What is menopause?
Menopause is a point in time when you’ve gone 12 consecutive months without a menstrual cycle. The time leading up to menopause is called perimenopause. This is when a lot of women or people assigned female at birth (AFAB) start to transition to menopause. They may notice changes in their menstrual cycles or have symptoms like hot flashes.
What are the three stages of menopause?
Natural menopause is the permanent ending of menstruation that doesn’t happen because of any type of medical treatment. The process is gradual and happens in three stages:
- Perimenopause or “menopause transition”: Perimenopause can begin eight to 10 years before menopause when your ovaries gradually produce less estrogen. It usually starts when you’re in your 40s. Perimenopause lasts up until menopause, the point when your ovaries stop releasing eggs. In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many people may experience menopause symptoms. But, you’re still having menstrual cycles during this time and can get pregnant.
- Menopause: Menopause is the point when you no longer have menstrual periods. At this stage, your ovaries have stopped releasing eggs and stopped producing most of their estrogen. A healthcare provider diagnoses menopause when you’ve gone without a menstrual period for 12 consecutive months.
- Postmenopause: This is the name given to the time after you haven’t had a period for an entire year (or the rest of your life after menopause). During this stage, menopausal symptoms, such as hot flashes, may get better. However, some people continue to experience menopausal symptoms for a decade or longer after the menopause transition. As a result of a lower estrogen level, people in the postmenopausal phase are at an increased risk for several health conditions, such as osteoporosis and heart disease.
The importance of understanding menopause
It is critical to see menopause as just one point in a continuum of life stages. A woman’s health status entering the perimenopausal period will largely be determined by prior health and reproductive history, lifestyle and environmental factors. Perimenopausal and postmenopausal symptoms can be disruptive to personal and professional lives, and changes associated with menopause will affect a woman’s health as she ages. Therefore, perimenopausal care plays an important role in the promotion of healthy ageing and quality of life.
Menopause can be an important transition from a social perspective, as well as a biological one. Socially, a woman's experience of menopause may be influenced by gender norms, familial and sociocultural factors, including how female aging and the menopausal transition are viewed in her culture.
The global population of postmenopausal women is growing. In 2021, women aged 50 and over accounted for 26% of all women and girls globally. This was up from 22% 10 years earlier. Additionally, women are living longer. Globally, a woman aged 60 years in 2019 could expect to live on average another 21 years.
Menopause can offer an important opportunity to reassess one’s health, lifestyle, and goals.
Public health challenges associated with menopause pose significant concerns.
Perimenopausal women need access to quality health services and communities and systems that can support them. Unfortunately, both awareness and access to menopause-related information and services remain a significant challenge in most countries. Menopause is often not discussed within families, communities, workplaces, or health-care settings.
Women may not know that symptoms they experience are related to menopause, or that there are counseling and treatment options that can help alleviate discomfort. Those experiencing menopausal symptoms may feel embarrassed or ashamed to draw attention to their experiences and ask for support.
Health-care providers may not be trained to recognize perimenopausal and postmenopausal symptoms and counsel patients on treatment options and staying healthy after the menopausal transition. Menopause currently receives limited attention in the training curricula for many health-care workers.
The sexual well-being of menopausal women is overlooked in many countries. This means that common gynecological effects of menopause, including vaginal dryness and pain during intercourse, may go unaddressed. Similarly, older women may not consider themselves at risk of sexually transmitted infections, including HIV[iii], or may not be counseled by their providers to practice safer sex or get tested.
Many governments do not have health policy and financing for the inclusion of menopause-related diagnosis, counseling, and treatment services as part of their routinely available services. Menopause-related services are a particular challenge in settings where there are often other urgent and competing priorities for health funding.
What impact does menopause have on your likelihood of developing cardiovascular disease?
This menopause is when you stop having periods and can’t get pregnant naturally. It usually happens between 45 and 55 but can happen earlier or what we call early menopause or later.
Your periods stop because your ovaries stop producing as much of the hormone estrogen and don't release an egg each month. The levels of progesterone and testosterone also go down. The fall in estrogen causes most of the symptoms of menopause.
Your estrogen levels usually start to go down before your periods stop. This period of time leading up to the menopause is called perimenopause. You may start getting menopausal symptoms during the perimenopause, even if your periods have not stopped.
Estrogen has a protective effect on your heart. It helps to control your cholesterol levels and reduces the risk of fat building up in your arteries. It also helps keep your blood vessels healthy.
If your estrogen levels fall, then fat can build up in your arteries causing them to become narrower. This increases your risk of developing coronary heart disease, a heart attack or stroke.
Menopause can also cause changes in your body that increase your risk of coronary heart disease.
- Weight gain – many people report putting on weight during and after the menopause, especially around the waist.
- High Cholesterol– after the menopause your cholesterol levels can go up, increasing your risk of heart attack and stroke.
- Your body cannot control sugar levels (glucose) as well – this can increase your risk of diabetes, high blood pressure and weight gain or metabolic syndrome.
- Your blood pressure increases – your blood vessels may not respond as well to change, meaning your blood pressure could go up.
- Higher fat around the heart– this could increase after the menopause.
Many people worry about their heart health when going through the menopause and want to know what their risk is. Your doctor can talk you through your individual risk factors. You can also take steps to manage your risk and take care of your heart health.
How can one handle the risk of heart disease during menopause?
- Heart Health Screening
Regular heart health screening is important especially for women experiencing menopause. As per American Heart Association cholesterol check must be done every five years, blood pressure check every two years, your blood glucose levels checked every three years, waist circumference checked as needed and body mass index checked during every regular healthcare visit.
- Exercise Regularly
Women should try to shoot for at least 150 minutes of physical activity per week to help lower their risk of heart disease.
“Even if you haven’t been an exercise person, now is a great time to start; it’s never too late,” says Rohm Young.
- Eat Healthy
Diet cannot be underestimated. Healthier eating translates into efficient heart function and overall well-being. Learn how to eat healthy without dieting.
- Stay Positive
Sometimes after menopause, women can suffer from depression. According to research from the American Heart Association, depression is linked to almost a doubled risk of stroke in middle-aged women. This is why staying positive after menopause is so important for women.Going through menopause can feel like a huge life change for some women, says Rohm Young. But instead of getting depressed, try to embrace this time in your life by eating right, exercising, and socializing with friends.“This is a time to celebrate your life, so get out there with people you enjoy,” suggests Rohm Young.
Conclusion:
Understanding the intersection of menopause and heart health is paramount for women's overall well-being. As hormonal changes during menopause can significantly impact cardiovascular health, adopting lifestyle modifications, such as maintaining a healthy diet, engaging in regular exercise, managing stress, and seeking medical advice, can help mitigate the risk of heart disease. By prioritizing heart health during menopausal years, women can empower themselves to lead fulfilling and healthy lives. Remember, knowledge and proactive measures are key to navigating this transitional phase with confidence and vitality.
Resources:
- https://www.who.int/news-room/fact-sheets/detail/menopause
- https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:~:text=Menopause%20is%20the%20time%20that,51%20in%20the%20United%20States.
- https://my.clevelandclinic.org/health/diseases/21841-menopause
- https://www.goredforwomen.org/en/about-heart-disease-in-women/preventing-cardiovascular-disease/how-to-prevent-heart-disease-after-menopause
- Menopause and heart and circulatory conditions - BHF.