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Your risk of heart disease go up after the menopause, making heart health more of a priority than ever before. What do you need to know about preventing heart disease at this time?

While the menopause doesn't directly lead to cardiovascular disease, your risk of having a heart attack does go up significantly in the decade after you hit this milestone. The consequences years of risky behaviors like smoking, fat-rich diets, and a sedentary lifestyle can come knocking during this time — making it more important than ever to choose a lifestyle that promotes heart health, as well as to recognize the signs that you need to see a doctor. 

What do you know about heart health as you approach and enter the menopause?

How dropping estrogen levels may impact your risk of heart disease

Dropping estrogen levels are, of course, one of the main things you've got going on during your menopausal transition, and that sucks in more ways than one. This female hormone is, you see, though to help keep your blood vessels in good working order, allowing them to manage changes in your blood flow without any problems. 

While ever-dwindling estrogen levels are by far the only cause of an increased risk of heart disease during the menopause, they contribute to a shocking number of heart-related conditions:

  • Hypertension (high blood pressure), which makes your heart work harder. 
  • High "bad" (LDL) cholesterol levels, while your levels of "good" (HDL) cholesterol remain steady.
  • Higher triglyceride levels.
  • A higher risk of diabetes because of increased insulin resistance — and diabetes, in turn, increases your odds of facing heart disease and stroke.
  • Atrial fibrillation, an abnormal heart rhythm, is also more common after the menopause. Both hypertension and declining estrogen levels can contribute.
  • Many women put on some weight around the abdomen as they approach the menopause and beyond. This kind of fat, called central obesity, can again be partially blamed on declining estrogen levels, as well as changes in metabolism. It is, unfortunately, this kind of fat that is associated with heart disease. 
  • Menopausal hormonal fluctuations impact brain chemistry as well. This, in combination with the stress of going through the menopause itself, means you're much more likely to be clinically depressed during this time — almost 20 percent of menopausal women are believed to have a bout of depression. Depression often goes hand in hand with a loss of motivation to engage in normal daily activities, making it especially difficult to make the kinds of changes that will keep you healthy at this time. (Treatment is available — please see your doctor if you are feeling depressed!)
  • Takotsubo cardiomyopathy, or "broken heart syndrome", is also more likely to strike after the menopause. This kind of heart disease is literally brought on by stressful life events.

In addition, women who receive chemotherapy or radiation therapy for cancers, such as the breast cancer that is also more likely to occur after the menopause, may contribute to a risk of cardiovascular disease. We should also note that women who suffered gestational diabetes during any of their pregnancies have a higher risk of developing both diabetes and heart disease later in life, after they have entered the menopause.

Hormone replacement therapy, which "supplements" declining estrogen levels, may seem like the obvious solution to address conditions linked to a lack of estrogen. The American Heart Association doesn't, however, advise women to use HRT just to decrease their risk of heart attack and stroke — as research has shown that the longer-term use of hormone replacement therapy can itself contribute to these adverse health outcomes. You should still be aware that HRT cuts women's risk of atherosclerosis (in which plaque builds up within the arteries), so this is something to discuss with your doctor. 

Heart disease: Symptoms to watch out for

Recognizing early signs of heart disease can help you get timely treatment — and because women don't tend to seek medical help until they are facing a true emergency, by which time their condition is harder to manage, it is especially important to know what to watch out for. Always see your doctor if you experience:

  • Heart palpitations
  • Excessive and unexplained fatigue
  • Shortness of breath
  • Feelings of pressure around the chest
  • Headaches
  • Lightheadedness or dizziness
  • A jaw ache
  • Swollen feet
  • Pain or discomfort in your shoulder, upper back, or abdomen — along with the more characteristic arm pain
  • Nausea and/or vomiting
  • Excessive and unexpected sweating
  • Trouble laying down flat
Some of these symptoms are ones you're probably quite likely to ignore or dismiss as either menopause-related or the result of a busy life. It is important to note that women tend to present with different heart attack symptoms than men, and even doctors sometimes miss them. Among other things, your symptoms may just be more likely to strike while you're resting or sleeping. Heart disease may look different in women because they are more likely to have blockages in the smaller arteries as well as the main arteries. This is known as coronary microvascular disease.

If you notice worrying symptoms that can point to heart disease, don't let your doctor dismiss it as "just hormones" or "just stress" — advocate for yourself if you need to.

What can you do to look after your heart during the perimenopause and beyond?

Maybe you've already protected your heart health by not smoking, exercising regularly, maintaining a healthy weight, eating a good, balanced diet, and going to the doctor whenever you've had troublesome symptoms. If so, you're at a lower risk of heart disease and stroke, though your family history also plays a role in determining this. Even if you've been less healthy than you could be, though, it's not too late to make changes that will help lower your risk of heart disease. 

A heart-healthy diet

You know the drill — a healthy and balanced diet requires vegetables, fruits, whole grains, nuts, and you can include lean meat like chicken and fish and low-fat dairy. The American Heart Association encourages people to focus on these foods, while going easy on the red meat and trying to stay away from overly sugar-rich, processed, foods and drinks.

Exercise regularly

Exercise has many different benefits, but better heart health is among them. Try to get a minimum of 150 minutes a week in, doing both cardio and strength training, to help reduce your risk of heart disease. You're more likely to stick with the program if you pick a form of exercise you like. A brisk walk, jogging, cycling, and swimming are all excellent choices to get your heart beat up. 

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