Perimenopause and heart health: What you need to know

• Hot flashes that many women will experience 

• Vaginal dryness  

• Body composition changes, on average women tend to gain fat mass particularly around the waist 

• Changes to the cardiovascular system 

Kim: There are some risk factors that do seem to change more rapidly around the final menstrual period – I’m thinking specifically of cholesterol.

Blood pressure tends to go up, body weight goes up, often glucose and insulin go up.

Most of these changes seem to be dictated more by aging than by menopause.

We like to encourage women to pay more attention to their cardiovascular risk factors during this period.

Willner: We see a lot of increased risks for cardiovascular events that can happen around this time. Specifically, an increase in your “bad cholesterol.”

We know that estrogen plays a role in how our vessels operate. We find that the decrease of estrogen causes decreased production of nitric oxide, which is very helpful and vessel protective.

That decrease causes some endothelial disfunction (condition where the inner lining of blood vessels, or endothelium, fails to function normally) which can increase your risk later for certain cardiovascular events.

Can perimenopause cause heart palpitations?

Kim: Doctors get uptight about the word “cause” because it implies that there’s one thing and, if you fix it, the problem will go away.

I would say that perimenopause and palpitations can go together.

Certainly, palpitations are very common during perimenopause, along with other symptoms like hot flashes and night sweats, difficulty sleeping because of those hot flashes, dryness and changes in mood, particularly anxiety and depression.

If women have hot flashes, they often are more likely to have palpitations.

Willner: It’s important to look out for some red flag-type symptoms that could indicate that it’s a bigger problem than your run-of-the-mill palpitations.

Particularly, if you feel like you’re going to pass out, lose consciousness, or feel lightheaded or dizzy.

That leads us to thinking we may need more of a workup because that can be a little more dangerous than the usual tachycardias we see that are not harmful around the perimenopausal time.

If you notice those red flag type symptoms, definitely talk with your doctor.

What symptoms might you experience if your heart is being affected by perimenopause?

Kim: Outside of palpitations, other complications are silent.

Endothelial dysfunction and occasional coronary artery calcium buildup are usually asymptomatic at this time.

That said, this can be a time to start thinking about those future complications.

It’s hard to think of something that might affect us 10-20 years down the line, but this is the time to worry about plaque buildup and to take steps to prevent that through healthy lifestyle and, potentially, medications.

Does hormone replacement therapy, or HRT, affect heart health?

Kim: Many people were prescribing hormone therapy until the early 2000s when a study came out suggesting it might be harmful.

Then, the pendulum swung really hard in the other direction and prescriptions for HRT dropped.

It has crept back into accepted use for symptoms, including palpitations, but palpitations in the context of hot flashes and urinary symptoms.

It’s perfectly acceptable to use to improve symptoms with very little risk for the heart.

We do try to avoid prescribing it in women with known heart disease — such as women who have had heart attacks or women who are at high risk for clotting — as well as those who have breast cancer or active liver disease.

Randolph: The concern with the big study that swung the pendulum the negative direction was that when women take estrogen orally, it increases the risk of blood clots.

We have very convincing data since then that if they take estrogen a different route — such as through patches — that the risk doesn’t seem to be there.

And there are several clinical trials that have demonstrated that if somebody starts taking estrogen within a few years of when they stop having periods, that may slow the progression of plaque in the vessels.

So, there is some biological plausibility that there may be long-term benefits, but we haven’t looked long enough to be able to say that that necessarily may delay or prevent heart attacks.

If you’re in perimenopause, should you be concerned about your heart health?

Kim: Every female that lives long enough will go through menopause, but will it affect our heart health?

I think it really depends on the woman.

This is a time if we pay attention to our health, if we’ve taken care of our bodies, our hearts will continue to do well for a long time.

Randolph: One of the things that’s so interesting in following a lot of women for a long time is the remarkable variability that we see.

It gets tricky to make any individual predictions about things, and that’s what we’re trying to do.

We can say things at a population level but it’s really important to individualize both behavior and health care.

Having a good relationship with a primary care provider is really important, especially during this time because things are changing.

Willner: Because you go through menopause doesn’t mean that anything’s technically going to suffer. It’s just time to look at your risk factors and optimize going forward.

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