Good heart health is important throughout your life but the risk of heart disease increases after menopause. Why does this happen? And what practical steps can you take to protect yourself?
Discover more about menopause and heart disease, including your personal risks and if HRT helps.
Find what you need quickly
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What is heart health?
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What are the signs and symptoms of heart disease in women?
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What increases the risk of heart disease?
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How does menopause affect heart health?
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Can menopause symptoms be confused with heart disease?
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Does HRT prevent heart disease?
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How can you reduce your risk of heart disease?
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Final word
What is heart health?
It goes without saying that your heart keeps you alive. When we talk about heart health, we mean:
- How efficiently your heart can pump blood around your body
- How well your heart valves work
- How electricity travels through your heart
- Whether there are any blockages caused by cholesterol build-up in your blood vessels
- The overall condition of your heart and blood vessels
Problems with any of these aspects of heart health can cause heart disease. Conditions you might have heard of include heart attacks (myocardial infarctions), angina, arrhythmias, aneurysms and valve disease.
If this sounds complicated, don’t worry, as it can be! There are simple changes that can reduce the risk of long-term problems.
What are the signs and symptoms of heart disease in women?
Women and men generally have similar heart disease symptoms, including symptoms of serious problems like heart attacks.
Be aware that heart disease is not always obvious and can go unnoticed or be picked up on a routine check. For some, the first time they know they have heart disease is when they have a serious medical condition, like a heart attack.
Look out for these symptoms, which might be mild or more severe:
- Chest pain
- Palpitations – a feeling of your heart beating in your chest
- Breathlessness
- Swollen ankles
- Feeling faint or dizzy
- Passing out
- Nausea or vomiting
- Pain between your shoulder blades
Go to A&E immediately if any of the above symptoms are severe. It’s vital that any potentially serious heart problems are assessed by a doctor as soon as possible. This is because treatments for most major medical problems, such as heart attacks, are more effective if started early.
See your doctor if symptoms are mild. It is always worth getting even subtle symptoms checked out, such as occasional dizziness or increased breathlessness when exercising. These can be signs of something more serious.
What increases the risk of heart disease?
Having heart disease is just bad luck sometimes. For example, some people are born with valves that don’t work properly and others have genes that make them more likely to develop heart disease.
However, certain things make heart disease more likely as you age. These are called risk factors.
There are some risk factors you can change when it comes to heart health, such as:
- Whether or not you smoke
- How much you exercise
- How much alcohol you drink
- How much you weigh
- Your cholesterol levels
- What you eat
There are some risk factors you can’t change, such as:
- Your age. Heart disease becomes more common after age 50
- Your family history
- Your ethnic background. People from South Asian and sub-Saharan African backgrounds are at higher risk
You are also more likely to develop heart disease if you have certain medical conditions, such as:
- Diabetes
- High blood pressure
- Chronic kidney disease
- Some inflammatory conditions like rheumatoid arthritis and lupus
- Dyslipidaemia or unhealthy cholesterol levels. This includes familial hypercholesterolaemia, also known as genetic high cholesterol
Your doctor may use a tool called QRisk to assess your risk of heart disease. QRisk is a calculator that takes into account your personal risk factors and works out how likely you are to have a heart attack or stroke over the next decade. You can also calculate your heart age online if you have your blood pressure and cholesterol details.
How does menopause affect heart health?
We are still learning about how menopause affects heart disease risk but it is thought that oestrogen has a protective effect on your heart and blood vessels. It can reduce a build-up of cholesterol in your arteries and lower your ‘bad’ cholesterol levels. During menopause your levels of oestrogen decline and this reduces its ability to boost your heart health.
Menopause also has an effect on your risk factors for heart disease as shown in recent studies. This has two main causes:
Hormonal changes
It’s easier to gain weight around your tummy during menopause, which is a known risk factor for heart disease. Many people also find it harder to stay active while struggling with menopause symptoms. Sitting around and not moving enough are risk factors.
Your menopause age
Those who go through premature or early menopause, before age 40, have a higher risk of developing heart disease. This is because people spend more time with low oestrogen levels and miss out on several years of the hormone’s protective effects. This is why people who go through early or premature menopause are advised to take HRT until around age 50.
