Dr Yassir Javaid
MA FRCGP FRP GPwSI Cardiology
Lifestyle changes, coupled with hormone replacement therapy (HRT), can help reduce the risk of cardiovascular disease in women of menopausal age.
The risk from cardiovascular events increases considerably in women as they enter the menopause. However, Dr Yassir Javaid, a GP with a career-long interest in cardiology, remains concerned about a lack of awareness of this risk.
Menopause and cardiovascular risk
While cardiovascular disease (CVD) is recognised as a leading cause of death among men, the scenario for women is often underperceived. “Far more women are likely to die prematurely in middle age from cardiovascular disease, predominantly of heart attack and stroke, than from breast cancer,”1 says Dr Javaid.
Men can suffer atherosclerosis, where their arteries ‘fur up,’ around 10 years before women and often by age 50. But once women hit menopause and their oestrogen levels drop, their arteries can fur up more quickly. By age 65, men’s and women’s arteries are similar in terms of the degree of atherosclerosis.2 Menopause ‘heralds’ the phase where women’s cardiovascular risk increases sharply and catches up with men. Dr Javaid believes healthcare professionals (HCPs) need to be more aware of that.
Figures show that post-menopausal
women can have a two-to-six-fold
increase in CVD risk.
Detrimental physiological changes
Physiological changes that occur during menopause as a result of oestrogen reduction can trigger detrimental cardiovascular effects. These include weight gain (particularly around the abdomen where metabolically active visceral fat can lead to increased blood pressure and cholesterol), type II diabetes and atherosclerosis.3 Dr Javaid emphasises the importance of lifestyle interventions such as exercise, diet, weight loss and stopping smoking to mitigate the physiological changes the menopause instigates.
Figures show that post-menopausal women can have a two-to-six-fold increase in CVD risk and that 51% of all deaths in women aged 45–69 are attributable to CVD.4 Meanwhile, women may not even consider taking HRT, as 24% report a lack of HRT knowledge and awareness.5
Protecting arteries
Acknowledging that HRT, particularly transdermal oestrogen HRT, can alter cardiovascular risk as well as help with bone protection and symptom relief, Dr Javaid underlines the importance of HCPs engaging with women as they approach the menopause.
He says: “We have data to suggest that early use of HRT soon after the menopause in relatively healthy women can potentially slow down, or protect those arteries, in that vulnerable 10–15 year period and has a potential for altering the cardiovascular trajectory.6
“We are now at a stage where we should be considering the menopause a trigger for a formal cardiovascular risk assessment in women.”
This article was initiated and funded by Theramex. The author and the subject of this article were chosen by Theramex, and Theramex had the opportunity to comment on the medical content and accuracy of this article.
[1] Kaczmarek, M. (2015). On the doorstep to senility: physical changes, health status and well-being in midlife. Anthropological Review, 78(3), 269–287. https://doi.org/10.1515/anre-2015-0017
[2] Harvard Health. (2013). 10 myths about heart disease.
[3] British Heart Foundation. (2023). Menopause and your heart.
[4] Nichols, M. et al. (2014). Cardiovascular disease in Europe 2014: epidemiological update. European heart journal, 35(42), 2950–2959. https://doi.org/10.1093/eurheartj/ehu299
[5] Bazeley, A. et al. (2022). Menopause and the Workplace. The Fawcett Society.
[6] Hodis, H. N., & Mack, W. J. (2022). Menopausal hormone replacement therapy and reduction of all-cause mortality and cardiovascular disease: It is about time and timing. The Cancer Journal, 28(3), 208–223. https://doi.org/10.1097/PPO.0000000000000591
New models of care could help women with the menopause
Tina Backhouse
General Manager UK & Ireland, Theramex
New models of care, such as nurse or pharmacy-led menopause clinics, may offer support and effective solutions for women going through this life change.1
Women are continuing to face healthcare access inequities for menopause symptoms. GPs often do not have the training to address menopause, and gynaecology services frequently have long waiting lists.2 Yet, experts believe new models of care, coupled with individualised approaches to therapy, may offer women effective solutions during their menopause journey.1
Menopause education and support
Tina Backhouse, general manager (UK and Ireland) for Theramex — a healthcare company specialising in women’s health covering fertility, contraception, menopause and osteoporosis is acutely aware of the issues women face. She says: “There is a perception that every woman gets menopause care, but the reality is that still, only about 15% in England are getting treatment3 and, on average, it takes women several visits before menopause is diagnosed.2
Some GPs, she suggests, need to be adequately trained to spot menopause symptoms.2 “That is strange considering that women make up 51% of the population4,and every woman will go through the menopause.”
Women from certain ethnic groups
could face additional challenges
when going through menopause.
