Menopause is the most dreaded part of a woman life because of a lot of non-specific symptoms and discomfort associated with this period. As God answers our prayers to live long, menopause is inevitable, hence the need to know how to manage that period and live well. If untoward cardiovascular events can be prevented during this period, other issues about menopause are but a fuss.

Cardiovascular Disease (CVD) remains the leading cause of death in both men and women, yet the extent of the problem in women is frequently underestimated and, compared with men, women are less likely to be offered interventions.  Most people tend to believe cardiovascular diseases are only for men.

Before menopause, women are well-protected but after menopause, the risk of cardiovascular diseases increases and in fact more women die from heart disease and stroke than from the next five causes of death combined, including breast cancer. Although many women perceive that one of the leading risks to their health is breast cancer, globally women are nine times more likely to die of CVD than of breast cancer. This is not to negate our campaign on routine breast screening for early detection of breast cancer but also to pay equal attention to stroke, hypertension, diabetes mellitus and heart attack cutting short the lives of our women.

Globally, estrogen (a sex hormone) produced by  the ovary of premenopausal women is believed to be the chemical that prevent cardiovascular diseases in them. As oestrogen levels drop, often from the mid-40s onwards, the protective effect is lost and changes occur that lead to an increased risk of heart disease in the ensuing years. In Europe, 55% of women died from CVD as opposed to 43% of men. It is reported that awareness among health care professionals of the risk of menopause on cardiovascular diseases was surprisingly low.  31% of health care professionals and 38% of women were aware that menopausal women are at an equal or greater risk of CVD than men, and that only 31% of women associate menopause with heart disease.

I stand to be corrected, considering the recent rate of admission among women for heart diseases, stroke, hypertension, and complicated diabetes mellitus; I want to believe that the awareness in this country may be as equally low if not lower.

Menopause
Menopause affects all women and occurs when the ovaries either naturally stop producing oestrogen due to the decline and cessation of oocyte development and ovulation, which is essential for the production of both oestrogen and progesterone, or when the ovaries are removed or damaged by other therapies. The average age at natural menopause varies between countries and is affected by factors such as genetics, nutrition, smoking and age of menarche; in Europe it is around 51 years.

It is estimated that the number of viable female eggs that can be released at ovulation is 400 and one is released per month. It then means the stock can be exhausted within 33 – 35 years. Adding 35 years to the age at which you started menstruation will give you a rough guide to the age at which you will attain menopause. The period is enjoyable if you prepare well for it and put in place all precautions against cardiovascular diseases.

The Effect of Menopause on Risk of Cardiovascular Disease
Weight
Being overweight is a significant risk factor for CVD and is an increasing problem in our community. Obesity tends to be commoner in men than in women before 45 years of age, but after this point the trend reverses. During the menopause, and in fact starting within the first year of the menopause, there is a shift in fat distribution and storage in women from the hips to the waist, more resembling that of the abdominal visceral fat storage in men (from a gynoid to an android pattern).These are often referred to as ‘pear’ and ‘apple’ shapes, the apple shape being associated with an increased risk of CVD. Waist circumference reflects this risk: women with a waist circumference >80cm have an increased risk of CVD, with even greater risk for those whose waist circumference is =88cm. The mechanism  is suspected to be related to a relative excess of androgens- men hormone (post-menopausal ovaries still produce some androgens) together with changes in leptin and thyroid function.

Blood Pressure
Hypertension is also a major risk factor for CVD, and after 45 years of age more women than men develop hypertension.

Cholesterol
There is no doubt that raised cholesterol is a significant risk factor for CVD. Menopause is associated with a progressive increase in total cholesterol, with, in particular, an increase in low-density lipoprotein (LDL), lipoprotein-a and triglycerides and a decrease in high-density lipoprotein (HDL). Estrogen that increases the good cholesterol (HDL) is no more available. Therefore, menopausal women are exposed to a more atherogenic lipid profile than pre-menopausal women.

Smoking
Tobacco use is one of the most important risk factors for CVD in both men and women, although the risks associated with smoking are consistently higher in women than in men.  Generally, more men than women smoke, but while there is decline in tobacco use among men, it is less apparent in women, while there is a disturbing rising trend of smoking  in younger women.

Diabetes
Diabetes is becoming increasingly common in both men and women, and changes in insulin secretion and insulin sensitivity after the menopause contribute to this increase in women. The risk of death from CVD associated with diabetes is higher in women than in men: in the 20-year Framingham study, women with diabetes were 3.3 times more likely to die from CVD than women without diabetes, whereas the risk for diabetic men was only 1.7 times than of non-diabetic men. Women are more admitted with complication of diabetes. Let us watch out.
Till next week maintain a healthy heart