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 in various ways:
blood pressure can rise
cholesterol can go up
arteries may become less healthy
weight can be gained, especially around the tummy.
This means someone's chance of heart disease and high blood pressure can increase after menopause.
2. What effect can hormone level fluctuations 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 don't know what effect the reduction in hormone levels has on the different types of cardiomyopathy.
3. Which menopause symptoms are similar to cardiomyopathy symptoms?
Some menopause symptoms can feel like heart symptoms, such as:
- 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're perimenopausal, if you're experiencing new breathlessness, chest pain or palpitations it's 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?
Oestrogen helps to protect the heart by:
- relaxing blood vessels
- improving cholesterol levels
- reducing inflammation in your arteries.
5. Is there any specific guidance on HRT for women with cardiomyopathy and/or heart failure?
Hormone replacement therapy (HRT) can help reduce menopause symptoms in some people.
However, in some cases, the tablet form of HRT can increase the possibility of blood clots and therefore the risk of having a stroke. Patches or gel are likely to be a safer HRT alternative to tablets. However, 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:
Visit the British Menopause Society website
6. When should a women with cardiomyopathy approach their GP, and would you advise that they're seen in a specialist menopause clinic by a gynaecologist?
If you've 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're seen in a menopause clinic, where you will be reviewed by a specialist nurse or gynaecologist. They may speak to your cardiologist to decide which treatment is right for you.
There's a common misconception that HRT is unsafe for women with heart conditions – however, the British Menopause Society says that women diagnosed with heart disease can take HRT safely. They advise that women should ideally be prescribed the lowest effective dose of oestrogen for the shortest time possible, normally via patches or gel. They suggest that HRT is safer if it's started less than 10 years since the start of menopause and in women under 60 years of age.
7. Are there any lifestyle changes women with cardiomyopathy could consider making to improve symptoms associated with perimenopause and menopause?
Healthy habits can make a big difference for both menopause and heart health.
- Stay active: Try walking, swimming or 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: Eat more fruit, vegetables, whole grains and lean protein; eat less salt, sugar and processed food.
- Keep a healthy weight: It can be harder to lose weight post-menopause. Extra weight can make heart related symptoms worse such as breathlessness. It's especially important to avoid too much tummy fat.
- Sleep well: Aim for 7–9 hours a night.
- Manage stress: Try yoga, meditation or talking therapies.
- Avoid unhealthy habits: Don’t smoke and keep your alcohol intake low.
- Follow medical advice: Take medicines you've been prescribed for your heart.
Take home message: 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.