Looking After Your Heart During the Menopause - managing high blood pressure and cholesterol

Understanding Cardiovascular Risk, Blood Markers, Supplements, and Metabolic Health

In menopause care, it’s easy to focus on current symptoms driven by hormonal changes. But beneath the surface, one of the most important health shifts is happening in the cardiovascular system. After menopause, a woman’s risk of developing cardiovascular disease (CVD) rises dramatically. While many associate heart disease with men, the statistics tell a different story. We often see women in our clinic who develop high blood pressure and cholesterol during the menopause. this helps to explain why we need to address these issues to protect our future health

The Hidden Risk: Cardiovascular Disease in Women

• Cardiovascular disease is the leading cause of death in women in the UK, accounting for around 27% of all female deaths.

• A woman’s risk of developing heart disease increases significantly after menopause, often catching women unprepared.

• Women are twice as likely to die from coronary heart disease (CHD) as they are from breast cancer in the UK.

• More than 4 million women in the UK are living with CVD, yet awareness and prevention efforts remain under-targeted. (British Heart Foundation, 2023)

Importance of monitoring blood pressure

Why Does Risk Rise After Menopause?

Before menopause, oestrogen offers natural protection by maintaining flexible blood vessels, supporting healthy lipid levels, and enhancing insulin sensitivity. After menopause, the decline in oestrogen leads to:

• Reduced arterial elasticity, increasing the likelihood of high blood pressure and atherosclerosis

• Higher LDL ("bad") cholesterol and lower HDL ("good") cholesterol

• Increased insulin resistance and abdominal fat accumulation, leading to metabolic syndrome

Physiology of Cardiovascular Disease in Women

Cardiovascular disease is not a single condition—it encompasses a range of disorders. Some forms of CVD affect women differently than men:

1. Coronary Artery Disease (CAD) and Heart Attacks

• In women, microvascular disease—damage to smaller coronary vessels—is more common than large-vessel blockages seen in men.

• Symptoms can be atypical in women: shortness of breath, fatigue, nausea, back or jaw pain, and palpitations, rather than classic chest pain.

• Women are more likely to be misdiagnosed, and delays in treatment can worsen outcomes.

2. Stroke

• Women are at higher lifetime risk of stroke, especially after menopause.

• Risk factors include high blood pressure, atrial fibrillation, diabetes, and hormone changes.

• Oestrogen has neuroprotective effects, and its loss contributes to vascular stiffness and clotting risk.

3. Heart Failure with Preserved Ejection Fraction (HFpEF)

• More common in older women than men.

• Often linked to high blood pressure, obesity, and diabetes.

• Presents with fatigue, breathlessness, and exercise intolerance.

4. Spontaneous Coronary Artery Dissection (SCAD)

• Rare but disproportionately affects women (often <50 years old), especially in peripartum or perimenopausal states.

• Associated with hormonal shifts and fibromuscular dysplasia.

Understanding and Monitoring Cardiovascular Risk: high blood pressure an cholesterol in the menopause

Routine monitoring of cardiovascular risk factors is essential for midlife women, especially as part of menopause care. This includes:

• Blood Pressure: Aim for <135/85 mmHg; even mildly elevated readings increase stroke and heart attack risk.

• Lipid Profile:

  • Total cholesterol ideally <5 mmol/L

  • LDL cholesterol <3 mmol/L

  • HDL >1.2 mmol/L in women

  • Triglycerides <1.7 mmol/L

• HbA1c and fasting glucose: Identify insulin resistance or diabetes

• CRP or hs-CRP: High levels indicate systemic inflammation, linked to higher cardiac risk

• Waist circumference: >88 cm (35 inches) in women is a marker for metabolic syndrome

Metabolic Syndrome and the Menopausal Body

Menopause often brings a shift in fat distribution to the abdomen, increasing risk for metabolic syndrome, which includes:

• Central obesity

• Raised triglycerides

• Reduced HDL cholesterol

• Elevated blood pressure

• Raised fasting glucose

Having three or more of these significantly increases the risk of both cardiovascular disease and type 2 diabetes.

Can Supplements Help? The Evidence So Far

The use of supplements for heart health is widespread, but the evidence base is mixed:

Supplements should be used with caution, especially if you are taking HRT, statins, or antihypertensives. Always check for interactions and ensure products are from regulated sources. However some supplements may be helpful in lowering cholesterol and managing high blood pressure.

