A UVA Heart & Vascular Center Initiative

Are Menopausal Women at Higher Risk for Heart Disease?

Posted September 17, 2009

What You Need to Know


Woman Cooking Menopause is an important milestone. But it’s more than the stage of life when a woman stops menstruating. It means an increased risk of developing heart disease.

To learn more about this link, we turned to JoAnn V. Pinkerton, MD , certified menopausal specialist at University of Virginia Health System Midlife Health Center . Learn what you can do to lower your risk, and read on especially if you’re considering taking hormones to treat menopausal symptoms.

What is the average age for women to reach menopause?

The average age is between 51 and 52 years of age.

How does menopause affect a woman’s heart health?

Once a woman reaches menopause, she experiences a decrease in estrogen. Estrogen has been shown to protect women from cardiovascular disease by maintaining healthy cholesterol levels.

Is hormone replacement therapy (HRT) effective in promoting heart health in menopausal women?

The effectiveness of HRT in protecting menopausal women against heart disease has been the subject of many studies over the past decade. But it’s clear that HRT should not be used for the prevention of heart attack or stroke.

Here’s what the studies have shown: In the 2002 Women’s Health Initiative (WHI) studies, hormone therapy was shown to increase the risk of heart disease and dementia and was no longer recommended as a prevention measure. However, after further evaluation, age appears to be the key factor in terms of who may benefit from hormone therapy.

In the January/February 2006 issue of The Journal of Women’s Health , the risk of heart disease demonstrated in the WHI was found to be related to the advanced age of the participants (average age 63), as opposed to the HRT. The study also found that women on HRT, who were under 60 at the onset of menopause or within 10 years of menopause, appeared to have a decreased risk of heart disease with lower mortality reported among those women who took the hormones than those who received a placebo.

Another study, published in the Feb. 13, 2006 issue of the Archives of Internal Medicine , looked at nearly 11,000 women ages 50 to 79 taking estrogen only (they did not have a uterus so did not need to take another hormone, progesterone, to protect against uterine cancer). No overall difference in heart attack risk was found among women who took the hormone and those who did not.

In addition, there appeared to be a lower overall risk of heart disease in the women who began taking the estrogen between the ages of 50 and 59, suggesting a heart-healthy benefit to taking the therapy, if begun at a younger age.

What are some recommendations for those considering HRT?

  • HRT may be used short-term (for 3-5 years) to treat menopausal symptoms.
  • HRT should not be used for prevention of heart attack or stroke.
  • Use of HRT for other problems, such as preventing osteoporosis, should be considered while weighing risks and benefits.
  • Women who have existing coronary artery disease should consider other options.
  • Long-term use is discouraged because the risk for heart attack, stroke and breast cancer increases with age and the longer HRT is used.

What other risk factors do women need to consider?

Additional risk factors for heart disease include smoking, elevated blood pressure, high “bad” cholesterol ( LDL), low “good” cholesterol (HDL), obesity, having a sedentary lifestyle or a family history of heart disease.

How should women approaching menopause alter their lifestyle to maintain a healthy heart?

Women entering menopause can decrease their risk of heart disease by:

  • Avoid or quit smoking. Smoking and second-hand smoke can put you at risk of heart disease.
  • Maintain a healthy body weight. Avoid gaining weight during menopause or work to lose extra weight.
  • Exercise at least three to five times per week. Being active or exercising regularly (at least 30 minutes every day) improves the heart’s ability to pump blood, reduces blood pressure, cholesterol and stress, helps keep weight off and improves blood sugar levels. Exercise can be done in three 10-minute intervals during the day. Sweating is good!
  • Eat well. Follow a diet low in saturated fat and trans fat (partially hydrogenated fats), and high in fiber, whole grains, legumes (such as beans and peas), fruits, vegetables, fish, folate-rich foods, and soy. Also consider adding fish oil supplements.
  • Treat and control medical conditions. Diabetes, high cholesterol and high blood pressure  are risk factors for heart disease that can be managed effectively with treatment.
  • Take an aspirin every day, if approved by your doctor. Recommended primarily for women over 65 with risk factors of heart disease. Check with your doctor who can determine risks and benefits and recommend a dose, if any, that is most appropriate for you.