Risk factors for heart disease increase before menopause

Risk factors for heart disease, diabetes and stroke increase more quickly than expected in the years preceding menopause, according to new research, and the risk factors seem to be more prominent in black women.

Metabolic syndrome describes a constellation of risk of factors that contribute to cardiovascular disease, including a large waist, high triglyceride levels, high blood pressure and high blood sugar when fasting. It has been known that metabolic syndrome is more common in women post-menopause, but it wasn't clear when the symptoms start to kick in.

Researchers assessed data from 1,470 women taking part in the Atherosclerosis Risk in Communities cohort, a long-term national study that looks at the root and effects of artery hardening. The analysis covered changes in menopause status over 10 years.

Mark DeBoer, a pediatric endocrinologist at the University of Florida and one of the lead researchers on the study, said his previous research on metabolic syndrome in children showed differences across racial and ethnic backgrounds.

“Metabolic syndrome is [a] cluster that appears more often than you’d think,” he said. “African Americans were less likely to be diagnosed even though there is a higher rate of heart disease and diabetes.”

DeBoer and other researchers found that menopausal black women are at greater risk for cardiovascular disease and diabetes than their white counterparts.

Women across all backgrounds experienced a rapid surge in metabolic syndrome severity during the transition to menopause. However, black women experienced an increase in metabolic syndrome severity before the transition to menopause. Black women overall had higher rates of metabolic syndrome, especially with high blood pressure and high fasting blood sugar levels, compared to white women.

Nearly 45 percent of black women in the study had hypertension compared to 15 percent of white women. Almost 10 percent of black women had high glucose compared to 8 percent of white women. Black women had a slower rate of metabolic syndrome increase after menopause compared to white women, however.

Although nearly 14 percent of white women used hormone replacement therapy in contrast to almost 7 percent of black women, that didn't explain the racial differences. DeBoer observed that the women in the study had a much higher use of hormone replacement therapy than what is currently the norm.

JoAnn Pinkerton, an OBGYN and executive director of the North American Menopause Society, said she was struck by the rapid progression of metabolic syndrome during the transition to menopause, or perimenopause. Pinkerton noted that it is the most difficult phase of menopause, saying that women can gain five to 10 pounds per year in the time leading up to actual menopause, and fibroid tumor growth is possible due to changes in estrogen and progesterone.

“Women who approach the perimenopause need to be really careful about keeping their exercise going and decreasing their portion sizes,” she said.

Pinkerton said the medical field needs to start testing women earlier for metabolic syndrome. “Intervention for women at risk or who are developing metabolic syndrome should not wait until 50 or post-menopause,” she said. “We need to start looking at women in the 40s before they hit those hormonal fluctuations.”

“The most important thing is an awareness of changes at the time leading up to menopause that increase cardiovascular diseases,” said DeBoer. “This serves as a motivator [for] healthy lifestyle changes.”

The 4 different types of hot flashes women get during menopause... Which do YOU suffer?

Every woman goes through menopause.

But the symptoms that come with it like hot flashes vary greatly from person to person. When side effects strike, and how long they last, seem arbitrary and impossible to predict - some start early, some start late, some last two years, some last 15.

However, a new study has outlined four distinct categories that all women supposedly fit into based on their race, weight, and dietary habits.  The research by the University of Pittsburgh has been hailed as a breakthrough which could have a dramatic impact on the way menopausal symptoms - known as vasomotor symptoms - are treated. 

WHICH GROUP DO YOU FIT INTO?

1 FEW SYMPTOMS

Chinese women had a consistently low chance of debilitating symptoms throughout the menopause transition.

2 SYMPTOMS LAST LONGER

Black women, those with less education, heavy drinkers and those who reported depression or anxiety had a higher chance of symptoms all the way through the decade.

3 SYMPTOMS HIT EARLY

Early onset symptoms at the start of the transition period were most common among obese women, women with depression or anxiety, women in poor health, and women who start menopause later. 

