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Menopause and your heart

Most women are well aware of the threat that breast cancer poses, especially as they approach menopause. Ask them about heart disease, however, and they’ll tell you that it’s something their husbands should worry about.

Contrary to popular belief, however, heart disease isn’t just a man’s disease. According to the World Heart Federation (www.world-heart-federation.org), cardiovascular disease (that’s heart disease and stroke) is the biggest killer of women around the world, killing more women than all cancers, tuberculosis, HIV/AIDS and malaria combined.

Once a women reaches the age of 50 (around the age of natural menopause), the risk of heart disease increases significantly. This happens for the following reasons:

1. Oestrogen helps protect a younger woman’s body from heart disease.
2. Changes in the walls of blood vessels make it more likely for plaque and blood clots to form.
3. Changes in levels of lipids (fats) in the blood are a risk.
4. An increase in fibrinogen (which helps blood to clot) is related to heart disease and stroke.

While all of the above makes it incredibly important for women entering menopause to check their heart health, those who unknowingly enter early menopause are in even greater danger. Research shows that women who experience early menopause, either naturally or due to the surgical removal of their ovaries, may face double the risk of heart disease.

Research results also suggest that lifestyle choices that may result in early menopause must be taken into serious consideration. Smokers, for example, reach menopause on average two years earlier than non-smokers, and quitting may delay menopause. Other factors that may influence the onset of menopause include diet and exercise.

An additional consideration when it comes to heart disease risk during menopause is the role of hormone replacement therapy (HRT). Initial research indicated that HRT could possibly reduce the risk of heart disease in women, but more recent large-scale studies have shown an increased risk of breast cancer, cardiovascular disease, blood clots and gall-bladder disease among women using HRT.

The very latest research – findings from the two Women’s Health Initiative trials, published in October 2013 – suggests that HRT has a harmful effect in terms of heart disease among older women, while the results in younger women remain inconclusive.

So, is HRT safe?
At this stage, research shows that HRT shouldn’t be used for chronic disease prevention. This includes cardiovascular disease. However, it still seems to be a “reasonable” option for managing moderate to severe menopausal symptoms in some women.

Before HRT is started, your doctor should review your medical history carefully. Your assessment at the onset of menopause shouldn’t just include a Pap smear, a mammogram and a bone-density scan, but also a full heart assessment, at the very minimum.

With the very real and largely unknown risk that stroke and heart disease poses for women, especially those entering menopause, it’s of the utmost importance to work closely with your healthcare provider.

Cut your cardiovascular-disease risk
Apart from carefully considering the use of HRT, the following steps will help to keep your heart healthy during menopause and beyond:

- Quit smoking, if you haven’t done so yet.
- Exercise regularly. Try to do a little bit of exercise every day – the more you do, the better, but any exercise is better than none.
- Maintain a healthy weight. Work closely with a dietician and aim to lose 0.5-1kg per week if you’re overweight.
- Follow a balanced diet that includes a variety of fresh foods. Try to eat less refined starches and sugar, and less salt.
- Drink alcohol in moderation. Have no more than one drink per day.
- Cut your stress levels. Consider doing yoga, Pilates, Tai Chi or meditation classes.

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