As the curtain falls on a woman’s reproductive years, menopause takes center stage. It is a natural transition that brings both physical and emotional changes. Beyond its impact on fertility, menopause is said to cast a shadow on cardiovascular health.
In this report, Weekend Trust examines the connection between menopause and heart related conditions as well as how to minimise the risks.
Understanding menopause
The Nigerian Institute of Health -NIH, in its report on the reproductive age of women, which is the entire period between the beginning and end of reproduction, says this period approximately starts within the ages of 12 to 14 years (menarche) and ends between the ages of 45 to 55 years (menopause).
While some women experience menopause earlier, which is before 40 years of age -considered a ‘premature menopause’, the World Health Organisation (WHO) revealed that natural menopause occurs between 45 and 55 years. It is deemed to have occurred after 12 consecutive months without menstruation for which there is no other obvious physiological or pathological cause and in the absence of clinical intervention.
However, the menopause journey has been characterised by the three transition stages of perimenopause, menopause, and postmenopause.
According to NIH, Perimenopause, also referred to as the menopause transition, is when the body starts transitioning to menopause. During this transition, a woman’s ovaries begin producing less hormones, causing menstrual cycles to become irregular. Menopause is said to occur after 12 consecutive months without a period. Whereas the postmenopausal stage, is the period after menopause occurs.
Menopause experiences
Despite the fact that transitioning to menopause is a part of every woman’s biological journey, most women are caught unprepared for this phase of their lives.
Sharing her menopause journey with Weekend Trust, Mrs. Dorathy Akomaye, a widow in her late sixties narrated the struggles she went through at the initial stages of menopause.
According to the Abuja based mother of six, night sweat, lack of sleep and anxiety characterised an experience she was not well prepared for.
She acknowledged that besides mood swings, irregular menstruation, “One thing I also observed was constant leg pain. I didn’t know the cause of the leg pain then, which became worse. I was even advised to go and have the bad blood taken out of the legs. At one point walking became a problem,” she said.
Meanwhile, Mrs Kehinde Umaru, a resident in the Karu area of Abuja, said her experiences made her to question her sanity.
Thinking she was going to lose her life, Kehinde said “at night, my pulse goes high and breathing becomes hard, as I find myself gasping for breath. I will then try to calm my nerves, after which my breath will come back to normal.”
She added that she was battling with her condition in ignorance until her husband’s friend came to the house and recommended that she saw a particular doctor.
“Mine came with low sexual urge due to virginal dryness. I literally sent my husband away when he comes to me. I sometimes became aggressive towards him, but he later understood,” she said.
However, Mrs Ijiofo Emily, a relationship and marriage counselor in her late fiftys, who shared her menopausal experience seemed to be more optimistic as she counted it a blessing.
“I entered menopause at the age of 49, and I’ve been in it for over five years. As a girl child you get to a stage where you see your menstrual circle, then it gets to when you no longer see it.
High cardiovascular risk
A 2024 report by the American College of Cardiology indicated the rapid decline of heart health in women after menopause. The research underscored the importance of recognising and addressing early warning signs of heart disease risk in women as they lose the protective effects of estrogen after menopause.
Dr Henry Uwandu, Gynecologist at Novelty Healthcare Limited, Abuja, who also linked menopause to an increased risk of cardiovascular diseases, said that, “during menopause, the levels of high-density lipoprotein (HDL) often referred to as the good cholesterol decrease. The HDL plays a crucial role in removing excess cholesterol from the bloodstream, which protects women against heart disease. Reduced HDL levels during menopause increases the risk of cardiovascular diseases”.
He added that menopause leads to alterations in lipid profiles, resulting in an increase in low-density lipoprotein (LDL), commonly known as bad cholesterol. This according to him is a contributing factor to the development of heart diseases, including heart attacks and strokes.
The absence of protective hormones like estrogen and progesterone which help maintain healthy blood flow prevents inflammation, and supports endothelial function, pose risks of heart conditions in women.
Other related conditions
According to research by the National Osteoporosis Foundation, about one in two women aged over 50 will experience an osteoporosis-related fracture. Osteoporosis is a condition characterised by weakened bones, making them more susceptible to fractures.
Meanwhile, menopause has been associated with vaginal dryness, thinning of vaginal tissues, and decreased elasticity.
These changes can cause discomfort during intercourse and may impact sexual health.
Also, some women are said to experience urinary incontinence or frequent urination during menopause. A 2018 research on Female Urinary Incontinence in Lagos, Nigeria indicated that about 200 million people worldwide, majority of who are females, suffer urinary incontinences. The hormonal fluctuations in this period are also known to affect mood stability and sleep patterns.
Managing menopause
In 2022, a research conducted by the University College Hospital in Ibadan, showed that about 41 per cent of women between the ages of 45 and 65 had no idea why their menstrual periods stopped. It further revealed that about 60 per cent of women were unaware of how to reduce menopausal symptoms.
Attesting to the low information level amongst women experiencing menopause, Dr Nwandu, noted that though there are several ways of managing the situation, one of the methods is the Hormonal Replacement Therapy-HRT. This he said is the process of replacing the lost estrogen and progesterone levels in the body, so as to reduce or eliminate risks associated with menopause.
Others includes the Selective Serotonin Reuptake Inhibitors (SSRIs), Gabapentin and Pregabalin, Clonidine among others.
Among other management methods, Dr Nwandu noted that life style changes such as regular exercise, healthy diets and proper stress management are important in minimising the symptoms of menopause.
He advised that women experiencing menopause should ensure they consistently monitor their blood pressures, cholesterol levels, and overall cardiovascular health.
Speaking of how they are able to manage menopausal symptoms and risks to remain healthy lives, Mrs Akomaye said that staying active played a key role in her case.
“I am almost 70, but I cook, clean and go to the market for shopping. I sometimes wash by myself; my children complained, but I didn’t stop,” she said.
Mrs Ijiofo and Kehinde also attested to how engaging in physical exercise and eating healthy have helped them stay strong through the period.
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