Good heart health is important throughout your life and the risk of heart disease increases more quickly 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 HT 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 HT 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! There are simple changes that can reduce the risk of long-term problems.
What are the signs and symptoms of heart disease in women?
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 or heavy chest pressure
- Palpitations – a feeling of your heart beating in your chest
- Shortness of breath
- Swollen ankles
- Feeling faint or dizzy
- Passing out
- Nausea or vomiting
- Pain between your shoulder blades/in your left upper arm
Go to the ER immediately if any of the above symptoms are severe and another problem is not obviously the cause. It is vital that any potentially serious heart problems are assessed by a healthcare provider as soon as possible. This is because treatments for heart problems such as heart attacks, are more effective if started early.
See your healthcare provider 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. 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 or genes that you have inherited
- 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
- High cholesterol levels. This includes familial hypercholesterolemia, which is a genetic predisposition to high cholesterol
Your healthcare provider may use a tool called QRisk or another risk estimation tool to assess your risk of heart disease. These calculators take your personal risk factors into account and work 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 estrogen 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 estrogen decline and this reduces its protective effect on your heart health.
Menopause also has an effect on your risk factors for heart disease such as weight, as shown in recent studies.
Weight gain
It is 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.
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 flashes.
Some women report increases in anxiety and this can be experienced as chest pressure or shortness of breath.
For this reason, if you have new symptoms that concern you, it is important that you speak to your healthcare provider and not assume that menopause is the cause.
Go to the ER if you have any of the following symptoms for more than a few minutes:
- Palpitations
- Chest pain
- Chest pressure
- Breathlessness
- Dizziness
- Feeling faint
Talk to your healthcare provider 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 HT prevent heart disease?
HT reduces your risk of heart disease if go 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 HT if they don’t have any other significant risk factors.
We are still learning about the effects of taking HT later in life. A medical review of research found that starting HT before age 60 may reduce your risk of heart disease. The risks of other conditions relating to HT use still apply, such as a small but significant risk of stroke, blood clots, and breast cancer. So while HT might benefit your heart health, it is not guaranteed and you also need to consider the possible risks of this treatment.
Your healthcare provider will help you make a decision based on your own menopause symptoms and medical history when it comes to deciding if HT is right for you. HT is a very effective treatment for some menopause symptoms and it is 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:
Try to control 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 healthcare provider about support services in your 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 and lean protein, like chicken and fish.
Watch what you drink
Aim to have fewer than one alcoholic drink per day, or seven per week.
Ask your healthcare provider to help you:
- Maintain a healthy blood pressure. Ideally, this should be below 130/80
- Lower your blood lipid levels through diet, exercise, and medication, if needed
- 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 HT.
Find out more about menopause on our blog or in our 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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