Early Menopause Does Not Increase Usual Heart Disease Risks Study Finds Everyday Health MenuNewslettersSearch Menopause News Early Menopause Does Not Increase Usual Heart Disease Risks Study FindsBut overall cardiovascular disease is something all midlife women must pay attention to regardless of when this change occurs. By Meryl Davids LandauFebruary 26, 2020Everyday Health ArchiveFact-CheckedHormone replacement therapy may help balance levels of estrogen and progesterone in women after menopause.Antoine Arraou/Getty ImagesA new study upends the conventional belief that women who experience early menopause (45 years old or younger) have more traditional cardiovascular health issues later on than women who develop menopause closer to the normal age. The study, published in February 2020 in the journal Heart, found that women who go through menopause at an earlier age don’t later have more troublesome blood pressure levels, blood cholesterol, or other traditional heart disease risk factors compared with women who go through menopause later in life. That sounds like good news. But it doesn’t mean that a woman who stops her periods early—or indeed any woman—doesn’t have to worry about her heart. Heart disease remains the number one killer of women. And prior studies have shown that those who enter menopause before age 45 have higher rates of dying from heart disease in later life than others. Doctors had previously assumed the premature cardiovascular deaths in these women were likely caused by the increase in traditional risk factors, such as weight gain, that often happen as women go through the menopausal transition and estrogen levels drop, says Tomas Ayala, MD, a board-certified cardiologist at the heart center at Mercy Medical Center in Baltimore, who was not involved in the study. RELATED: 12 Women Over 60 Who Inspire Wellness and Living Your Best Life The study, conducted by researchers at British medical centers, looked at females in Britain’s comprehensive UK Medical Research Council National Survey of Health and Development, which has followed participants over many years. In roughly 1,000 women they were able to track the numbers for their blood pressure, unhealthy blood fats, body mass index (BMI), fasting blood glucose, and waist circumference (an indicator of the most dangerous fat around the abdominal organs) from midlife or even earlier, through age 69. What they found was that by age 69, women who had gone through early menopause — whether naturally or from surgery — did not have unhealthier levels of these markers than women who entered the change later. “Our findings suggest that the impact of timing and type of period cessation on conventional cardiovascular disease intermediates from midlife is likely to be small,” the authors conclude. RELATED: 10 Ways to Beat Menopausal Belly Fat Why Menopause Still Matters for Your Heart Still, all women have a higher risk of heart disease once they reach menopause and lose the bulk of their estrogen. “The clock starts ticking at menopause for increased cardiovascular disease risk,” Dr. Ayala says. That’s why all women of menopausal age need to take heart disease seriously, he says. “A woman’s cardiovascular system is hugely impacted by the loss of ovarian hormones,” agrees Felice Gersh, MD, a board-certified gynecologist and integrative medicine physician in Irvine, California, and a consultative faculty member at the University of Arizona College of Medicine. Dr. Gersh, who cowrote an editorial that accompanied the study, notes that disease and death from heart issues start happening as early as women’s fifties and sixties, not only in older ages. There are numerous theories about how estrogen in premenopausal women helps the heart, but none are proven. Most have to do with the way estrogen protects the lining of your blood vessels, known as the endothelium. According to the editorial, estrogen offers “anti-inflammatory, antioxidant, and anti-proliferative pathways” in the endothelium, and its steep reduction after menopause contributes to dysfunction in the vessels. RELATED: Fitness After 40 and Beyond: What to Know About Midlife Exercise Needs Researchers Suggest Better Preventive Measures for Women at Risk of Heart Disease The study presents another example of how women’s heart health is different from men’s, Gersh says. For example, women have different symptoms when having a heart attack, are more likely than men to die from their first heart attack, and develop heart failure through a different pathway, she observes. “Rather than labeling female symptoms as atypical, they should be labeled as what they are: female-typical symptomatology,” Gersh says. The results of this study are likely to change the way cardiologists treat women’s heart risks. “Before this study, if a patient had gone through menopause early, we would have been very aggressive in treating her high blood pressure, cholesterol, and other traditional risk factors,” Ayala says. Doctors should still treat these, he says, “but maybe we don’t have to go overboard or be super-aggressive” because these factors are not impacted by the earlier age of menopause the way doctors had thought. Regardless of a woman’s age when she enters menopause, getting serious about heart disease prevention is paramount. How best to do that remains controversial, but Gersh and her coauthor wrote in the editorial that hormone therapy (HT, or HRT) likely offers the best hope. “The current state of research is enough to justify the use of human-identical HRT with most women” as they go through menopause, they wrote in the editorial, although they call for additional studies to document the benefits more fully. HT had previously been used after menopause in part to aid a woman’s heart. But many abandoned this treatment after the famed Women’s Health Initiative (WHI) trial was prematurely stopped in 2002 due to concerns about detrimental health effects. Many doctors, including Ayala, now think the panic over the results was excessive. “The risks for cardiovascular disease in the study were well overblown,” Ayala observes. Gersh says the WHI shouldn’t have tarnished HT the way it did, because that study included women well past their menopause transition and it used conjugated estrogens made from horse urine. RELATED: Some Hormone Therapies Are More Effective Than Others in Preventing Heart Disease Ayala says that he generally recommends HT to his female cardiology patients in their forties and early fifties and will continue to do so in the face of the revelation that treating traditional heart risks is not enough. Gersh advocates that most women at the start of menopause should be offered HT with “human-identical transdermal estradiol” also known as bioidentical estrogen delivered by a patch or gel into the skin, along with micronized progesterone for women who have not had a hysterectomy. The key exception: women with diagnosed cancers involving estrogen receptor–positive tumors. “Much of what is viewed as the consequence of aging is actually a consequence of hormonal deficiency,” especially when it comes to the heart, Gersh says. “With proper informed consent, each woman can then decide for herself what path she chooses to follow.” NEWSLETTERS Sign up for our Women' s Health Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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