Women who have experienced early menopause (either surgically from hysterectomy or from early ovarian decline) often make appointments with their health care providers when hot flashes or insomnia start to interfere with their quality of life.
Although these symptoms are important to address and treat, one of the larger concerns regarding the menopausal transition are the changes that occur in the cardiovascular system and the increased risk that women have for heart disease after menopause.
For women, their risk of cardiovascular disease increases dramatically after they transition through menopause. Women are protected against cardiovascular disease compared to their male counterparts up until menopause, where the protective effect of estrogen disappears
This is important information for women to understand because if they do not suffer from the quality of life disrupting symptoms of menopause they may not seek care, and the current screening recommendations for cholesterol an heart disease in women under 50 may miss a critical window to assess changes in cholesterol and other markers of heart disease.
Following menopause, cholesterol levels change dramatically with increases in LDL (bad cholesterol) triglycerides and total cholesterol, with a reduction in HDL (good cholesterol). These changes are related in overall increase for cardiovascular events such as heart attack and stroke. Women who have a younger age of menarche (first period) and later menopause are protected against heart disease versus women who have a shorter duration of menstrual cycles in her lifetime and it is well established that early menopause is a significant risk factor for death from cardiovascular disease.
Within the first year after surgical or early menopause, women should seek a full cardiovascular work up with their practitioner including assessment for cholesterol levels, hormone levels and other markers of metabolic health such as fasting insulin, SHBG and vitamin D status. A proactive approach to cardiovascular care can help diminsh the impact that early menopause has on women and may guide towards optimal treatment.
Often women are prescribed oral contraceptives to manage hot flashes and bone loss that occur after early menopause. Combined oral contraceptives do not protect against cardiovascular disease, and in many women cause an increase in insulin resistance and LDL (bad cholesterol). Whether a woman uses the pill, HRT or leaves her early menopause untreated, she requires a proactive plan to support her cardiovascular health which can include the addition of specific foods, nutrition recommendations or supplements.
Support options for women with elevated cholesterol can look like supportive hormone therapy or focused dietary strategies and supplements that support a healthy cardiovascular system. Cholesterol testing is an inexpensive marker for cardiovascular disease and can help guide women towards an individualized care plan unique to her needs.