Menopause and Cardiovascular Health – World Menopause Day 2023

The theme of this year’s World Menopause Day is Cardiovascular Disease. Breast cancer is believed to be the number one cause of death and disability in women. In reality, it is cardiovascular disease. According to the World Heart Federation, more than a third (35%) of deaths in women each year are due to cardiovascular disease. That’s more than 13 times greater than deaths resulting from breast cancer. (World Health Federation, 2023)

Cardiovascular disease includes coronary artery disease (CAD), stroke and congestive heart disease. 

1. Coronary artery disease is caused by a blockage or spasm in the arteries leading to conditions such as angina or heart attack. The symptoms of CAD include chest tightness/pain and/or shortness of breath. 
2. Stroke or Transient Ischaemic Attacks (TIA) include a range of symptoms from arm/leg weakness; facial weakness, changes to vision or speech and/or confusion. 
3. Congestive Heart Failure (CHF) is also increasing in women. CHF is when your heart can’t pump the blood efficiently to your lungs and other organs/parts of your body. Symptoms associated with CHF include shortness of breath and fatigue, especially when exercising; and also, there may be swelling of feet or legs. 

Cardiovascular disease is increasing, particularly in younger women, due to a higher rate of obesity, diabetes and high blood pressure. This can largely be attributed to lifestyle and diet. 

However, there is also another piece to this puzzle. Researchers have identified that a woman’s reproductive experiences throughout her life (including menstruation, pregnancy, any breast cancer treatments, and menopause) can affect her chances of developing cardiovascular disease later in life.

Menstrual history: If a female starts menstruation at a very early age, or has an absence of irregular periods  this may lead to an increased risk of cardiovascular disease in later life. 

Pregnancy complications: If a woman has complications soon or after pregnancy, high blood pressure for example, these can also increase the risk of developing heart disease. 

Breast cancer treatment: Some of the medications or treatments used to treat breast cancer can stiffen the arteries or damage the heart leading to an increased risk of blockages or CHF. 

Menopause: If someone has early menopause (<45 years) or premature menopause (<40) this can increase their risk of cardiovascular disease. This occurs as oestrogen has an important protective role for your heart. When oestrogen falls during perimenopause and menopause, the cholesterol in your blood often rises, which can lead to fatty deposits building up inside the large blood vessels. This narrowing of the arteries can increase the risk of heart attacks and strokes. Also, oestrogen also has an anti-inflammatory effect on the lining of the blood vessels and increases the levels of chemicals that protect your heart and the blood vessels. As you get older, the blood vessels can become stiffer, caused by high blood pressure. This is another risk factor associated with heart attacks and stroke.

The risk of heart attack is five times higher post-menopause than before. (Balance-Menopause: 2023) Unless there is a good reason not to, women who are considered to have early or premature menopause are advised to take Hormone Replacement Therapy (HRT) to slow the development of cardiovascular disease. HRT can also have a place for those whose menopause occurs at the acceptable age of 50/51 also as research shows that if you start HRT during your perimenopause, or within 10 years of your menopause, you have a lower risk of developing heart disease than those who don’t take HRT. (Newson, 2023)

“Cardiovascular risk represents a lifetime of choices and experiences, but 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.” Professor Cynthia Stuenkel. 

Cardiovascular health should be a top priority for women at this point in their lives. 

The world menopause society also recommends informing your doctor about your reproductive history, including:

1. Missed or irregular periods
2. Pregnancy complications
3. Breast cancer treatment
4. Onset of menopause or menopause symptoms.

To maintain good cardiovascular health these are the most important lifestyle checks or modifications to include: 

1. Eat a healthy diet, a Mediterranean diet is recommended.
2. Exercise (see below)
3. Maintain or achieve a healthy body weight
4. Quit smoking
5. Develop healthy sleep habits.

During perimenopause or menopause exercise recommendations from both the World Health Organisation and the UK Chief Medical Officer include:

• A minimum of 150 mins moderate intensity exercise weekly. This includes brisk walking; cycling; dancing; gardening; aqua-aerobics. You should be able to hold a conversation when doing moderate intensity exercise. 
• Or you can complete a minimum of 75 minutes vigorous activity. This includes running; aerobics; team sports; swimming; climbing the stairs. You should be able to speak but probably need to pause after a few words to catch your breath.  Here in PMC Physiotherapy, we are experts in exercise or movement prescription. 
• Two strength training sessions per week. These ideally should be supervised initially to reduce the risk of injury. Strength training should be progressive and include activities such as lifting weights, using body weight in exercises such as squats etc. 
• Body movement exercises that improve flexibility and balance and include pilates and yoga. This is recommended for anyone over 65 and for those at risk of falling in particular.

Newer research also shows that in relation to the specific cardiovascular benefits associated with physical activity, the type of activity is not the key factor. Regular exercise is the key factor in accruing cardiovascular benefits from physical activity! (Rodrigeues et al, 2019)

It can be overwhelming to start a type of exercise that you have no previous experience of, such as strengthening exercises. In PMC Physiotherapy we provide a thorough individualised assessment and introduce you to a safe bespoke exercise programme that will address cardiovascular fitness, strengthening, posture, balance and flexibility. We also provide in-person and online pilates classes.

Here in PMC Physiotherapy, we also recognise that there are many barriers for women during Menopause, which make it difficult to embark on the recommended exercise and lifestyle changes. Many of these barriers include the Genitourinary symptoms of Menopause. Over 50% of Menopausal women suffer urinary leakage and at least 50% of women over the age of 50, that have had a baby, have prolapse. Our Specialist Pelvic Health Physiotherapist Julia helps to address and manage these conditions to allow women to achieve their exercise goals.

International Menopause Society 2023

Boardman, H. et al. (2015), ‘Hormone therapy for preventing cardiovascular disease in post-menopausal women’, The Cochrane database of systematic reviews, doi:10.1002/14651858.CD002229.pub4

https://www.balance-menopause.com/menopause-library/heart-disease-perimenopause-and-menopause-factsheet/ 2023 Louise Newson

Rodigeus et al, 2019. Effect of PA on cardiometabolic parameters in post menopause. Gerentology