Without the protective effects of hormones such as oestrogen, women are at an increased risk for heart disease, weight gain, and other health challenges.
Your period – or more specifically, the lack thereof – isn’t the only thing that changes after you go through menopause. The hormone levels that keep your menstrual cycle regular have additional roles in the body. Without the protective effects of those hormones, especially oestrogen, as they diminish, women face new health challenges.
In addition, other changes related to ageing, such as a slower metabolism, can increase your risk for heart disease, stroke, osteoporosis, and other conditions, according to the Office on Women’s Health (OWH).
“Postmenopausal women are unique in that their health risks increase not just due to age but also due to the loss of oestrogen,” says JoAnn Pinkerton, MD, a professor of obstetrics and gynaecology at the University of Virginia Health System and executive director emeritus of The North American Menopause Society (NAMS).
When Are You Postmenopausal?
Menopause is diagnosed after you have gone a full year without a period, Dr. Pinkerton says. Before that, you might skip a cycle or have periods spread out farther than usual, which is known as the perimenopausal phase. During perimenopause, the amount of oestrogen in your body fluctuates wildly. Once you are menopausal, though, this hormone drops to a very low level and stays there, according to NAMS.
New Health Risks Emerge as Oestrogen Level Declines
Women who have had no health issues before menopause can face increased odds of problems after going through the change. In addition to the loss of oestrogen, other shifts happen in the body that can harm your health. For example, blood pressure and LDL (“bad” cholesterol) and triglycerides (a form of fat in the blood) tend to go up after menopause, according to the American Heart Association (AHA), although scientists are unsure why.
While every woman faces unique risks based on genetics and other factors, it’s a good idea to be mindful of how to protect yourself against these common health conditions that can increase in health risks after menopause.
1. Heart Disease
Women often think breast cancer is their biggest threat, but the most significant danger they face after menopause is actually heart disease. Nearly a third of women develop cardiovascular disease, the AHA says, and the rate of heart attacks in women begins increasing roughly a decade after menopause.
A key reason is that oestrogen helps keep blood vessels flexible, so they contract and expand to accommodate blood flow. Once oestrogen diminishes, this benefit is lost. Coupled with other changes, such as a rise in blood pressure that can thicken artery walls, women’s hearts suddenly become more vulnerable.
The Study of Women’s Health Across the Nation (SWAN) has been examining the physical, biological, psychological, and social changes experienced by women during their midlife years. They have found that women who have more hot flushes during menopause also seem to have a higher risk for heart disease, says John F. Randolph, Jr., MD, a professor of obstetrics and gynaecology at the University of Michigan Health in Ann Arbor.
That finding was also borne out in a study published in February 2021 in the Journal of the American Heart Association, which found that frequent and persistent hot flushes were associated with cardiovascular disease. “Women who have a family history [of heart disease] or early and significant hot flushes should ask their healthcare provider if they need additional screenings for cardiovascular disease,” says Dr. Randolph.
Reduce the heart disease risk factors that you can
While you cannot control your family history which influences your risk, you can lower your overall risk by following a heart-healthy lifestyle. This includes eating a diet filled with vegetables that is also low in red meat and sugar, exercising for 150 minutes or more each week, and not smoking.
The AHA also encourages women to know their blood pressure, cholesterol, and blood sugar levels, as well as their body mass index (BMI). Plugging these numbers into the ASCVD (Atherosclerotic Cardiovascular Disease) risk calculator introduced in 2013 by the AHA and the American College of Cardiology, can help you assess your 10-year heart disease risk.
Women are 4 times as likely as men to develop osteoporosis, a disease in which bones become thin and weak and fracture more easily, reports a study published in May 2017 in the Journal of Clinical Medicine Research. Before menopause, women’s bones are protected by oestrogen, but in the year before the final menstrual period and continuing for about three years afterwards, bone loss is rapid, according to the American College of Obstetricians and Gynaecologists (ACOG).
Given that the acceleration of bone loss can start before women stop having periods, Randolph says you may want to talk to your healthcare provider as your periods become less predictable to find out what you can do to try to maintain your bone health.
Osteoporosis symptoms can be invisible
Further, you may not even notice that your bones are weakening, as osteoporosis may not cause symptoms for decades. A bone fracture can be the first sign of the disease. This is why women 65 and older are urged to get the test known as DXA or DEXA (dual-energy X-ray absorptiometry which measures bone density in the spine and hips.
Osteoporosis screenings and testing you may need
If you are post-menopausal and have other risk factors, including rheumatoid arthritis, you are a smoker, you suffer from alcoholism, have a low BMI or a parent with a history of a hip fracture, talk to your doctor about having a DXA test before age 65.
You can also use an online tool called FRAX to estimate your fracture risk in the next 10 years. This takes into account your age, gender, BMI, and alcohol intake, if you smoke or take certain medications, and other risk factors.
