Why does the loss of oestrogen in menopause effect women’s bodies so dramatically?
What impact does loss of oestrogen have on a woman’s body during menopause?
From puberty oestrogen has a key role in female lives. Not only does it govern our reproductive system – oestrogen also affects our mood, appetite and energy. Importantly though, it also has a powerful protective impact on our cardiovascular system, keeping women’s risk of cardiovascular disease (CVD) significantly lower than men’s, for our first 40–50 years.
But…when our natural levels of oestrogen decline during perimenopause, this protective effect is lost. So, in the space of 5–10 years, our CVD risk rises to equal the risk that men face.
What is it about oestrogen that drives this significant impact over our cardiovascular health – and is there anything we can do to keep the benefits it provides earlier in life?
Dr O’Kennedy is a research chemist, specialising in the field of natural products chemistry and cardiovascular disease, and she helps to explain the impact the loss of oestrogen has on our heart health through menopause.
Ever wondered why you are gaining weight during menopause?
Oestrogen regulates metabolism in the female body, organising our energy intake and output. It also works in the brain to help curb our appetite – all working to protect us from weight gain and diabetes.
During perimenopause, many women notice their body shape change – they gain weight around the middle and struggle to shift the weight gained. This is an early sign of falling oestrogen levels and a shift in our metabolism. Many women struggle to control their appetite, notice that it is harder to keep a balanced blood sugar level and suffer changes in their blood cholesterol. Sadly, changes to our metabolism, from this falling oestrogen, are one of the greatest challenges of menopause.
Oestrogen helps our blood vessels do their job
Blood vessels are amazing – they expand when we need more blood to flow through them, and they constrict when we need to conserve blood in the major organs. In women, oestrogen helps to control these changes in the blood vessels, when the body needs them, by telling the body to release a precious molecule called nitric oxide.
Everybody produces less nitric oxide from the age of 40, which means our blood vessels are not as pliable, and not as able to expand when the body needs them to, putting pressure on our cardiovascular system. For women, though, the fall in oestrogen around menopause makes the situation worse, and so ramps the pressure up even more.
What happens to the blood itself during menopause?
Very few people know that our naturally high oestrogen levels before we reach menopause, help to control blood clotting in women - but why is that important?
Well, we have platelets in our blood, which are vital in clotting when we suffer a cut or injury. But, inside the body, these platelets can sometimes change from being smooth to being ‘sticky’. They can do this several times a day, as they are directly affected by our lifestyle; but in a healthy person, they will return to their normal non-sticky state quickly. Our platelets are more likely to be stickier more of the time if, for example, we smoke, have an unhealthy diet, are inactive, stressed or often exercise intensively. This leads to a ‘thickening’ of the blood when sticky platelets stick to each other and to the blood vessels.
Up until menopause, oestrogen helps the body to keep all of this under control. Women even have special oestrogen receptors on their platelets, to stop them from becoming too sticky. This is another reason why women have a lower risk of cardiovascular disease than men until they reach menopause…
During perimenopause, platelet oestrogen receptors reduce in number, and after menopause they disappear. So, with lower levels of nitric oxide, and falling oestrogen levels, our platelets can become persistently sticky after menopause.
All these oestrogen related changes create a perfect storm for the cardiovascular system at menopause.
After menopause, oestrogen levels are vanishingly low. The result is a combination of metabolic changes, loss of blood vessel elasticity and sticky platelets which are the classic recipe for increased risk of cardiovascular disease. By understanding this sudden increase in risk, we can try to hold on to some of the previous advantages that oestrogen provided….
5 Tips to protect women’s cardiovascular health during menopause
Start early
During perimenopause – around age 40 in most women – is the time to get good diet and lifestyle habits ingrained.
Exercise is key
Exercise is key to keeping a good energy balance, maintaining a healthy metabolism, and keeping natural nitric oxide reserves as high as possible. Remember, it is moderate exercise that’s associated with these benefits – high intensity exercise can be counterproductive, making platelets sticky and causing unnecessary inflammation.
Know your numbers
Familiarise yourself with the changes happening to your body, get your blood pressure and cholesterol measured regularly. If your cholesterol starts creeping up, take steps to lower it – changing your fat intake may help, or taking plant stanol esters in some foods. Stanol esters is a diverse group of chemical compounds known to reduce the level of low-density cholesterol in blood when ingested.
Pamper your platelets
No one can reverse all the effects of ageing, but a healthy lifestyle helps to minimise knock-on effects on your platelets. Keeping your platelets from becoming sticky helps prevent disease like atherosclerosis from taking hold. Taking a natural Omega-3 supplement helps to maintain normal platelet aggregation, contributing to healthy blood flow and circulation and the normal function of the heart.
Keep an eye on your diet
Make sure that half of every meal is made up of vegetables, and that your fibre intake is adequate. Check that you get enough B vitamins like folic acid – and you may need vitamin D and selenium supplements too.
Dr Niamh O’Kennedy
Chief Scientific Officer - Provexis plc. Dr O’Kennedy is a research chemist, specialising in the field of natural products chemistry and cardiovascular disease.
May 2020
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