Menopause and heart health

Published December 2023 | 7 min read
Expert contributor Professor Jason Kovacic, a cardiologist and Director and CEO of the Victor Chang Cardiac Research Institute
Words by Karen Burge

Heart health is more important than ever during and after menopause. We explain why and what you can do to stay heart healthy.

Women's bodies go through an enormous amount of change before and during menopause. While the focus is often on symptom management, there are many good reasons to prioritise your heart health, too.

In pre-menopause years, oestrogen levels provide some protection to women against heart disease. One important role it plays is in helping protect the artery walls, reducing the build-up of plaque. However, during perimenopause and menopause (between the ages of around 45 and 55), that protection wanes and the risk of heart disease significantly rises, explains the Victor Chang Cardiac Research Institute.

The Institute's director and CEO, Professor Jason Kovacic, says there are also changes after menopause, throughout our 50s and 60s, when people tend to experience weight gain, have elevated blood pressure and exercise less, adding to the risk that lowered oestrogen brings.

An Australian Institute of Health and Welfare report found 'acute coronary events' occurred in five per 100,000 women aged 25 to 34 compared with 223 per 100,000 women in those aged 55 to 64.

Heart disease is the top cause of death for women in Australia – nearly three times more women die of heart disease than breast cancer, says Prof Kovacic. So, for women approaching menopause, there’s no better time than now to put your heart health first.

Risk factors for heart disease in women

It's important to understand the key risk factors for developing cardiovascular disease (CVD) in both men and women. Prof Kovacic says they include:

• being overweight and obese
• lack of exercise
• smoking
• poor diet
• high blood pressure
• high cholesterol
• stress
• poor sleep
• genetics.

In addition, there are some women-specific factors that may increase the risk of developing CVD, including polycystic ovary syndrome, premature menopause, pregnancy complications, autoimmune disorders and their treatments, some cancer treatments and depression, according to the Heart Foundation.

"When talking to a new doctor, it is important to mention these conditions as part of your personal history, so they can take it into account."

Indigenous women also face further risk, being almost twice as likely as non-Indigenous women to have CVD.

What is SCAD and why are women aged 40 to 50 most at risk?

Spontaneous coronary artery dissection (SCAD) is a rare but serious condition where an inner layer of a blood vessel in the heart tears. Women in their 40s and 50s are most at risk and those who develop SCAD are often healthy, with no known risk factors.

Fit and active mum-of-two, Sarah Penn, knew something was wrong when pain hit down her arm and chest while paddleboarding on Sydney's Northern Beaches. As a registered aged care nurse, alarm bells were ringing.

"I thought it was cardiac and my husband Mike called for an ambulance. My arm felt very heavy but by the time I got to hospital most of the pain had gone," recalls Sarah.

An ECG showed nothing unusual, but blood tests revealed she'd had a heart attack. Doctors told Sarah the following day that her heart attack was caused by SCAD. "I had to Google it. Even as a registered nurse, I had never heard of it."

The 55-year-old has made a full physical recovery and is now back exercising but admits it has taken a huge emotional toll and she worries about it happening again.

SCAD is responsible for about 25% of heart attacks in women under 50, and it's the most common cause of heart attack associated with pregnancy. While causes are still unknown, the Victor Chang Cardiac Research Institute points to some contributing factors, including changes in blood vessels, sex hormones and blood volumes, extreme stress and changes in women related to pregnancy or menopause.

Prof Kovacic says we're learning more about SCAD, including its link to fibromuscular dysplasia (FMD) – a vascular disease thought to affect up to one in 20 women that can make the artery wall too weak or too stiff. Like with SCAD, Prof Kovavic says most FMD cases are women (about 85 to 90%) and the average age of diagnosis is 50 to 55.

Menopause can cause heart palpitations

During menopause, some women can experience heart palpitations or a racing heart. According to the Endocrine Society, your heart rate can increase during a hot flush by as much as 8 to 16 beats per minute. While heart palpitations are common, any change in your heart could also be a sign of another health problem, so it's important to flag heart palpitations with your GP, the Society recommends.