Evidence-Based Supplements for Cardiovascular Health in Menopausal Women

Supplement	Evidence	Typical Dose Range	Notes & Safety
Omega-3 fatty acids (EPA/DHA)	Reduces triglycerides; possible cardiovascular benefit at higher doses.	1,000–4,000 mg/day combined EPA and DHA	Higher doses may be needed for triglyceride reduction (under medical supervision). May increase bleeding risk at very high doses. Use with caution if on anticoagulants.
Plant sterols/stanols	Shown to lower LDL cholesterol by 7–10% when consumed regularly.	1.5–2.4 g/day	Often found in fortified foods (e.g. spreads, yoghurts). Best taken with meals. Not suitable for people with sitosterolemia.
Magnesium (citrate or glycinate)	May lower blood pressure in people with hypertension or deficiency.	200–400 mg/day (elemental magnesium)	Start with lower doses to avoid diarrhoea. Avoid in significant kidney disease.
Red yeast rice	Lowers LDL cholesterol; contains monacolin K (natural statin).	5–10 mg monacolin K/day	Use with caution. Can interact with statins, antifungals, grapefruit, and liver medications. Choose products with standardised content and quality control.
Coenzyme Q10 (ubiquinone or ubiquinol)	May support endothelial function and reduce mild blood pressure elevation.	100–300 mg/day	Generally well tolerated. Can be helpful in statin-associated muscle symptoms.
Vitamin D3 (cholecalciferol)	No direct evidence for CVD prevention, but supports overall health.	800–2,000 IU/day	Aim for serum 25(OH)D level of >50 nmol/L. Higher doses only with monitoring. Consider combination with vitamin K2 if used long-term.

What About HRT and Heart Health?

Hormone Replacement Therapy (HRT) is not primarily prescribed to prevent heart disease, but timing matters:

• HRT started within 10 years of menopause onset or before age 60 may reduce coronary heart disease risk.

• Transdermal oestrogen and micronised progesterone are associated with fewer adverse effects on clotting and blood pressure.

• The NICE (NG23) and British Menopause Society recommend an individualised approach, weighing cardiovascular risk alongside menopausal symptom burden.

Practical Steps to Protect Your Heart Post-Menopause

1. Have regular health checks – Track your blood pressure, cholesterol, HBA1c and weight.

2. Eat a Mediterranean-style diet – Rich in vegetables, oily fish, nuts, legumes, and olive oil.

3. Move more – Combine aerobic activity with resistance training at least 3–5 times per week.

4. Sleep well and manage stress – Both affect blood pressure, insulin sensitivity, and inflammatory markers.

5. Stop smoking – Risk reduction begins within weeks of quitting.

6. Drink alcohol in moderation – Excess intake increases blood pressure and triglycerides.

Menopause, the Heart, and the Brain: The Overlap with Vascular Dementia

As we consider the cardiovascular effects of menopause, it's important to highlight the growing recognition of the link between heart and brain health. Vascular dementia, the second most common type of dementia after Alzheimer’s disease, is caused by reduced blood flow to the brain, often due to small vessel disease, stroke, or chronic high blood pressure. The hormonal changes of menopause may contribute indirectly by accelerating vascular ageing.

After menopause, declining oestrogen levels can lead to endothelial dysfunction (impaired blood vessel function), higher blood pressure, and atherosclerosis—all of which increase the risk of vascular dementia.

Women with metabolic syndrome, type 2 diabetes, or a history of stroke are at significantly increased risk. Symptoms of vascular dementia often include problems with planning, decision-making, slowed thinking, and mood changes, and may develop gradually or in a step-wise fashion after vascular events.

Protecting cardiovascular health during menopause is therefore also an investment in long-term cognitive function. Managing blood pressure, blood glucose, cholesterol, and adopting an anti-inflammatory, brain-friendly diet (such as the Mediterranean or MIND diet) can help reduce risk. There is also emerging interest in whether early use of HRT might have a protective effect against dementia in some women, though this remains under active investigation and is not yet a formal indication for treatment.

Final Thoughts

Menopause is a natural life stage, but it comes with real and modifiable risks. Cardiovascular disease is not just a man’s issue — it is the single most significant health risk to women after menopause. With the right monitoring, lifestyle strategies, and personalised medical support, women can take control of their heart health and reduce risk for decades to come.

Get in touch with us to organise your blood test to review your metabolic and cardiovascular markers.

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