Around 45% of British women will suffer from heart disease or a stroke and it is the biggest single cause of death in the UK in post-menopausal women. According to David Morris, “coronary heart disease is the principal cause of death in North American women over the age of 50”.
Up to the time of menopause, women appear to have a natural immunity to heart disease unlike their male counterparts, it appears that the incidence of heart disease is around a third of the level of men. However, after the age of menopause, the incidence gradually increases to come into line with men at around the age of 75.
According to John Studd, hysterectomy in premenopausal women is associated with a three-fold increased risk of coronary heart disease and this is the case even when the ovaries are left intact. We may also assume that if a woman has a hysterectomy and consequently goes through menopause early, the age at which she comes into line with the male incidence of heart disease will be correspondingly lower.
Oestrogen affects blood cholesterol levels and also regulates the circulation of LDL (low-density lipoproteins – “bad” cholesterol) and HDL (high-density lipoproteins – “good” cholesterol). After menopause, the blood cholesterol and LDL levels go up and the HDL levels drop. This encourages an increase in the hardening of arteries and is particularly pronounced in women who smoke, are overweight and do not take regular exercise.
In addition to heart disease, insulin resistance also increases following menopause which, in turn, can lead to an increased risk of heart disease itself. Insulin resistance can lead to type II diabetes, the link between insulin resistance and heart disease is due to high levels of LDL and low levels of HDL.
Particularly at risk are the following groups:
- People who are overweight
- Families with a history of heart disease
- High levels of cholesterol before your operation
- People who do not take regular exercise.
Most people dislike the idea of taking any form of medication for a long time, but one of the major benefits of taking HRT is that it is probably the single most effective way of preventing heart disease as it returns the body to its pre-menopause state. According to Dr Sandra Cabot, “the risk of cardiovascular disease can be reduced by 50% by taking oestrogen at or soon after menopause”.
The Framingham Heart Study looked at 48,000 nurses and found that after 10 years there were half as many deaths from cardiovascular disease amongst those women who took oestrogen-only HRT after their menopause as opposed to those that did not take any form of HRT. David Morris also states that the protective effect of oestrogen-only hormone replacement therapy is also found in those women who already have the disease.
Fortunately, women who have had menopause do not need to take progesterone as well as oestrogen in their HRT. This is fortunate because there seems to be some indication that progesterone has the effect of reducing the benefits of oestrogen as well as having a possible detrimental effect on the endometrium.
If you do not wish to take Hormone Replacement Therapy there is much that you can do to help yourself. You will need to take regular exercise and also reduce the number of fats that are present in your diet. An increase in the amount of fruit and vegetables will also be of benefit. Try taking vitamins A, C and E as these are the anti-oxidant vitamins that can help to strengthen your immune system. For further information check out the Alternatives to Hormone Replacement Therapy section of the site.
If you would like to use other resources on the web, the American Heart Association provides information on the prevention of heart disease, together with other useful links.
As always, your GP and local library can help to locate specific items of information and your GP will be able to perform a simple blood test to measure the amount of oestrogen in your blood to determine what your risk may be.