Menopause and heart health

When to get a heart check

For many women, heart disease risk rises after menopause. Here, we look at why the hormone oestrogen matters and the best ways to care for your ticker at midlife.

Most of us know that eating well and exercising regularly are great for our heart. But what you mightn’t know is that the hormone oestrogen is another key player in the heart health game.

Oestrogen not only supports reproductive and bone health, it can also help keep our cholesterol levels in check, according to Professor Garry Jennings, Chief Medical Advisor at the Heart Foundation.

The hormone is believed to be one of the reasons younger women are somewhat protected from heart disease – they have relatively high levels of oestrogen. However, come menopause, oestrogen levels naturally fall and a woman’s risk of heart disease increases.

More to the story

According to Professor Jennings, this drop in oestrogen can lead to a rise in LDL or ‘bad’ cholesterol and fall in HDL or ‘good’ cholesterol. Of course, women’s hormone levels aren’t the only factor affecting heart health at midlife. Professor Jennings says that blood vessels can become less flexible and more prone to plaque build-up. “Together, these changes can lead to high blood pressure and sometimes high blood sugar (glucose) levels, which are important risk factors for heart disease.”

Oestrogen not only supports reproductive and bone health, it can also help keep our cholesterol levels in check.

Weight gain generally occurs around this time, which can have an impact too, adds Jean Hailes Endocrinologist Dr Sonia Davison. “[It] tends to be around the abdominal or tummy region, and is linked with increased risk of heart disease,” she says.

There’s also the effect of menopause on exercise levels. “Women who have bothersome menopausal symptoms that impact mood or sleep may do less exercise as they may not feel [up for] exercise,” says Dr Davison.

An illustration of a heart.

The power of heart health checks

According to Dr Davison, women are encouraged to get regular heart health checks from age 45. Aboriginal and Torres Strait Islander women have a higher risk of heart disease, so checks should ideally start at age 30 to 35.

Professor Jennings adds that all women should see their GP for a heart check earlier than these recommended ages if they have a family history of heart disease at a young age or any of the ‘women-specific’ risk factors for heart disease. “These include premature or early menopause, polycystic ovarian syndrome (PCOS), or a history of pregnancy conditions like pre-eclampsia or gestational diabetes,” he says.

What to expect from a heart health check
A 20-minute consultation. This gives your GP time to assess your risk of heart attack or stroke within the next five years.
Different tests. Including cholesterol, blood pressure and blood sugar level checks.
A chat about your lifestyle and medical history. Think eating and drinking habits, smoking status, exercise levels, weight, family history and medical history.
Personalised planning. If needed, your doctor may recommend ways to reduce your risks, prescribe treatment or refer you to other health experts.
Regular checks. Your GP can tell you when you need to have your next heart health check – commonly once every year or two.
Medicare subsidy. For women aged 45+, and First Nations women aged 30+, an annual heart health check is free at practices that bulk bill the service. Phone ahead to check for any out-of-pocket costs.

Time to take action!

“Menopause [including the years leading up to it] is generally associated with symptoms that bring [women] to their GPs for information and advice, plus general screening,” says Dr Davison. So for many women “this time is a great opportunity to talk about cardiovascular health and plan for the future”.

As for ways to protect your heart at midlife, beyond getting it checked, Professor Jennings says “following a heart-healthy eating pattern, being physically active, quitting smoking, cutting down on alcohol and maintaining a healthy weight [all count]. Looking after your mental health is also important for heart health because we know depression and anxiety are risk factors for heart disease”. This is partly because it can be difficult to maintain heart-healthy habits, like regular exercise, when you are struggling mentally.

Ultimately, Dr Davison says it’s about understanding your risk, and finding healthy ways to reduce that risk.

© 2023 Jean Hailes Foundation. All rights reserved. This publication may not be reproduced in whole or in part by any means without written permission of the copyright owner. Contact: licensing@jeanhailes.org.au

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Words by Kate Cross. Illustrations by Tam Bower.

Published October 2023

This article is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your medical practitioner.

Jean Hailes for Women’s Health gratefully acknowledges the support of the Australian Government.

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