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Menopause and Heart Health

What is Menopause?

Known as the "change of life," menopause is the last stage of a gradual biological process in which the ovaries reduce their production of female sex hormones. This process begins about 3 to 5 years before the final menstrual period. This transitional phase is referred to as the perimenopausal phase. Menopause is considered complete when a woman has been without periods for 1 year. It marks both the end of menstruation and the end of a woman's ability to naturally conceive a child. 

In the United States, the average age of menopause is 51, with most women usually reaching natural menopause somewhere between 40 and 58 years of age. For some women natural menopause has occurred as early as in their 30s and some have been in their 60s, though this is quite rare. Typically, a good indicator of when a woman will reach menopause is to look at when a woman's mother and sisters experienced menopause. If a woman smokes or is a former smoker, menopause may occur up to 2 years earlier than expected.

How Does Menopause Occur?

The ovaries contain structures called follicles that hold the egg cells. You are born with about 2 million egg cells and by puberty there are about 300,000 left. Approximately 400 to 500 egg cells mature fully and are capable of release during the menstrual cycle. The remaining eggs degenerate over the years. During the reproductive years, the pituitary gland in the brain generates hormones that cause a new egg to be released from its follicle each month. The follicle also increases production of the sex hormones estrogen and progesterone, which thicken the lining of the uterus. This enriched lining is prepared to receive and nourish a fertilized egg following conception. If fertilization does not occur, estrogen and progesterone levels drop, the lining of the uterus breaks down, and menstruation occurs. 

For unknown reasons, the ovaries begin to decline in hormone production during the mid-thirties. In the late forties, the process accelerates and hormones fluctuate more, causing irregular menstrual cycles and unpredictable episodes of heavy bleeding. By the early to mid-fifties, periods finally end altogether; however, estrogen production does not completely stop. The ovaries decrease their output significantly, but still may produce a small amount. Also, with help from the adrenal glands, another form of estrogen is produced in fat tissue. Although this form of estrogen is weaker than that produced by the ovaries, it increases with age and with the amount of fat tissue. 

Progesterone, the other female hormone, works during the second half of the menstrual cycle to create a lining in the uterus as a viable home for an egg, and to shed the lining if the egg is not fertilized. If you skip a period, your body may not be making enough progesterone to break down the uterine lining. However, your estrogen levels may remain high even though you are not menstruating. 

At menopause, hormone levels don't always decline uniformly. They alternately rise and then fall again. Changing ovarian hormone levels affect other glands in the body, which together make up the endocrine system. The endocrine system controls growth, metabolism and reproduction. This system must constantly readjust itself to work effectively. Ovarian hormones also affect all other tissues, including the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract, and skin. 

Does Menopause Increase the Risk for Heart Disease? 

Heart disease, also known as coronary disease, is the leading cause of death among postmenopausal women. Increased risk for coronary disease is primarily associated with the process of aging, yet there is also a relationship between heart health and a woman's transition through menopause. Before menopause a woman's heart and blood vessels seem to have some protection due to hormones; the natural estrogen level in a woman's body is associated with healthy cholesterol. After menopause, estrogen levels decline, and along with it goes the protection that natural estrogen provides. A woman's risk for heart disease, therefore, goes up. 

Prior to menopause, a woman has a reduced rate of heart disease compared with men the same age. After menopause, however, a woman's rate of heart disease increases considerably, and at the age of 65, the risk is equal to that of her male peers. Recent studies show that Hormone Replacement Therapy (HRT) does not protect against heart disease and may, in fact, slightly increase the risk of heart attacks, strokes, and blood clots. 

Studies also show that after menopause, women have higher levels of several blood components. These include triglycerides, cholesterol, and low-density lipoprotein (LDL) cholesterol. These changes are due to the loss of estrogen, as well and weight gain and aging.

