Lower estrogen levels and your personal health history pair up to present special challenges to your heart health at midlife. Here’s how menopause affects your heart, and what you can do about it.
Cholesterol levels. Generally speaking, levels of LDL-cholesterol (“bad” cholesterol) increase while HDL-cholesterol (“good” cholesterol) declines after menopause, upping the chances for clogged arteries that block the flow of blood to your heart, brain, and legs. Get your cholesterol tested every 4 to 6 years, or more often if you’re at higher risk. If you’re over age 20, total cholesterol should be under 200 milligrams per deciliter (mg/dl). Aim for an LDL less than 100 mg/dl and HDL levels of 60 mg/dl or higher.
Belly fat. Menopause often means weight gain in the abdomen, which signals an increase in visceral fat. This is the type that surrounds your internal organs and contributes to high blood pressure, elevated blood cholesterol, and type 2 diabetes -- all risk factors for heart disease. If you carry more weight around the middle, you have a greater chance for heart attack than if you’re just heavier overall. If your waist measures 35 inches or more, you probably have extra visceral fat.
Blood pressure. Even without excess visceral fat, a combination of estrogen loss and aging results in less flexible blood vessels. Stiffer arteries contribute to higher blood pressure, which plays a role in the development of heart disease, heart failure, and stroke after menopause. Being overweight may also lead to higher blood pressure because it puts more stress on the heart to pump blood.
Hot flashes. Fluctuating estrogen levels during perimenopause, which lasts an average of 4 years before menopause starts, often cause hot flashes. These can be annoying, embarrassing, and debilitating -- and they may also be a health issue. Hot flashes are linked to higher blood pressure and cholesterol levels. Some research suggests that they’re also a risk factor for cardiovascular disease. Tell your doctor if you’re having frequent or persistent hot flashes, or if you did during perimenopause.
Blood glucose levels. Menopause doesn’t cause diabetes, but research suggests there’s a link between estrogen loss and rising blood sugar levels early in the process. If you reach menopause before age 40, you’re four times as likely to get type 2 diabetes by the time you’re 55. High sugar levels damage blood vessels and the nerves that control your heart and blood vessels. Prediabetes, when blood sugar is higher than normal but not yet at the level of diabetes, is also linked to increased risk of heart attack and stroke.
Health history matters. If you had certain complications during pregnancy, including high blood pressure, gestational diabetes, preterm delivery, and pregnancy loss, you’re more likely to develop cardiovascular disease later in life. Other risk factors for heart disease include:
- Having a father or brother who had a heart attack before age 55
- Having a mom or sister who had one before age 65
- Being treated with certain chemotherapy drugs and radiation therapies
- Being diagnosed with polycystic ovary syndrome or endometriosis
Diet and lifestyle for heart health. Following a plant-based diet that’s low in saturated fat, sodium, and added sugar is the best way to help keep your cholesterol, blood sugar, and blood pressure, in check. Exercising on most days of the week for at least 30 minutes, adding at least two resistance training sessions a week, getting enough sleep, reducing stress, and not smoking are heart-healthy habits no matter your age, but particularly after menopause.
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