Gender health gap
Backhouse says a gender health gap remains for women over gynaecological issues.5
Women from certain ethnic groups could face additional challenges when going through menopause, which can make it difficult for them to access appropriate support or have their symptoms taken seriously.6 According to the World Health Organization, the UK has the widest gender health gap among G20 countries.5 However, there have been advances with menopause and perimenopause (the time leading up to menopause) being more widely talked about.
Individualised management approach
TV programmes, media articles and celebrities like Davina McCall have reshaped the conversation around menopause. “It’s great that this is happening, but the crux of the matter is that if they cannot get to see a healthcare professional, a woman’s health will be impacted,” says Backhouse, who points to the value of different models1 for dealing with women’s health, such as nurse-led or pharmacy-led menopause clinics.
“Pharmacists are well-placed because they are in the community and see the medication women are taking.” While hot flushes and night sweats are common menopause symptoms, women may experience vaginal dryness and pain, anxiety, brain fog, muscle ache, weight gain, sleeplessness and skin rashes.7
“It’s different for every woman,” she adds. “That is why healthcare professionals must understand menopause and why treatment should be individualised for each woman. Ongoing education and support for healthcare professionals in women’s health is really important going forward.”
[1] Royal Pharmaceutical Society, Position Statement on Women’s Health, 2021
[2] The Fawcett Society, Landmark study: menopausal women let down by employers and healthcare providers, 2022
[3] gov.uk, Hundreds of thousands of women experiencing menopause symptoms to get cheaper HRT, 2023
[4] gov.uk, Male and female populations, 2023
[5] Winchester, N., Women’s health outcomes: Is there a gender gap?, House of Lords Library, 2021
[6] Theramex, Tackling unequal access to menopause care in the UK, 2024
[7] NHS, Common symptoms of menopause and perimenopause, 2022
How hormone replacement therapy helps manage menopause symptoms
Dr Katie Barber
GPwER Menopause and Gynaecology Recognised BMS Menopause Specialist
A family GP and expert in women’s health highlights the benefits of hormone replacement therapy (HRT) for women going through the menopause.
Treatment for menopause symptoms must be tailored, as “no two women are the same,” according to Dr Katie Barber, a GP with special interest in women’s health. She believes an individual approach is paramount in how practitioners treat menopause, particularly with HRT.
Menopause symptoms and therapy
HRT replaces oestrogen and progesterone, which fall to low levels as women approach menopause and can improve quality of life. “HRT is one of the best treatments to eliminate menopause symptoms,” she adds.
While hot flushes and night sweats are common symptoms, she sees “more subtle menopause symptoms” in her specialist clinics including mood changes, anxiety, over-analysing, insomnia and fatigue. Dr Barber, also a British Menopause Society-recognised specialist, says women can also suffer vaginal dryness, loss of libido and urinary symptoms.
Window of opportunity
Other benefits of HRT — which can be taken as tablets, patches, gel, spray and via topical vaginal therapy — include a lowered risk of cardiovascular disease, particularly if initiated in the “10-year window of opportunity” at the onset of menopause, says Dr Barber.
HRT oestrogen also helps bone density and improves glycaemic control. Yet, in the UK, only 15% of eligible women are receiving it.1 Barriers include risk concerns or lack of knowledge among healthcare professionals. However, since qualifying as a GP in 2002, Dr Barber has observed growing awareness, with menopause included in more medical school curriculums.
For the majority of women under 60
with no significant contraindications,
HRT is a fantastic option.
HRT suitability
Dr Barber emphasises that conversations must focus on individual patients and their specific circumstances. “The conversation I have with a fit and healthy 46-year-old with no relevant medical history will be different to a 46-year-old whose mum, sister and aunt have had breast cancer. However, for the majority of women under 60 with no significant contraindications, HRT is a fantastic option.”
Seek advice from menopause experts
Acknowledging concerns over breast cancer, she stresses the risk is lower than that posed by lifestyle factors like alcohol consumption, smoking and obesity.2 Even if women have concerns or contraindications, they should not feel the HRT avenue has been cut off.
She explains: “A lot is about what the risk and benefit might be for them and giving the right choice on what is safe and effective. It should be tailored to the patient and not generalised because no two women are the same.”
Dr Barber encourages women to seek menopause advice, and don’t hesitate to ask who the menopause specialist is within a practice to get a different opinion. If HRT is not appropriate due to pre-existing medical conditions, she adds that other non-hormonal menopause treatments are available.
Paid for by Theramex
EVOR_UK_EN_20331_v1 October 2024
[1] gov.uk. (2023). Hundreds of thousands of women experiencing menopause symptoms to get cheaper HRT.
[2] Women’s Health Concern. (2015). Understanding the risks of breast cancer.
