Normalizing menopause and its association with cardiovascular disease

Cardiovascular disease is actually the No. 1 killer for women in menopause and the post-menopause age group, according to Sandra Hurtado, MD, OB-GYN with UT Physicians and assistant professor at McGovern Medical School at UTHealth Houston.

This focus on women’s health and cardiovascular disease is especially timely, said Hurtado, based on themes presented at the North American Menopause Society’s (NAMS) annual meeting she recently attended. Concentration on cardiovascular disease was one of several significant takeaways she brought back from the meeting.

“We know that the incidence of cardiovascular disease increases with menopause and after,” Hurtado said. “We’re not going to give women estrogen to prevent heart disease, but it is important for them to know it’s an added benefit.”

Recent studies reveal women who begin hormone replacement therapy (HRT) during the transition of menopause, versus waiting 10 years out, see a benefit and a decrease in all-cause mortality and a decrease in heart disease, according to Hurtado. She believes it’s important for women to be aware of this and understand the benefits. This is in addition to other benefits provided by HRT including decreased risk of osteoporosis, treatment of hot flashes, night sweats, and vaginal dryness.

The new recommendation, she continued, is to look at each patient individually to understand their effects from menopause, their symptoms, family history, and other risk factors.

“We want to look at the benefits versus the risks of taking hormone replacement therapy to see if it’s a good idea for them and engage the patient in that conversation,” Hurtado said.

Taking action for cardiovascular health

Controlling high blood pressure can reduce the risk of heart disease by 40%, according to statistics from the NAMS conference. Hurtado said hypertension is what really leads to causing cardiovascular disease and death. She stated that 56% of women aged 55-64 have hypertension, while 65% of women aged 65-74 have hypertension. And the rates continue to increase with age.

Women can develop positive lifestyle choices to achieve good cardiovascular health by following the top five factors: healthy diet, regular exercise, appropriate weight, not smoking, and adequate sleep.

Maintaining average cholesterol levels along with normal body mass index (BMI) are important for preventing cardiac disease, said Hurtado. This translates to keeping BMI under 25 and exercising regularly. New recommendations reveal 150-300 minutes a week of sustained aerobic exercise.

“That’s a lot more than we used to say,” Hurtado said. “That is basically one hour of exercise, five days a week. That’s going to be the most helpful for prevention of heart disease, along with a healthy diet.”

A Mediterranean diet and the Dash diet are two examples, said Hurtado, including low cholesterol, no salt, modified carbohydrates, and limiting alcohol.

Normalizing menopause

Another takeaway important to Hurtado was the misconception of menopause being a negative life event for women. This can translate to discrimination, especially in the workplace, she said, in terms of women being older, having hot flashes, and not thinking as clearly due to potential brain fog. It’s not like women are no longer useful or can no longer fulfill their job, she said.

“We need to have more cultural awareness of menopause, that it’s an accepted life change and not taboo,” Hurtado said. “The conference was pushing for more public awareness of what menopause is for women, which I really liked.”