Can menopause symptoms be confused with heart disease?
Menopause symptoms can mimic heart disease in some cases – palpitations are particularly common in menopause and they’re often accompanied by hot flushes.
However, palpitations may also signify problems within the electrical system that keeps your heart beating. For this reason, it’s important to speak to your doctor and not to assume that menopause is the cause.
Go to A&E if you have:
- Palpitations with chest pain, breathlessness, dizziness or feeling faint
- Palpitations that last longer than 10 minutes
- A fast heart beat (over 100 beats per minute)
- Any other serious worries about your heart health
Talk to your doctor if you have experienced milder forms of any of the above issues, even if they have since settled down. There could still be an underlying problem that needs investigating. The same applies if you have palpitations that come and go, an irregular heartbeat, shortness of breath, or palpitations with a personal or family history of heart disease.
Does HRT prevent heart disease?
HRT reduces your risk of heart disease if you’ve been through early menopause, before age 45, or premature menopause, before age 40. Everyone who goes through menopause before the age of 40 is advised to take HRT if it is right for them.
We are still learning about the effects of taking HRT later in life. A medical review of research found that starting HRT before age 60 may reduce your risk of heart disease. The risks of other conditions relating to HRT use still apply, such as a small but significant risk of stroke, TIA and blood clots. So while HRT might benefit your heart health, it’s not guaranteed and you also need to consider the possible risks of this treatment.
Your doctor will help you make a decision based on your own menopause symptoms and medical history when it comes to deciding if HRT is right for you. HRT is a very effective treatment for some menopause symptoms and it’s suitable for most people.
How can you reduce your risk of heart disease?
You can reduce your risk of heart disease during and after menopause by making changes to your lifestyle. If this seems overwhelming, choose one area to focus on first. Here are some ideas to try:
Check your weight
Change your diet and exercise levels to work towards a body mass index (BMI) of less than 25. Use this BMI calculator to work out what this means for you.
Cut down and aim to quit smoking and/or vaping
Talk to your doctor about support services in your local area.
Exercise regularly
Start with an achievable daily step goal and gradually increase your activity levels.
Eat a healthy, balanced diet
Choose plenty of vegetables, complex carbohydrates and lean protein, like chicken and fish.
Watch what you drink
Drink fewer than 14 units of alcohol per week, spread across three days or more.
Ask your doctor to help you:
- Maintain a healthy blood pressure. Ideally this should be below 135/85 if measured at home, or 140/90 if measured in clinic
- Achieve a healthy balance of lipids, including cholesterol
- Manage other medical conditions, such as diabetes
Final word
Heart health may seem like an intimidating, complex topic, but looking after yours doesn’t have to be. There are lots of things you can do to protect your heart, with or without HRT.
For more information about other menopause topics, read more on our blog or symptoms library.
- Ambikairajah, A, Walsh, E, Cherbuin, N 2019, ‘Lipid profile differences during menopause: a review with meta-analysis’, Menopause, vol. 26, no. 11, pp. 1327-1333
- Dam, V et al. 2019, ‘Association of menopausal characteristics and risk of coronary heart disease: a pan-European case–cohort analysis’, International Journal of Epidemiology, vol. 48, no. 4, pp. 1275-1285.
- National Institute for Health and Care Excellence 2023, ‘Cardiovascular disease: risk assessment and reduction, including lipid modification’ [Clinical Guideline No. 181]
- Nudy, M, Chinchilli, VM, Foy, AJ 2019, ‘A systematic review and meta-regression analysis to examine the ‘timing hypothesis’ of hormone replacement therapy on mortality, coronary heart disease, and stroke’, Int J Cardiol Heart Vasc. pp. 123 -131.
- Van Oosterhout, REM, de Boer, AR, Maas, AHEM, Rutten, FH, Bots, ML, Peters, SAE 2020, ‘Sex differences in symptom presentation in acute coronary syndromes: a systematic review and meta-analysis’, Journal of the American Heart Association, vol. 9, no. 9
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