17 March 2022

 Menopause is a natural phase of a woman’s life cycle. The hormonal changes that occur during menopause carry increased cardiovascular risks linked to inevitable physiologic and metabolic alterations including higher blood pressure and cholesterol levels.

AS a custodian of women’s Heart Health, we in YADUNA endeavor to stress the importance of this phase of women’s Health and call for special attention to prevention and early diagnosis and intervention for mitigating the changes that could impact their health.

Menopause is the time that marks the end of a woman’s menstrual cycles. It's diagnosed after a woman has gone 12 months without a menstrual period. The mean onset of menopause is 50 years, however, there is an inter-individual variation, ranging between 40 and 60 years. It is known that heart disease is more common in men but, following the menopause, the risk increases in women with a significant catch up. Studies have found that women with early menopause (45 and younger) have excessive cardiovascular health issues later on than those who have menopause closer to the normal age; this risk is higher among Women with family history of heart diseases. If cardiovascular disease runs strongly in the family, the risk is even higher.  An overall rise in heart attacks among women is seen about 10 years after menopause.

With onset of menopause, the ovaries gradually stop producing estrogen. Estrogen, a hormone that regulates important protective cardiovascular functions and maintains the wellbeing of the vessels and the heart. Hence lower hormonal levels can bring an increased cardiovascular risk.

These hormonal changes can trigger increased appetite, change in diet and can lead to obesity. Obesity may then cause depression, which in turn enhances further food intake and sleep deprivation and reduces physical activity.

Menopause results in lipid profile changes, with a 10–15% higher LDL-cholesterol and triglyceride levels and slightly lower HDL cholesterol levels. Sodium sensitivity frequently increases, as well, leading to intermittent fluid retention usually presenting as oedema of the legs, hands, and eyelids.

Gynecologists might prescribe hormone replacement therapy (HRT) as a way to give some of the estrogen back and help regulate common menopausal symptoms such as hot flashes, as well as prevent osteoporosis. HRT however may have controversial benefit on the described vascular changes.

These developments call for the primacy of monitoring women’s health during midlife, a critical window for implementing early intervention strategies to reduce cardiovascular risk.

Adherence to a healthy lifestyle and diet with regular exercise are important factors that can prevent weight gain while reducing lipids, blood pressures, as well as blood glucose, insulin, and subclinical carotid atherosclerosis, among women going through menopause.

At the Women Health Heart Center at Yaduna, a personalized approach is offered to women in this transitory period. Making use of the laboratory tests, imaging facilities, and medical staff expertise to screen and guide women in this critical stage of their life is a unique opportunity to fight Heart Disease and Stroke.

Samir Alam MD, FACC, FRCP

Professor of Medicine, Cardiology

Associate VP for Health, Chief of Staff

American University of Beirut Faculty of Medicine and Medical center

YADUNA-WHHC Board of Trustees and Directors

Wissam Harb MD

General Cardiologist

Clinical Associate AUBMC, Yaduna – WHHC