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Menopause is not just gynecological. Fluctuating hormone levels during this transition affects many of the body’s systems, including the cardiovascular system.
“Blood vessels are responsive to estrogen and it affects the way they dilate and keep blood pressure in a healthy range,” explains Dr. Nivee P. Amin, director of the Weill Cornell Medicine Women’s Heart program. “The protective cardiovascular effects of estrogen and progesterone may decline throughout menopause.”
Well before women approach and undergo menopause, there are some important heart-health risk factors to understand, Dr. Amin says.
“It’s important for patients to know their numbers and start understanding the ones that are modifiable,” she explains.
That means learning more about weight, blood pressure, and (HDL and LDL) cholesterol and triglyceride levels, and their impact on heart health. It’s important to understand which factors we can control (for example, weight), and those we cannot (for example, genetics)—in some cases well before menopause.
“Sometimes there’s a focus on other parts of menopause, but we need to highlight the fact that the number one killer of women is heart disease—and women tend to have worse outcomes,” Dr. Amin adds. “This is a real public health need.”
Patients also need to work with an internist to understand the full scope of their health. Together, physicians and patients should carefully review individual and family histories, Dr. Amin says. They also can look closely at the risk factors and address them as soon as possible.
She also offers important guidance that’s “easy to say and hard to do,” she says. “Exercise matters.”
Exercise helps people manage weight and (lipid and sugar) metabolism, bone health, and cardiovascular fitness. It also helps regulate blood pressure, and blood vessel responses to stress in the body and the heart.
Some women also may be able to use exercise to relieve stress.
Women also need to pay attention to how they’re feeling. Even subtle symptoms can warrant a closer look.
“Sometimes women will feel a repeated twinge, or are feeling more tired than usual—it doesn’t always mean they’re having a serious problem, but we need them to report it,” Dr. Amin says.
Hormonal changes can cause certain natural symptoms, like heart palpitations, that are not worrisome. And sometimes the intensity or persistence of such symptoms mean a doctor should be notified. Let your internist or cardiologist know how and what you’re feeling, and the length and intensity of the symptoms.
Since every woman experiences menopause and cardiovascular changes differently, patients should seek individualized, collaborative care.
“Even as we apply large-scale data and evidence, we take into account the individual,” Dr. Amin says as she describes the supportive patient care at Weill Cornell Medicine. “Because we treat a broad range of patients from different backgrounds, we know that one size does not fit all.”
For example, it used to be common to turn to hormone replacement therapy (HRT) when women experienced symptoms of menopause, Dr. Amin says, explaining that this was an extension of the concept that women’s own hormones protected against heart disease. But the added hormones from HRT raised the likelihood of uterine cancers, strokes, and blood clots.
HRT still may help certain women address conditions such as early menopause or osteoporosis, but physicians need to monitor patients closely, possibly adjust the duration of the therapy, and perhaps reevaluate its use, rather than simply prescribing HRT for all menopausal patients.
Multi-specialty collaboration also is key to successful women’s care.
“We’re in communication with each other to allow for a team-based approach,” Dr. Amin says, and adds, “We are really dedicated to improving outcomes.”
October is World Menopause Month and we here at Weill Cornell Medicine deliver the highest level of care at every stage of life, from adolescence to childbearing, to menopause and the post-menopausal years. Our team of North American Menopause Society Certified Menopause Practitioners focus on preventative care and patient education, empowering you to achieve your optimum level of health. Schedule your appointment today.