Chijioke Iremeka
Menopause is the time that marks the end of a woman’s menstrual cycle and it comes with a series of symptoms that could at times be uncomfortable.
Medical experts, however, have suggested many ways menopausal women can reduce their risks of developing cardiovascular diseases, stressing that there is a need for women to monitor their health, especially during middle age to avoid such diseases.
The physicians said this is crucial as middle age is a critical time in which early intervention strategies should be implemented to reduce the risk of CVD during menopause.
They noted that hormonal changes increase the risk of CVD but that preventing such diseases should begin early.
The experts stated that consultations during the perimenopausal and menopausal periods are ideal opportunities to assess cardiovascular risk.
They warned that early menopause is generally referred to as the superior risk of CVD and this factor should be a strong warning sign during a medical consultation and shouldn’t be ignored.
According to an online medical portal, Mayo Clinic, menopause is a natural biological process and the time that marks the end of the menstrual cycle, which is diagnosed after one has gone 12 months without a menstrual period.
“Menopause can happen in your 40s or 50s, but the average age is 51 in the United States. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy, or affect emotional health. There are many effective treatments available, from lifestyle adjustments to hormone therapy,” the Clinic said.
More so, the 2017 World Health Organisation report indicates that cardiovascular disorders are the first cause of death in the world, followed by cancer, estimating that about 17.9 million people die from cardiovascular diseases, an estimated 31 per cent of global deaths.
The global health body listed CVDs to include disorders like coronary heart disease, cerebrovascular disease, rheumatic heart disease, arterial disease, peripheral arterial disease, congenital heart disease, deep vein thrombosis, and pulmonary embolism.
However, physicians, who spoke exclusively with PUNCH Healthwise in different interviews said, that as the increased risk of CVD coincides with menopause, studies have shown that female hormones, especially estrogens, are cardioprotective and play significant roles in both reproductive and non-reproductive systems.
A Consultant Gynaecologists and Obstetrician at the Epe General Hospital, Epe, Lagos, Dr Cynthia Okafor said that menopause is associated with increased blood pressure, body mass index, obesity, and body fat distribution, saying that there is a need for regular monitoring to nip CVD in the bud.
Okafor said though the hormones can be synthesised in non-reproductive tissues such as the brain, bone, muscles heart, and liver, early intervention to reduce the risk of cardiovascular diseases among menopausal women becomes pertinent.
She said, “Before the onset of menopause, sex hormones such as estrogens are manufactured mainly in the ovaries, placenta as well as the corpus luteum, which is a temporary collection of cells that forms on your ovary each menstrual cycle if you’re still getting a menstrual period.
“This doesn’t stop there; the hormones are also created by the brain, heart, and the liver, but the risk of cardiovascular disease increases after menopause when the level of estrogens is dropping and these protective hormones are deficient.”
According to her, the three main forms of estrogens are estrone, estradiol, and estriol, and they play a critical role in the development of cardiovascular.
She noted that the protective role against cardiovascular disease in women during childbearing age is related to estradiol as endogenous estradiol levels expression varies between the sexes.
Speaking on the symptoms, she said irregular periods during premenopause is common and expected, stating that sometimes, the periods will miss out a month and return, or several months, and then start monthly cycles again for a few months.
“Unfortunately, this could also be a sign of cervical cancer and some women may be agitated about this, but it is just normal. Periods also tend to happen on shorter cycles, so they are closer together. Despite these irregular periods, pregnancy is possible,” she said.
Other signs of menopause, she noted, include irregular periods; vaginal dryness; hot flashes; night sweats; sleep problems; mood changes; weight gain and slowed metabolism; thinning hair and dry skin.
The Consultant Gynaecologist also advised any woman of premenopausal age who skipped a period but was not sure of the onset of menopause to go for a pregnancy test as she may have taken in.
Okafor said because menopause is a natural biological process facing every woman, there is a need for them to know how to navigate around it without developing CVD which they are susceptible to.
She encouraged women of menopausal age to get screened regularly, saying that regular heart health screenings are important to maintaining a healthy heart coupled with regular exercise regularly.
“Women should try to engage in physical fitness exercises at least 150 minutes per week to help lower their risk of heart disease; eat a healthy diet and stay positive,” Okafor added.
Corroborating her position, a Consultant Cardiologist at the Lagos University Teaching Hospital, Idi-Araba, Dr Akinsanya Olusegun-Joseph, said when estrogen levels decline, the risk of cardiovascular disease increases.
Olusegun-Joseph noted that heart disease is the leading cause of death in women as well as in men and therefore, is important for regular body fitness exercise, healthy diet, and maintenance of a normal weight.
The specialist, who said many women gain weight during the menopausal transition and after menopause because of slow metabolism, said that menopausal women need to eat less and exercise more, just to maintain good sight.
According to him, studies show that women who experienced premature menopause had a significantly increased risk of a non-fatal cardiovascular event before the age of 60, but not after the age of 70 in comparison to women who reach menopause at the age of 50–51 years. “Early menopausal women require close monitoring in clinical practice. Moreover, the age at which a woman reaches menopause may be considered as an important factor in assessing the risk of cardiovascular disease in women.”
A study published in the National Library of Medicine by Kamila Ryczkowska et al titled, ‘Menopause and women’s cardiovascular health: is it an obvious relationship?’ affirms that hormonal changes in menopause can predispose women of menopausal age to risk of cardiovascular diseases.
The study stated that cardiovascular diseases are common for men and women but there are differences between the sexes in terms of clinical symptoms, pathophysiology, and response to the treatment.
“Women develop heart diseases later than men because of the protection in the reproductive phase of their life. Once they enter menopause, the risk increases. Estrogen provides a protective effect against heart disease in women.
“Therefore, the risk of CVD increases after menopause in most cases. The presented work emphasises the importance of the menopausal period as the time of increasing CVD risk.
“It also emphasizes the importance of monitoring the health of women in their middle age, a critical time in which early intervention strategies should be implemented to reduce the risk of CVD.”
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