Hot flashes, insomnia, and night sweats probably come to mind when you think of menopause. Heart disease may not be high on your list of related health concerns, but perhaps it should be.Heart disease is the top killer of women, and a woman’s risk for heart disease increases dramatically around the time she goes through menopause — typically between ages 50 and 54.During menopause, levels of the female hormoneestrogen drop significantly, explains Nicole Weinberg, MD, a cardiologist at the Pacific Heart Institute in Santa Monica, California.

Estrogen Drops, and Your Body Responds

High blood presure When estrogen levels drop, your heart and blood vessels become stiff and less elastic. Because of these changes, your blood pressure tends to rise, causing hypertension. Elevated blood pressure can place added strain on the heart, says JoAnne Foody, MD, medical director of the cardiovascular wellness program at Brigham and Women’s Hospital and an associate professor of medicine at Harvard Medical School in Boston.

High cholesterol Lack of estrogen can also cause detrimental changes in yourcholesterol and blood fats: Your good cholesterol (HDL) may go down, and your bad cholesterol (LDL) may go up, which increases your risks of heart attack and dying from heart disease, says Dr. Foody. Triglycerides, another kind of fat in the blood, also increase becasue of the drop in estrogen.

Diabetes When women go through menopause, they can also become more resistant to insulin, the hormone needed to convert blood sugar and starches into energy for cells to use. As a result, “women are more likely to become prediabetic and diabetic as they transition from premenopause to menopause,” explains Foody. Having diabetes puts you at a higher risk for heart disease and stroke.

Atrial fibrillation Women may see an increase in abnormal heart rhythms like atrial fibrillation (afib) around the time they go through menopause. “Sometimes hormonal changes can cause a slowing of the heart and heart blockages that can cause symptoms, including dizziness,” notes Foody. More commonly, the change in hormones causes faster heart rates. Atrial fibrillation can also be brought on by high blood pressure, which is more common after menopause.

Weight gain Estrogen affects where women store fat and how it is burned, says Stacey E. Rosen, MD, a cardiologist and vice president of women’s health at Northwell Health’s Katz Institute for Women’s Health in New Hyde Park, New York. Menopause can cause the metabolism to slow, which contributes to weight gain. And this can put stress on your heart and increase your risk of heart disease, says Dr. Rosen.

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