Expert Blogs | Heart Health
What Your Mother Never Told You About Menopause
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As a physician specializing in women’s health (and specifically, women’s heart health), I always hear a belief that hot flashes, sleep problems, sudden weight gain, difficulty concentrating, irritability, and the extreme inconvenience of unpredictable menstruation are all considered “normal,” “natural,” and “part of life.”

The symptoms of the menopausal transition are inevitable for most of us and although menopause may be natural, nothing about it feels normal. Menopause affects everything from our sleep to our happiness and even our heart health.

The Truth About Menopause

Menopause, by definition, is when you have gone exactly 1 year without a period. So, if you get your period in February and it shows up again in September, you are not in menopause. What you are in is purgatory, or this limbo called perimenopause, where your hormones are sputtering out, and every so often, waking up again to do their thing. Your hormones are swinging, and the menopausal dance has begun.

Hot flashes are often the most problematic symptom, but that isn’t to underestimate the life-altering effects of:

  • Dramatic mood swings
  • Brain fog
  • Forgetfulness and distraction
  • Rising anxiety or sinking depression
  • Serious sleep difficulties
  • Sexual dysfunction

Then There Are the Heart Palpitations

Although it’s somewhat different for everyone, one of the biggest changes that tends to happen to women as they approach and go through menopause has to do with the effects of estrogen. Estrogen is the hormone of caretaking and nurturing, and it’s highest between puberty and menopause. Eventually, after menopause your body doesn’t produce estrogen. This can cause heart palpitations.

Palpitations in menopause often happen during hot flashes. A few other causes of palpitations include:

  • Stress
  • Intense exercise
  • Caffeine, alcohol, and nicotine use
  • Some cough and cold medicines, and asthma inhalers
  • Fever

Menopause Affects Sleep and Heart Health

I get a lot of complaints from my patients about the inability to get to sleep, but it’s more than that. I also hear about waking up drenched in sweat in the middle of the night, waking up at 3 a.m. and not being able to get back to sleep, and even chronic bad dreams. All these issues would be bad enough, but the fact is that sleep issues don’t exist in a vacuum. They’re often connected to -- or lead to -- overeating and weight gain, fatigue, moodiness and anger.

Lack of sleep can lead to high blood pressure and obesity, which can lead to diabetes. It’s also associated with heart disease.

To help get better sleep try a few adjustments:

  • Cut out the caffeine. Don’t forget that you can find it in some teas, coffee, chocolate and even medications. And it can stay in your system from 7 to 20 hours, keeping you awake.
  • Skip the alcohol. It may make you sleep for a bit, but then it can wake you up early, or cause restless sleep.
  • Get back to the basics, like daily exercise, small snacks with lean protein and carbs before bed, and practicing a daily sleep-inducing ritual.
  • Turn your bedroom into a den of peace and calm. Leave the craziness outside the door -- make it a dark cave that allows you to escape.

Menopause Headaches

Headaches, and often migraine headaches, are a common symptom of the time surrounding menopause. It’s part of the hormone dance. Migraines in particular have been linked to hormonal shifts.

Signs that you are having a migraine include trouble with light, nausea or vomiting, and sometimes an aura, or visual changes that precede the pain. You might see lights, wavy lines, or other disturbances. You could have issues with speech, or notice numbness and tingling.

If your symptoms are severe, see a doctor. Aura symptoms have been linked with stroke later in life. But more often than not, menstrual migraines are just a pain in the brain -- something that may need treatment now, but which will come to an end when menopause does.

Tension headaches can also become more frequent with menopause. These are easier to deal with, and are often a side effect of stress, both emotional and hormonal. You may find you can handle them by taking a nap, a bath, doing some exercise or yoga, engaging in a good hearty crying session, or just popping a couple of naproxen, ibuprofen, aspirin, or whatever you find wedged into the corners at the bottom of your pocketbook.

Could You Have Menopause Brain?

So-called “menopause brain” is notorious. It’s that sudden inability to concentrate … forgetfulness … problems with word recall … and brain fog. It may feel like impending dementia, but it’s actually caused (like so many other unpleasant things) by shifting hormones.

If you’re having trouble recalling all the details of life that you used to know instantly -- the ones that made you the quick-witted, go-to person everyone relied on for information like names, dates, times, and places -- these sudden “senior moments” can be upsetting and even alarming. Menopause brain is a temporary condition. You can ease it by going back to the basics: eat healthy food, watch your alcohol intake, and exercise.

Do what you need to do to keep yourself healthy. Breathe. Make healthy choices. Talk to friends, a therapist, the woman next door in her 70s who can remember when it happened to her, or a psychiatrist, if you need one. Keep some ibuprofen in your bag. Most important, stay informed and proactive.

Know Your Numbers

This is the perfect time of life to schedule a “well woman” doctor visit (aka annual physical) if it’s been a while. Besides a physical exam from your doctor, it should include some basic screening tests:

  • Cholesterol level, including LDL (the bad kind), HDL (the good kind), and triglycerides (the kind attached to sugar that reveals how much sugar you are eating).
  • Hemoglobin A1c -- a measure of your average blood sugar level over the past 3 months.
  • Blood pressure.

During menopause, LDL cholesterol, A1c, and blood pressure all tend to go up, and these are all risk factors for heart disease. Knowing your numbers will tell you whether you need to step up your menopausal training regimen.

Heart disease is the No. 1 killer of all women, and the rate is highest about 10 years after menopause, as risk factors continue to increase and the protective estrogen drops away. You will have a higher risk of an expanding waistline and overall weight gain. You know these things happen, so train, train, train by eating a healthy diet and keeping up with regular exercise. You can control this process!

Check Your Bones

Here’s another menopausal truth: With the drop in estrogen that comes with menopause comes a drop in bone density. Check your bone density! This is the time to eat well, get enough calcium and vitamin D, and stress your bones just enough to keep them rebuilding -- through walking or running and weight training.

Muscle mass also builds bone, while smoking and some medications can compromise bone density. A DEXA scan will assess your risk of osteopenia (diminished bone density) and osteoporosis (significant reduction in bone density). When you lose bone density, you’re more likely to have fractures, and this can cause significant health issues, especially for women over 65 years old. Don’t give up on this: It’s crucial for your long-term quality of life.

When you know exactly what’s going on with your body, you have a much better idea of how to answer the question: Who do you want to be in this second half of your life? Someone vibrant and alive, full of health and vitality, who can bravely step into her life to figure out what’s waiting for her … beyond motherhood or caretaking … beyond being a wife or partner … beyond the constraints of those earlier years?

Menopause isn’t the beginning of the end. It’s the start of a whole new phase in life. Menopause is not the end of womanhood. Menopause is the beginning of self-care, of self-nurturing, of self-fulfillment.



Photo Credit: Flashpop via DigitalVision / Getty Images

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Suzanne Steinbaum, DO

Suzanne Steinbaum, DO

Board-certified cardiologist

Dr. Suzanne Steinbaum is a leader in preventive cardiology, now in private practice in New York. She launched heart prevention programs at Mt. Sinai Heart, Northwell Lenox Hill and Beth Israel. She is the CEO/Founder of Heart Tech Health, a technology-based prevention model. She published Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart Healthy Life and has been an advocate for women's health for two decades appearing on The Doctors, Oz, The Today Show and Good Morning America. She now is an advisor and spokesperson for American Heart Association, Go Red For Women and Peloton.

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