If you believe concerns about heart health and longevity only pertain to older women, new research may have you thinking differently.
The analysis highlights the importance of focusing on heart health in perimenopause. “We as a medical community are increasingly realizing the impact of reproductive health on cardiovascular disease over the lifespan,” says Ersilia M. DeFilippis, MD, a cardiologist specializing in advanced heart failure and transplants at NewYork-Presbyterian Columbia University Irving Medical Center in New York City, who was not involved with the new research.
“This is a huge time of vulnerability for women,” says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine in Chicago. “Perimenopause is the time to look at cardiovascular health and make changes — not five years later.”
Here, doctors (none of whom were involved in this new research) break down what’s behind this shift in cardiovascular health in perimenopause, plus what women can do to combat it.
Perimenopausal Women Saw Their Heart Health Take a Hit
The analysis focused on data from more than 9,000 women ages 18 to 80 who participated in the U.S. National Health and Nutrition Examination Survey between 2007 and 2020.
The researchers assigned participants a score between 0 and 100 based on Life’s Essential 8, the AHA’s measurements for improving and maintaining heart health. Life’s Essential 8 includes factors that impact heart health like diet, sleep, and exercise.
Some key findings:
Perimenopausal women experienced heart health declines. They were twice as likely to have an overall low heart-health score (below 50) as those who were premenopausal. Heart-health scores were even lower in postmenopausal women.
Perimenopausal women had more issues with blood sugar and cholesterol. They were 76 percent more likely to have higher cholesterol and higher blood sugar than their younger peers.
Diet quality declined with age. Participants consistently received the lowest scores in the diet category, and these scores dropped over time.
How Lowering Estrogen Impacts Heart Health
Levels of the sex hormone estrogen start to decrease during perimenopause, Dr. DeFilippis says.
“As estrogen levels fall, LDL (“bad” cholesterol) levels tend to increase, and insulin resistance can worsen,” she says. “This means that cells in the body do not respond to insulin as well as they once did, which can increase blood sugar and the risk of diabetes.”
Lower estrogen levels can also make blood vessels in the body stiffer, which increases blood pressure, DeFilippis says.
Women are more vulnerable to weight gain during perimenopause, which is a risk factor for heart disease, says Dr. Streicher. Estrogen levels also fluctuate in perimenopause, with some dips and surges in levels of the hormone in the body.
“The body is getting all kinds of mixed messages from these hormonal changes, and may respond in ways that are not the healthiest,” Streicher says.
All those hormonal changes can have a lasting impact on heart health. “We know that women who go through early menopause at 45, or premature menopause at 40, are at higher risk of heart disease due to that loss of estrogen earlier in life,” DeFilippis says.
Ultimately, “these changes can significantly increase cardiovascular risk,” says Jennifer Wong, MD, a cardiologist and the medical director of noninvasive cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.
It’s important for women to act before it’s too late, says Catherine Weinberg, MD, a cardiologist at Northwell Lenox Hill Hospital in New York City. “Perimenopause is the time to address those changes, not after menopause — before they become a diagnosis,” she says.
Strengths and Limitations
The study analyzed data from women across a range of ethnicities and age groups. But there were some clear limitations.
The data was self-reported, including the women’s menstrual history (which was used to determine their reproductive stage), and lifestyle factors like physical activity levels and smoking status. Some information may not have been accurate as a result.
The researchers didn’t have clear information from all participants on other risk factors that might have influenced their heart health and hormones, like the use of hormone replacement therapy or whether a woman had her ovaries removed.
Finally, there were far fewer women who were classified as being in perimenopause than other groups — just 205 women out of more than 9,000. That makes it difficult to get an accurate representation of women in this life stage, Streicher says.
Women in Perimenopause Can Make Heart-Healthy Changes
The analysis did not paint a rosy picture of cardiovascular health in perimenopause, but it highlights opportunities for change, doctors say.
“Middle age and the perimenopausal transition represent a critical window for prevention,” Dr. Wong says. “Adopting heart healthy habits can substantially improve long-term cardiovascular health.”
These habits include regular physical activity and a heart-healthy diet with a range of vegetables and fruits, whole grains, minimally processed foods, and lean sources of protein, according to DeFilippis.
“Being mindful of lifestyle habits in addition to consistent engagement and follow-up with medical care is imperative to ensure early and prompt treatment of cardiovascular risk factors,” she says.
Dr. Weinberg says it’s “concerning” that heart-healthy diet quality dropped at every reproductive stage. “That is where the largest gains are still available,” she says. “We need to be talking to women about food and exercise early, and we need to keep talking so they continue healthy habits and teach the next generation.”
Hormone therapy can help women navigate this time, too, Streicher says.
“Hormone therapy is not just so you will feel better and have fewer hot flashes,” she says. “It can help you have a better quality of life and impact your long-term cardiovascular disease risk.”
Streicher also urges women in perimenopause to interact with the medical community more, specifically when it comes to heart health. “This is a time when cardiovascular disease might emerge for the first time, and women might not be paying attention,” she says.
“Some women are interested in getting their hormone levels checked. Get your blood pressure and cardiovascular measures checked instead. That’s really important.”
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