaecology. 2002;16(3):329-55.
- Mahmud K. Natural hormone therapy for menopause. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology. 2010;26(2):81-5.
- Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Annals of internal medicine. 2000;133(12):933-41.
- Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, et al. Estrogen plus progestin and the risk of coronary heart disease. The New England journal of medicine. 2003;349(6):523-34.
- Casanova G, Spritzer PM. Effects of micronized progesterone added to non-oral estradiol on lipids and cardiovascular risk factors in early postmenopause: a clinical trial. Lipids in health and disease. 2012;11:133.