Aging, Menopause, and Your Heart

What is menopause?

Menopause is a normal change in a woman's life when her period stops. That's why some people call menopause “the change of life.” During menopause, a woman's body slowly makes less of the hormones estrogen and progesterone. This usually happens between the ages of 45 and 55. A woman has reached menopause when she has not had a period for 12 months in a row, and there are no other causes for this change (such as pregnancy). Menopause is considered early or premature if it occurs before age 40.¹⁶ The average age of menopause is 51 years.¹⁷

During and after menopause, a woman's ovaries no longer produce estrogen, though her body still produces a small amount of this hormone. It is partly this lack of estrogen that increases a woman's risk for developing heart disease.

What is surgical menopause?

Surgical menopause is when your periods stop because of the surgical removal of the uterus. This procedure is called a hysterectomy, and it may also involve removing one or both ovaries. Your periods stop once your uterus is removed; however, your body will continue to produce estrogen if your ovaries are left intact .^{17, 18} Eventually you will stop producing estrogen with natural menopause probably a year or 2 earlier than if you still had a uterus.

You may also have surgery to remove your ovaries that leaves your uterus in place. This procedure is called oophorectomy. If both ovaries are removed, you will enter menopause. If only one is removed, you will continue to have periods until natural menopause. In addition, some medical treatments such as radiation treatment (e.g., for cancer) may damage the ovaries and trigger menopause.

Each year, more than 600,000 hysterectomies are performed in the US. About one third of women in the United States have had a hysterectomy by age 60.¹⁸ Black, Hispanic, and American-Indian women are significantly more likely to have a hysterectomy than white women, while Asian/Pacific Islander women are less likely.¹⁷

Should I consider hormone therapy to reduce my risk of heart disease?

No. Even though your body's natural estrogen can help protect your heart, studies have shown that simply taking replacement estrogen doesn't have the same benefits. In fact, in some studies, women taking hormone therapy actually had a higher risk of heart disease.^19-21 Scientists now think that the estrogen a woman's own body produces acts differently than manufactured forms of the hormone. Ongoing trials of hormone therapy are investigating whether these findings are true for all postmenopausal women and all types of hormone therapy. One recent study indicated that heart risk did not increase, and may even have dropped slightly, in younger woman who start taking hormones soon after menopause.²²

For more information, see our article on Hormone therapy.

How will menopause affect my risk of developing heart disease?

Whether or not you have gone through menopause is more important than your age in terms of your risk of heart disease. Heart disease rates in women after menopause are 2 to 3 times that of premenopausal women of the same age.⁶ Among the 2,873 women in the Framingham Heart Study, heart disease rates in postmenopausal women aged 45 to 54 were twice that of premenopausal women of the same age.²³

Early or premature menopause has been linked to early death. A 1999 study of more than 6,000 women found that those who underwent early menopause (ages 35 to 40) had a greater likelihood of dying early from any cause and specifically dying from heart disease.²⁴ Early surgical menopause may also increase a woman's risk for heart attack and stroke, particularly if the ovaries are removed.^{1, 25}

Does age or menopause have an effect on other risk factors for heart disease?

Yes. The risk of developing diabetes, high blood pressure, and high cholesterol increases with age. Almost all risk factors become more common in women than in men at older ages because women live longer than men. Only smoking remains more common in older men.⁸

Menopause, either natural or surgical, increases your levels of total cholesterol. It also increases levels of chemicals involved in the body's immune system response, such as interleukin-6, and it increases levels of homocysteine, a protein linked to the development of damaged arteries.^26-29 Both of these compounds may increase your risk for heart disease.

The risk of developing metabolic syndrome—a collection of risk factors including a large waistline, higher than normal blood sugar, blood pressure, and triglycerides—is higher in postmenopausal women than premenopausal women. ³⁰

See also:
Menopause & Stroke Risk
Menopause & Heart Failure Risk

References

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