Menopause can increase your blood pressure

Women going through menopause often experience higher blood pressure (hypertension), which is a risk factor for heart disease. Prof Kovacic says that being overweight can increase your risk of hypertension, so maintaining a healthy diet, exercising regularly, keeping an eye on weight and ensuring your blood pressure (and heart health) is monitored by your doctor are essential.

How heart attacks present in women

While chest pain is a common symptom for heart attack in both sexes, women are more likely to experience non-chest-pain symptoms including jaw, shoulder or back pain, nausea or vomiting, dizziness, shortness of breath/difficulty breathing, indigestion or fatigue/tiredness, according to the Heart Foundation.

A recent study by the Australian National University showed men were more likely than women to receive coronary procedures in hospital, such as certain types of imaging and coronary artery bypass grafting. The authors say this could come down to differences in the way men and women presented with heart issues, or an "unconscious gender bias" by health professionals.

How to reduce your risk of cardiovascular disease during menopause

Understanding your risk factors is an important step in supporting your heart health. People over 45 (or over 30 for Aboriginal or Torres Strait Islanders) can see their GP for a comprehensive Heart Health Check and eligible HCF members in some states can access a free Heart Health Check at certain times of the year thanks to our partnership with the Victor Chang Cardiac Research Institute.

As for living a heart-healthy lifestyle, Prof Kovacic says there are eight areas that will help women reduce their risks, not only after menopause but at any age. These also apply to men.

Eat well

Try to eat a Mediterranean diet featuring the right proportion of fruits, vegetables, legumes, wholegrains and fish, while also reducing saturated fats and salt.

Stay physically active

Prof Kovacic recommends you aim for at least 150 minutes a week of aerobic activity, like brisk walking, swimming, cycling or jogging, or gentle walking for seniors. Research shows even short bursts (three to four minutes) of vigorous exercise daily can reduce your risk of CVD.

Monitor blood glucose

Get your blood glucose levels checked with your GP and make sure your diabetes is under control. Over time, high blood sugar levels from diabetes can increase your risk of heart disease.

Maintain a healthy weight

Aim to keep your body within a healthy weight range. This means having a body mass index of between 20 to 25, recommends Prof Kovacic.

We're helping eligible members save on the evidence-based CSIRO Total Wellbeing Diet. Created by Australia’s national science agency, the program combines a higher protein, low-GI eating plan with proven weight loss tools to help improve habits and create lifelong positive behaviours.

Keep cholesterol levels healthy

Have your cholesterol levels checked and kept within healthy range. For some, this might mean taking medication. It’s a good idea to check your cholesterol levels with your GP.

Quit smoking

Quitting smoking will decrease your risk of heart attack and stroke almost immediately, according to the Heart Foundation.

Monitor blood pressure

Have your blood pressure checked and consider lifestyle changes or medical therapy if required to keep it under control.

Get enough sleep

There is increasing evidence that adults need seven to nine hours of sleep to keep their hearts healthy.

Thanks to our partnership with Sleepfit Solutions, eligible HCF members^* can get a free 12-month subscription to the Sleepfit app designed to improve sleep and overall wellbeing.

Help to keep your heart healthy

Need some support of your journey to better health? The COACH Program® is a four- to six-month phone-coaching support program provided at no extra cost for eligible members^{^} with heart conditions or diabetes that can help improve your health.

Menopause Matters Podcast

Want to know more about navigating your way through menopause? In our Menopause Matters podcast, join host Alison Brahe-Daddo as she unpacks the experience of this life-changing yet entirely normal part of life. Speaking with leading menopause experts, Alison sheds light on issues faced by many women, including some of the best ways to manage your symptoms, how to navigate your career, mental health and relationships during this time, and shares the joys of life post-menopause.