World Menopause Day was created to show the impact menopause has on the lives of women around the world. Despite affecting about half of the world’s population, menopause is not getting the attention and research it needs. The day was established by the World Health Organization (WHO) and the International Menopause Society (IMS). About 25 million women experience menopause each year, yet the public and medical professionals are still underinformed about the topic.
Every year, the day has a focus. The theme for World Menopause Day 2022 was Cognition and Mood. Previous years highlighted Hot Flushes and Night Sweat (2011), Understanding Weight Gain (2012) and Perimenopausal Bleeding (2017). This year, the focus is cardiovascular disease.
Why Cardiovascular Disease?
In the developed and developing world, cardiovascular disease (CVD) is the leading cause of death in women. CVD comprises a group of disorders of the heart and blood vessels including strokes and heart attacks. In our previous post on gender medicine, we explained that recognition of heart attacks in female patients is demonstrably worse than in males, making prevention even more important for women.
Research has identified many CVD risk factors related to menopause in general. Moreover, specific female reproductive events influence chances of developing CVD later in life. This includes:
- Premature or late start of first menstruation
- Amenorrhea (missed periods) or Oligomenorrhea (infrequent periods) which can be related to polycystic ovarian syndrome (PCOS)
- Complications during pregnancy often related to high blood pressure or gestational diabetes
- Preterm delivery
- Premature menopause before the age of 40
- Early menopause before the age of 45
Why is menopause a risk factor for CVD?
Several symptoms of menopause have been linked to CVD: vasomotor symptoms (VMS), commonly known as hot flushes and night sweats, sleep disturbances, depression and shortened reproductive lifespan (the time between first menstruation and menopause).
Moreover, age-related weight gain and menopause-related redistribution of fat to the abdomen both increase cardiovascular risk. Meanwhile, as estrogen levels decrease, insulin sensitivity, blood lipid profiles, skeletal muscle composition and metabolism also deteriorate and lead to a worse cardiometabolic profile. Early-onset and frequent VMS have been unfavorably linked but further research is needed to clarify whether treatment of VMS will directly reduce CVD risk. (Read more about the prevalence of VMS and hormone therapy).
Women who experience menopause before their 40th birthday usually have a reproductive lifespan of less than 30 years. This shortened reproductive time has been associated with higher risk of heart disease, heart failure and diabetes. It is not known whether this link is caused by premature ageing or premature estrogen deficiency. However, unless there are counterindications, menopausal hormone therapy can be considered and is particularly recommended for women experiencing premature and early onset menopause.
The risk for cardiovascular disease can be reduced with lifestyle changes.
Cardiovascular disease risk is closely related to lifestyle choices. The risk can be lowered by
- Reducing smoking and alcohol consumption
- Regular physical activity
- Eating a healthy diet high in fruits and vegetables
- Lowering salt consumption
- Maintaining a healthy weight
- Sleeping enough
These are healthy lifestyle changes with a range of positive effects which can also lower blood pressure, blood sugar, cholesterol and increase quality of life in general.
Professor Cynthia Stuenkel who heads this campaign, encourages women:
“Menopause offers the opportunity of a single point in time to step back, take stock, and do all you can toward promoting future cardiovascular health for the rest of your life.”