1) Perimenopause and menopause – what are they, and how do they affect the heart?
- Perimenopause is the time before periods stop, when hormone levels go up and down.
- Menopause is when periods have fully stopped for 12 months.
These hormone changes, especially the fall in oestrogen, can affect the heart:
o Blood pressure can rise
o Cholesterol can go up
o Arteries may become less healthy
o Weight can be gained, especially around the tummy
This means the chance of heart disease and high blood pressure can increase
after menopause.
2) What effect can fluctuations in hormone levels have in women with cardiomyopathy?
The changes in hormone levels can increase the chance of symptoms such as palpitations, generalised aches including in the chest area, and tiredness. Some of these symptoms may be similar to cardiomyopathy symptoms.
At present, we do not know what effect the reduction in hormone levels has on the different types of cardiomyopathy.
3) Which menopause symptoms might be similar to symptoms in cardiomyopathy
Some menopause symptoms can feel like heart symptoms. For example:
- Palpitations (fluttering, fast, skipped or strong beats)
- Tiredness, low energy or fatigue
- Dizziness or feeling lightheaded
Because the symptoms overlap, it’s important not to ignore them.
Even if you are perimenopausal, if you are experiencing new breathlessness, chest pain or palpitations it is important to speak to your GP or cardiac team in case your symptoms are heart related.
4) What do we know about the protective effects of oestrogen on the heart and any relation to cardiomyopathy?
Oestrogen is a female hormone that helps protect the heart by:
- Relaxing blood vessels.
- Improving cholesterol levels
- Reducing inflammation in your arteries
5) Is there any specific guidance for women with cardiomyopathy and/or heart failure, in relation to HRT?
Hormone Replacement Therapy (HRT) can for some people help reduce menopause symptoms.
However, tablet form of HRT can in some cases increase the possibility of blood clots and therefore the risk of having a stroke can be increased.
HRT in the form of patches or gel are likely to be a safer alternative to tablet form.
We recommend that women with any type of heart disease discuss HRT with a specialist.
The British Menopause Society has guidance on HRT use in heart disease:
British Menopause Society
6) When should a women diagnosed with cardiomyopathy approach their GP and would you advise that they are seen in a specialist menopause clinic by a gynaecologist
If you have been diagnosed with cardiomyopathy and you have any new or worsening symptoms, such as breathlessness, swelling, palpitations or dizziness, see your GP, call NHS 111 or contact your ICC specialist clinic. If you collapse or your symptoms are severe, seek emergency help via 999.
If you think that some of your symptoms might be related to perimenopause or menopause speak to your GP for advice. They might suggest that you are seen in a menopause clinic, where you will be reviewed by a specialist nurse or gynaecologist. They may speak to your cardiologist to decide the right treatment for you as an individual.
There is a misconception that HRT is unsafe for women with heart conditions, however, the British Menopause Society advise that women diagnosed with heart disease can take HRT
safely. They say that ideally women should be prescribed the lowest effective dose of oestrogen for the shortest amount of time possible, and to use patches or gel where possible. They suggest that HRT is safer if it is started less than 10 years since the start of menopause and in women under 60 years of age.
7) This year’s World Menopause Day theme is ’Lifestyle Medicine.’ Do you have any advice for women with cardiomyopathy on lifestyle changes they could consider making to improve potential symptoms associated with perimenopause/ menopause?
- Healthy habits can make a big difference for both menopause and heart health:
- Stay active: walking, swimming, light weights (women over 40 lose muscle mass and should consider regular strength training). Your cardiomyopathy specialist team can guide you on what is safe for your heart. Most people with cardiomyopathy can and should exercise.
- Eat a heart-healthy diet: more fruit, vegetables, whole grains, lean protein; less salt, sugar, processed food.
- Keep a healthy weight: especially avoid too much tummy fat. It can be harder to lose weight post menopause. Extra weight can make heart related symptoms worse such as breathlessness.
- Sleep well: aim for 7–9 hours.
- Manage stress: try yoga, meditation, or talking therapies.
- Don’t smoke and keep alcohol low.
- Take medicines as prescribed for your heart.
Take home: Menopause changes can affect the heart, and in women with cardiomyopathy, symptoms may overlap. Oestrogen has protective effects, but HRT must be carefully chosen and guided by a specialist. Healthy lifestyle choices are powerful tools to protect both heart and menopause health.