Menopausal transition, or the years leading up to a woman’s last period, often begins between ages 45 – 55 and marks the beginning of significant biological and psychological change. A decrease in ovarian function, changes to hormone levels, and other biological processes related to nutrition and energy become more prevalent, and psychological conditions such as depression or anxiety can manifest or become worse. A recently shared statement from the American Heart Association suggests that these changes also include an increased risk for postmenopausal cardiovascular disease, the leading cause of death in women in the United States, and highlights a need for education and preparation.
We answer that call by taking a closer look at what menopausal transition is, the connection between menopausal transition and CVD risks, and what you should know about prevention.
Menopausal Transition, or perimenopause, refers to the time leading up to a woman’s last menstrual cycle and ovarian function, and most often begins in a woman’s 40s through mid-50s. For most women, this transitional time before menopause will last roughly 7 years, though for some it can extend up to 14 years, and during this period, several significant physical, hormonal, and psychological changes are occurring as your body prepares for menopause.
During menopausal transition, your levels of regulating hormones like estrogen, progesterone, inhibin, and FSH start to vary, causing irregularity in menstrual cycles, with some women reporting periods that are shorter and less frequent, while others report longer, heavier periods. These changes can also cause vaginal dryness, and hot flashes, or sudden rapid senses of heat and flushing of the chest and face—typically followed by chills. Additionally, during this time a woman’s body reduces the levels of melatonin production, a hormone responsible for regulating sleep, which leads to irregular sleep cycles, a feeling of forgetfulness, a decrease in sex drive, and depression or anxiety.
Other physical changes begin to appear as well, with most women experiencing a change in body fat distribution. Many see a decrease in lean muscle mass and an increase in abdominal fat, as well as an increase in visceral fat, or the fat that surrounds the organs. While less health/more sedentary lifestyle choices for many can also be a contributing factor, this change in fat production and storage appears even in women with a previously healthy body mass index. Production levels of lipids and lipoproteins change as well, leading to increased issues with vascular function and healthy cholesterol levels.
Recognizing that these changes are starting to take place is important, so be sure to maintain an open, ongoing dialogue with your doctor to identify and address these issues. This is the first and most important step toward easing your symptoms and best-preparing for the further changes to come as you enter menopause.
As if the symptoms discussed above weren’t already challenging enough, a new statement from the American Heart Association shares that 20 years of longitudinal studies suggests that these significant biological changes could be a contributing factor explaining why women have such a notable increase in CVD after menopause, and why coronary heart disease appears several years later than it does in men.
While each woman’s risk factors are unique and should be discussed with her doctor, and CVD is a somewhat broad term that covers several specific coronary diseases, the most common cause of CVD is Atherosclerosis. This is when fatty-deposits, or plaque, builds up on the inner lining of the coronary arteries and restricts healthy blood flow to the heart. This lack of blood flow starves the heart and brain of critical oxygen and other nutrients and leads to heart attack or stroke. During menopausal transition and the processes outlined above, more sedentary lifestyle choices, combined with changes in key hormonal and lipid/lipoprotein production lead to increased risk of Atherosclerosis and development of CVD.
Prevention begins with healthy lifestyle choices as you age. Exercise, healthy sleep habits, and a diet that emphasizes fresh fruits and vegetables, whole grains, low-fat dairy, poultry, fish, and nuts are a great start. Avoid smoking and show moderation with red meat, sugary foods and drinks, and alcohol. Keeping these patterns going as you age will provide your body with the best possible defenses to help alleviate the symptoms you’ll encounter through perimenopause and menopause, and will provide the best platform for you and your doctor to work from to address CVD risk factors.
Another excellent way to reduce your risk of CVD is to be vigilant in your awareness and treatment of other health conditions you may have, as they can also contribute to your risk factors. Conditions such as diabetes, high blood pressure, or pre-existing problematic cholesterol levels can be managed with the help of your doctor and should be considered as a lens through which to view your other risk factors.
What is most important is that you continue ongoing, open conversations with your doctor about your concerns regarding your own menopausal journey, especially as it relates to other serious conditions such as CVD. This will provide you and your doctor the best chance at recognizing symptoms early while they are still manageable and help set the course for a healthy you as you experience these significant changes.