POSTMENOPAUSAL YEARS

We the clinicians as well as the women, all worry about hot flushes , night sweats , bladder problems, insomnia and mood swings, but do not think about heart problems in peri and post menopausal women .  However the fact remains that the highest cause of death in women after 50 is cerebrovascular disease (CVS) and stroke. These account for 75-76% deaths in western society as compared to deaths due to breast cancer which is 6-8%. Out of every 3 deaths in women 1 is due to CVS. We have to start paying attention to this and prevent them from happening. There is a 10 years lag time when this happens in women as compared to men, unless women have a premature ovarian failure, premature menopause or early surgical menopause. Women lose oestrogen, this causes the blood vessels to become stiff, lose their elasticity, blood pressure increases and this increases the strain on the heart. The LDL (Low Density Lipoproteins) and Triglycerides (bad cholesterols) increase. HDL decreases (good cholesterol). Insulin resistance increases leading to, prediabetes and diabetes as time goes on. Oestrogen also effects fat stores slows metabolism, this leads to weight gain and an increase in BMI and increase in abdominal girth. These are not ideal to prevent heart disease. The coagulation factors are altered, such as antithrombin3, factor 7c and plasma fibrinogen are all increased, leading to increased risk of thrombosis. So the risk of heart disease becomes multi factorial, there is increased blood pressure, strain on the heart, diabetes, obesity, changed cholesterol, increased thrombotic factors and increased sympathetic tone. All these lead to, metabolic syndrome and CVD. Some research has indicated that changes in cholesterol, apoproteins B, happen within the one year after the final menstrual period where as most other changes are related to chronological age.

What are the symptoms of CVS and heart disease? Heart Palpitations, Shortness of Breath, Light Headedness, Headaches, Diabetes, Swelling of the Feet, (change in the rhythm of the heart) Fibrillation, Pain in the Chest and Stomach. Women often do not have a chest pains when they have a heart attack. For neurological problems (Stroke); a women may not be able to smile put her tongue out and cannot lift her arms above her head (these are very simple test for the public to work out what is happening) . Take them to a hospital immediately if this is happening. If stroke sufferers are treated within 4 hours they suffer very little residual damage. It has been shown that if treatment for prevention of long term CVS is started soon after menopause or within 10 years of menopause, these can be prevented.                        Most women need treating for hot flushes, night sweats, lack of sleep, mood swings, dry vagina and psychosexual problems, why not give them MHT (Menopausal Hormone Treatment) and not let them suffer and also prevent them from long term  effects of oestrogen deficiency such as increased risk of CVS and osteoporosis. This early period of peri menopause is called period of opportunity. Later on after many years of menopause, changes in women’s blood vessels have already occurred and oestrogen is not helpful. If a woman has a uterus and she needs oestrogen, she needs progesterone as well for uterine protection from cancer; a form of progesterone called micronized progesterone is recommended. This has less side effects and is better tolerated. For prevention of thromboembolic problems dermal oestrogens are prescribed in the way of oestrogen patches and or jelly.  Women should watch their weight, abdominal girth, exercise, nutrition and quit bad habits such as smoking, excessive drinking of alcohol and soft drinks and being a couch potato.

It is very important to start MHT during the WINDOW of OPPORTUNITY to prevent cardiovascular disease, which is the main cause of death in women in later years.