Other factors that can increase your likelihood of developing heart disease include: 

family history
cigarette smoking
lack of exercise and/or being overweight
black heritage
high cholesterol
high blood pressure
heavy alcohol consumption
weight more than 30% above ideal

About Homocysteine

Homocysteine is an amino acid metabolite that is very damaging to the cells that line the arteries. Increased plasma (blood) homocysteine concentration is an independent risk factor for premature atherosclerosis. Atherosclerosis is an accumulation of fatty deposits that build on the inner walls of the arteries interfering with blood flow. Abnormal homocysteine levels appear to contribute to atherosclerosis in at least three ways: (1) a direct toxic effect that damages the cell lining on the inside of the arteries, (2) interference with clotting factors, and (3) oxidation of low-density lipoproteins (LDL). Recent research found that even moderately elevated homocysteine levels may be associated with a greater risk of death related to cardiovascular disease.

The postmenopausal state is associated with higher plasma (blood) homocysteine levels. The prevalence of atherosclerosis caused by increased levels of homocysteine, rises sharply in the years immediately following menopause, independent of age. The presence of atherosclerosis is subclinical; meaning the development of the disease is at a stage when there are no observable symptoms. Studies show that postmenopausal women who subsequently developed some form of cardiovascular disease had higher baseline homocysteine levels. In addition, studies show a strong association between homocysteine levels and cardiovascular disease related deaths among postmenopausal women.

How to Minimize Your Risk for Heart Disease

Experts say making lifestyle changes can be critical to decreasing your risk for heart disease. Research has shown that the perimenopausal period (roughly the decade leading up to the onset of menopause) is a key time to reduce the risk of developing heart disease from occurring after menopause. Women are urged to make the following lifestyle changes to reduce the risk for heart disease: 

quit smoking
lower and/or control their blood pressure
lower and/or control their cholesterol levels
exercise regularly
eat a high-fiber, heart healthy diet
supplement with appropriate vitamins and minerals as recommended by a physician
control diabetes
achieve and maintain a healthy weight
continue regular, annual checkups with their physician
smile – doing so causes your brain to produce hormones that make you, and your heart, feel good
eat foods with high soy content such as tofu, soy milk and legumes

Heart Healthy Nutrients

Studies suggest that by lowering homocysteine, it may be possible to reduce the risk of cardiovascular disease such as coronary artery disease. Numerous studies demonstrate the affects of folic acid on homocysteine levels in humans. Increasing folic acid intake greatly reduces homocysteine levels. With a significant percent of the U.S. population at risk of cardiovascular risk, the increased benefits and effects of taking folic acid to decrease homocysteine levels are gaining widespread awareness. Scientists believe that up to as many as 50,000 deaths per year due to coronary artery disease could be prevented by increasing intake of folic acid by supplementation. 

Vitamin B6 (pyridoxine) and vitamin B12 (cobalamin) are also involved in the homocysteine reduction process. Both vitamins are important in the function of protein metabolism reactions, particularly in the conversion of homocysteine. Deficiency of vitamin B6 and vitamin B12, as well as folic acid, leads to mild-to-moderate elevation of homocysteine levels. Along with vitamin B6 and folic acid, vitamin B12 helps metabolize homocysteine to non-damaging forms.

Soy has recently received much attention due to the surprising number of health benefits it possesses. In addition to possibly preventing or controlling many conditions such as osteoporosis, and symptoms of menopause, soy can also help guard against cardiovascular disease. One of the major risk factors for heart disease is hypercholesterolemia, or high blood cholesterol levels. Studies have shown that soy protein can help to reduce total cholesterol, as well as low-density lipoproteins
(LDL), which are also known as the "bad cholesterol". Soy does not decrease the amount of high-density lipoproteins (HDL) or the "good cholesterol." In fact, some studies have shown that it may even raise HDL levels. Individuals need at least 25 grams of soy protein per day to help lower cholesterol. This is equivalent to approximately one cup of soybeans or one-half cup of soynuts.

Soy is also packed with other nutritional value that will help in reducing the risk for cardiovascular disease. Soybeans are low in saturated fat, cholesterol-free, and high in fiber since they are a plant product. Soy also contains isoflavones, which may play a role in reducing cholesterol, along with soy protein. There are two main isoflavones in soy, genistein and daidzein. Studies have indicated that genistein slows or may even stop the formation of blood clots as well as the growth of cells that may cause blocks in the arteries.

Note: All information on this website is intended for your general knowledge only and is not a substitute for medical advice or treatment for a specific medical condition. Please consult your physician if you have questions or concerns regarding your health.
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