The debate continues on over how much of the aging process in women during midlife occurs due to the passing of time and how much occurs as a result of the loss of hormones due to menopause. We know that the risk of heart disease in women starts rising a decade later than men and coincides with the loss of hormones from menopause. Research shows pretty clearly that the menopausal transition – when women’s bodies stop producing estrogen, progesterone, and testosterone – is associated with the following:
higher LDL (the bad cholesterol
higher apolipoprotein B (a marker for heart disease)
poorly functioning HDL (the good cholesterol)
increased risk of the metabolic syndrome (a clustering of these disorders: high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels)
increased cholesterol plaque formation in the carotid arteries (the arteries in the front of the neck that bring blood flow to the brain)
increased fat deposition around heart
From an editorial in Menopause, The Journal of the North American Menopause Society, the authors state that multiple studies “link menopausal symptoms (vasomotor symptoms, sleep problems) to cardiovascular disease risk beyond either chronologic or reproductive axis aging.” In other words, the more hot flashes and insomnia a woman has, the higher her risk of heart disease. It’s not just the passing of time that puts women at higher risk of heart disease after age 50, it’s also the loss of hormones that increases women’s risk.
Women gain an average of 4 -5 pounds during the menopause transition, and this seems more related to aging than the loss of hormones. However, the body composition – the ratio of fat to muscle and where the fat is located – is associated with hormone loss. The loss of female hormones allows body fat to increase in the abdominal area (belly fat) and around the organs in the abdomen. One study showed a 10% increase in fat mass and a 7% decrease in spinal bone mass over the 6 years from pre-menopause to post-menopause. A pooled analysis of multiple studies showed that use of hormone therapy lead to a 7% reduction in abdominal fat.
Insomnia is affected equally by menopause and the passing of time. We know that poor sleep contributes to heart disease and accelerated biologic aging.
Ongoing studies will hopefully further clarify the effect of hormones on memory and cognition. Menopause is a time when women are more vulnerable to anxiety and depression.
This statement rang so true to me: “Midlife is a unique time of life for women that encompasses chronologic aging, reproductive axis aging [hormone loss], and significant life events and role transitions.” That’s why women need to take more time for self-care during this season of life and find great healthcare advocates. We can muddle through, or we can thrive and flourish and continue becoming the best versions of ourselves! I choose the latter!
Disclaimer: While hormone therapy (HT) has tremendous benefits, it is not for everyone. The decision to use HT must be individualized, and women should discuss risks and benefits with their personal physician.
Source: Menopause, Vol. 25, No. 8, 2018