Heart disease has long been considered more common in men, but we now know that it is the leading cause of death in women as well, especially after menopause. The risk of heart disease increases dramatically after menopause. A major reason for the increased risk is the drop in oestrogen levels that occurs during menopause.
Dr Udgeath Dhir, Senior Director and Head of CTVS and Heart Transplant at Fortis Memorial Research Institute, Gurugram, says that oestrogen plays a protective role in cardiovascular health by helping to maintain healthy cholesterol levels, promoting flexibility in blood vessels, and reducing inflammation. With the decline of this hormone, women become more vulnerable to the build-up of plaque in the arteries, known as atherosclerosis.
How the Heart Is Protected by Oestrogen
- Oestrogen supports normal blood pressure by keeping blood vessels flexible prior to menopause.
- Enhances cholesterol balance by lowering LDL ("bad") cholesterol and raising HDL ("good") cholesterol.
- Prevents artery damage by lowering inflammation.
- Encourages improved regulation of fat metabolism and blood sugar.
These benefits slowly go away after menopause because oestrogen levels drop. This raises the risk of atherosclerosis (narrowing of arteries), high blood pressure and other heart problems.
Menopause causes a number of physical changes that raise the risk of heart disease:
- Cholesterol levels getting worse: More LDL and less HDL.
- Higher blood pressure: As you get older and lose estrogen, your blood vessels get stiffer.
- Gaining weight, especially around the stomach: This kind of fat is linked to heart disease.
- Lowering insulin sensitivity: This raises the risk of diabetes.
- More inflammation, which makes plaque build up in arteries more likely.
In addition, postmenopausal women often experience changes in body fat distribution, with more fat accumulating around the abdomen. This visceral fat is strongly linked to insulin resistance, high blood pressure, and elevated cholesterol levels—all of which are significant risk factors for heart disease.
Dr Neelam Suri, Senior Consultant, Obstetrics and Gynaecology, Robotic Surgery at Indraprastha Apollo Hospitals, says that when these changes happen at the same time, they make a dangerous mix for the heart. Risk factors that accumulate for postmenopausal women with preexisting medical conditions include high blood pressure. An increased risk is associated with diabetes, obesity, smoking, and a family history of heart disease. The impact of menopause on heart health can vary significantly depending on lifestyle choices and pre-existing medical conditions.
Many women also experience a rise in stress, anxiety, or disrupted sleep during and after menopause, which further impacts heart health. Moreover, symptoms of heart disease in women can often be atypical, such as fatigue, breathlessness, or nausea, leading to delays in diagnosis and treatment.
It is important for women to proactively monitor their cardiovascular health as they age. Regular check-ups, blood pressure and cholesterol monitoring, a heart-healthy diet, regular exercise, and stress management are key to reducing risk. Recognising menopause as a turning point for heart health can empower women to take preventive steps at the right time.
Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.
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