How to boost bone health midlife
To keep your bones strong, make sure you include weight-bearing exercises as well as brisk walking or jogging in your routine, because they allow your bones to work against gravity to get stronger. Also, don’t smoke: It’s been linked to an increased risk of bone fracture and osteoporosis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Lastly, eat a healthy diet, including foods high in Vitamin D such as fortified orange juice, cereal, and milk – or from 15 minutes of sun exposure several days a week – and calcium (dark leafy greens, dairy, and canned fish such as salmon and sardines). “Make sure you have adequate calcium and vitamin D,” says Randolph. “Most diets don’t have enough of either [nutrient].”
3. Weight Gain
Menopause has a definite effect on a woman’s metabolism. According to research from SWAN published in March 2019 in the journal JCI Insight, menopause causes your body to gain fat and lose lean tissue mass approximately two years before your last menstrual period until two years into your postmenopausal period.
Extra weight, especially around the abdomen, is dangerous Randolph says, because it can boost your risk of type 2 diabetes. Plus, another SWAN study published in June 2021 in the journal Menopause, found that women who quickly developed abdominal fat during menopause were at greater risk of heart disease, even if their weight stayed steady.
Even menopause itself is linked to an increased risk for metabolic syndrome, a group of health conditions, including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels that increase your risk for heart disease, stroke, and type 2 diabetes – according to a study published in September 2020 in the journal Menopause.
Why fat migrates to a woman’s midsection midlife
Part of the reason for this increased risk of abdominal fat is the loss of oestrogen, which shifts fat from the hips to the midsection. Women close to menopause who experience sleep problems, night sweats, and mood issues may find that these symptoms interfere with eating a healthy diet or exercising.
Cutting back on calories can help counter increased weight after menopause. Other helpful tips include adding more vigorous exercises to your routine, eating your biggest meal at noon, not snacking too often, and doing stress-reducing activities like mindfulness meditation or yoga.
4. Urinary Tract Infection
After menopause, a decrease in oestrogen levels can cause the vaginal tissue to become thinner and drier. This can make it easier for bacteria to flourish, which could eventually lead to a urinary tract infection (UTI), according to ACOG.
While a woman’s risk for UTIs depends on individual factors, such as overall health, the occurrence of UTIs generally increases with age. In women over age 65, the rate is approximately double that of women of all ages, according to a review article published in May 2019 in the journal Therapeutic Advances in Urology, which also found that nearly 10 percent of postmenopausal women reported having had a UTI the previous year.
To reduce your risk of UTIs, the OWH recommends the following:
- Urinate when you feel the urge to go, and try to avoid going longer than 3 or 4 hours without urinating. (The longer your urine sits in your bladder, the more bacteria is able to grow.)
- Be sure to wipe from front to back.
- Drink plenty of fluids, preferably at least six to eight glasses of water a day.
- Urinate before and after sex.
- Avoid using douches or feminine hygiene deodorant sprays.
- Opt for breathable cotton underwear and avoid tight-fitting pants.
If you experience frequent UTIs (two UTIs in 6 months or three in a year), be sure to talk to your doctor to find out what may be causing them and which treatment options might be best for you.
5. Urinary Incontinence
Difficulty controlling the bladder can begin in perimenopause and continue for years after. According to the OWH, approximately half of postmenopausal women experience urinary incontinence.
The most common type is stress urinary incontinence, where coughing, sneezing, or physical activity causes leakage. Urgency incontinence happens when leakage is accompanied by an uncontrollable urge to get to the bathroom immediately. Many women have a mix of the two.
Why your risk of urinary incontinence may increase and what you can do about it
The tissues of the bladder and urethra (the tube that carries urine from the bladder) contain oestrogen and progeserone receptors and are thickened by those hormones. After menopause, these hormone levels drop, and the tissue thins and weakens. In addition, the muscles around the pelvis may lose tone with ageing, a process known as “pelvic relaxation.”
That said, the SWAN research indicates that urinary incontinence is probably more age related than specifically menopause related, says Randolph. “With incontinence, people have theorised for a long time that there is an oestrogen piece of it, because there is an oestrogen receptor in the base of the bladder and urethra,” he notes. “But in general, that doesn’t seem to be a huge, directly associated feature.”
To prevent urinary incontinence, empty your bladder as often as possible and do Kegel exercises which contract and relax the muscles of the pelvic floor. The key to proper Kegels is to work the subtle muscles controlling the stream of urine, rather than the butt muscles. Hold each contraction for two to three seconds, building up to five sets of 10 repetitions per day, according to NAMS. If problems persist, talk to your doctor or seek a physical therapist with expertise in working the pelvic floor.
SOURCE: Everyday Heatlh