A new study in the Journal of the American Heart Association has found that women’s cardiovascular health declines as they advance to perimenopause and menopause. Specifically, findings revealed that perimenopausal women were two times more likely to have a low cardiovascular health score compared to women having regular menstrual cycles. Knowing this, it’s critical to have a plan in place to prioritize your heart health during this time of life.
Defined as the transitional period from the reproductive to the non-reproductive phase, perimenopause is marked by hormonal and metabolic changes when cardiovascular health can decline in comparison to the premenopausal years. A 2020 scientific statement from the American Heart Association emphasized that the transition to menopause can increase cardiovascular disease risk and is an important time for women to implement early intervention strategies.
“A focused plan during perimenopause helps women understand that midlife changes are not simply something to ‘push through,’” said Dr. Celia Egan, Director of Obesity Medicine & Metabolic Health at true. Women’s Health in Grand Rapids. “With the right prevention-based approach, this stage can become an opportunity to reduce risk, improve symptoms, and preserve long-term health during menopause and beyond."
During perimenopause, estrogen and progesterone levels fluctuate, menstrual periods may become irregular, and women often experience mood changes, sleep problems and hot flashes. When 12 consecutive months pass after a woman’s final menstrual period, she is considered postmenopausal.
According to Dr. Garima Arora, senior author of the study and a professor of medicine in the division of cardiovascular disease at the University of Alabama at Birmingham, mid-life women should think of the perimenopausal period as a “window of opportunity.”
“They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels,” Dr. Arora explained. “Women should talk with their health care team about their reproductive status and any changes they are experiencing. It may be the perfect time to get a baseline for their heart health.”
Life’s Essential 8™ (LE8) scores—defined by the American Heart Association—are scientifically based measures of optimal cardiovascular health. These recommendations encapsulate effective management of lifestyle/behavior (diet, physical activity, tobacco use and sleep) and health factors (blood pressure, cholesterol levels, body weight and blood sugar levels) to achieve optimal cardiovascular health. Using the LE8 score, an average measure of all eight factors on a 100-point scale, researchers assessed participants’ heart health.
The analysis revealed:
• Median LE8 scores among all participants declined with advancing reproductive stage, from 73.3 out of 100 (in premenopausal women) to 69.1 (in perimenopausal women) to 63.9 among women in postmenopause.
• Among the individual LE8 components, diet consistently received the lowest scores and continued to decline over time among all reproductive stages.
• After accounting for the effect of aging, perimenopausal women were twice as likely to have an overall low LE8 score compared to premenopausal women. They were 76% more likely to have a low cholesterol score and 83% more likely to have a low blood sugar score.
• Fluctuations in estrogen levels during perimenopause may contribute to the decline in cardiovascular health because varying estrogen levels may negatively affect cholesterol, insulin resistance, blood pressure and weight management.
• Sleep duration scores remained high across all reproductive stages, despite perimenopausal women reporting difficulty sleeping, suggesting that sleep quality may be more affected than sleep duration.
“Our analysis highlights that perimenopause, women’s reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified,” said Dr. Amrita Nayak, lead author of the study and a research fellow in the division of cardiovascular disease at the University of Alabama at Birmingham. “When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
Recommendations for early and proactive intervention include focusing on heart-healthy habits like getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt.
“Perimenopause is an important time to preserve lean muscle mass, support bone density, and prevent worsening insulin resistance,” Dr. Egan added. “Treatment plans that include resistance training, adequate protein, metabolic screening, weight management support, and individualized hormone or non-hormone options can help women maintain function, independence, and long-term cardiometabolic health.”
Courtesy of West Michigan Woman.
