World Heart Day 2021: Why early menopause is a risk factor for coronary heart disease

The menstrual cycle, with its associated hormonal change, is the hallmark of the reproductive phase in a woman’s life. In this period, the ovaries produce hormones, which are essential for not only reproduction but also for a woman’s sense of wellbeing. With age, the ovaries stop producing eggs and menstruation ceases along with a decline in female hormone levels, especially estrogen. Twelve consecutive months of not having a period is defined as natural menopause. The average age of menopause is between 45-55 years. If menopause occurs between the age of 40 and 45, it is termed as early menopause and if it occurs before the age of 40, it is considered premature menopause. As a woman undergoes menopausal transition she may have many unpleasant symptoms like hot flashes, night sweats, mood changes, depression, anxiety, as well as genitourinary and sexual function changes. The link between early/ surgical (operative removal of ovaries) menopause and cardiovascular risk has a significant impact on a woman’s life. In the reproductive phase, female sex hormones have a protective effect on cardiovascular health making it rare for young women to have heart attacks. Heart attacks occur due to blockages created by a buildup of cholesterol in the walls of the coronary arteries, which supply the heart with oxygen. As per preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Conference 2021, when a woman enters her menopause phase before the age of 40, she incurs a 40 percent increased risk of developing coronary heart disease as compared to women who don’t go through the transition early. Menopause leads to complex hormonal changes and is associated with an increase in blood pressure, higher levels of LDL (bad cholesterol) and lower levels of HDL (good cholesterol). It also leads to changes in body fat distribution, with fat distribution around the waist. These are all risk factors for developing heart disease. If a woman already has risk factors such as a strong family history of heart disease, diabetes, high blood pressure, obesity, smoking, and a sedentary lifestyle, she is more likely to have cardiovascular problems after early menopause. Knowledge of these facts gives us an opportunity to closely monitor women with early menopause in terms of their cardiovascular health. Interventions like lifestyle modifications such as regular exercise and a healthy diet, frequent monitoring of blood pressure, regular checks of cholesterol levels, blood sugar control in diabetic women, as well as quitting smoking, will go a long way in preventing heart disease. Whether hormone replacement therapy (estrogen) prevents cardiovascular disease is a long-debated issue. At present, it is only recommended for short-term relief of menopausal symptoms such as hot flashes. No cardioprotective benefit has been seen in women who go through hormone replacement therapy. In conclusion, women with early menopause will benefit from annual screenings for cardiovascular diseases as well lifestyle modifications in addition to their regular gynecologist appointments. The author is Director, Obstetrics and Gynaecology, Fortis Hospital, Shalimar Bagh in New Delhi.