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Menopause and Cardiovascular Disease

Taking charge of your midlife heart health

Women's Health

Cardiovascular disease (CVD) is the leading health threat to women today, with heart disease and stroke accounting for more deaths than all forms of cancer combined. Because heart health, bone health and cognitive health are the three domains most affected after menopause, it is crucial for healthcare practitioners to address a woman’s heart health as she enters midlife. Her risk factors for coronary heart disease and stroke – including high blood pressure, high cholesterol, and diabetes – begins to increase once she reaches menopause. Smoking, genetics and family history can also accelerate a woman’s risk of CVD.

When ahealth care practitioners care for a menopausal woman, it is important that they not only treat their symptoms, but also manage their risk by encouraging positive lifestyle changes.

Estrogen and the “Window of Opportunity”

Dr. Janice Weiss, a family physician at Medcan and assistant professor of family medicine at the University of Toronto (UofT), explains that old scientific data has led to an unfounded fear of hormone use.

Women between the ages of 50 and 60 have a lower cardiovascular risk than those over 60. Estrogen and hormone therapy is deemed safe for this low-risk population, as they will not necessarily be harmed or helped. This “window of opportunity” – sometimes referred to as the “timing hypothesis” –  is the specific timeframe in which women partake in hormone replacement therapy to help prevent coronary heart disease, either before 60 years of age or within 10 years of menopause, then continued for six years or more. While interesting to think about, clinical trial data on this “window” has yet to be proven, and as far as we know, estrogen and progesterone have no protective effects in the long run.

Aspirin use

Plenty of data suggests that Aspirin is ineffective if the user hasn’t developed cardiovascular disease or experienced a heart attack or stroke. While it can be used for secondary prevention, it is not recommended to be taken as primary prevention since the risk-versus-benefit equation is unclear.

Weight distribution

It is crucial for women under the age of 65 who are at high risk for CVD (including smokers on cholesterol medication) to maintain a healthy body weight – even if they haven’t experienced a heart attack or stroke. As a woman approaches midlife, her distribution of fat changes, making it extremely common to shift from a pear- to apple-shaped figure. This increase of android fat puts menopausal women at risk for high blood pressure, high cholesterol, and diabetes.

This shift is not inevitable, and women should embrace menopause as an opportunity to lead a heart healthy life – to watch what they’re eating, increase their physical activity, and educate themselves on CVD – their biggest health threat.


Content courtesy of a 2018 interview with Dr. Beth Abramson and the North American Menopause Society (NAMS). Dr. Abramson is the Director of Cardiology at Medcan, a national spokesperson for the Heart and Stroke Foundation, and author of “Heart Health for Canadians: The Definitive Guide”. Watch the full interview here on Youtube.


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