4 SYMPTOMS HIT LATE

And late onset symptoms were most common in skinnier women, smokers and black women. Most women get vasomotor symptoms, and we used to think these symptoms lasted from three to five years, right around the time of the final menstrual period,' senior author Rebecca Thurston, professor of psychiatry at the University of Pittsburgh, said. 'We now know that these symptoms persist for far longer - typically seven to 10 years - and occur at different times for different women. 

This is strong evidence that we need to further investigate the underlying physiological causes of vasomotor symptoms and their link to potentially preventable health conditions. Menopause, when a woman stops menstruating, typically occurs at some point between the ages of 45 and 55.

The experience is linked to hot flashes and night sweats caused by sudden flushes of heat. These symptoms are the result of a decrease in estrogen and progesterone produced by the ovaries. Other symptoms include vaginal dryness, mood swings, and insomnia. 

KNOW YOUR LEVELS - TAKE A 60-SECOND ASSESSMENT
 

For the study, published in Menopause, the team followed 1,455 women enrolled in the Study of Women's Health Across the Nation (SWAN) who were yet to start menopause. None of them were on HRT and none of them had had a hysterectomy. Each year, the women described the vasomotor symptoms they had experienced. They also had annual clinical exams and blood tests.

After 15 years of testing, the researchers concluded certain factors led to different side effects.
Chinese women had a consistently low chance of debilitating symptoms throughout the menopause transition. Black women, those with less education, heavy drinkers and those who reported depression or anxiety had a much higher chance of severe symptoms all the way through the decade-long period.

Early onset symptoms at the start of the transition period were most common among obese women, women with depression or anxiety, women in poor health, and women who start menopause later.  And late onset symptoms were most common in skinnier women, smokers and black women. 

'It's fascinating that we can distinguish these unique patterns and then pinpoint specific characteristics associated with each of these trajectories,' says coauthor Maria M. Brooks, professor of epidemiology and associate professor of biostatistics. 

'When we see patterns like this, it indicates that there's something going on beyond hot flashes and night sweats being a passing nuisance. Depending on which category a woman falls into, there may be important implications regarding her health.' 

Know Your Levels - Take a 60-Second Assessment

How to Know If You Have a Hormonal Imbalance

Hormonal imbalances can affect both men and women, with symptoms ranging from barely noticeable to extremely severe. Many sufferers of a hormonal imbalance may not even realize they have a hormonal problem, blaming their symptoms on other medical problems or even lifestyle choices. But when problems persist and standard medical treatments do not fix the issue, it is important to look at the patient’s symptoms and see if hormone replacement therapy could provide a solution to their troubles. So, how can you recognize a hormonal imbalance in both men and women?

Hormone Changes in Women vs. Men
For women, an imbalance in hormones is usually tied to naturally occurring life events such as pregnancy, pre-menopause or post-menopausal changes. Since such a noticeable change is happening, women are more likely to know they are experiencing the side effects of fluctuating and changing hormones. But for men, a change in hormones may be harder to recognize. Hormone changes in men can happen gradually over time, making it hard to know if an imbalance is responsible for the problems they are experiencing. Here are some of the common symptoms of a hormone imbalance for men and women.

Women: Symptoms of a Hormone Imbalance
Typical symptoms for women with changing hormones can vary based on their age, menstrual cycle and life events. For menopausal women, most symptoms of a hormonal imbalance include the "classic" night sweats, hot flashes, weight gain and mood swings. These symptoms are well known because of their prominence in social discussions, television shows, advertisements and gender studies. For women with a hormone imbalance, the signs are usually easy to recognize. But, there are also symptoms associated with changing hormones that are less noticeable. For example, digestive problems, severe acne, sleeping disorders and fatigue can be signs of changing hormones, but also can be signs of other medical problems. In these cases, it is harder for women to know if they are experiencing an imbalance.

Men: Symptoms of a Hormone Imbalance
For men with changing hormones, the symptoms can happen slowly over time, making the problem less noticeable and harder to diagnose. For example, loss of hair, low libido, increased body fat and muscle weakness can happen as gradual changes in a man’s body, and may also be associated with age, genetics or other medical conditions. But these symptoms can also be signs of a hormone imbalance. Other common symptoms experienced by men include memory loss, night sweats, constipation, erectile dysfunction, irritability and more.

Correcting a Hormone Imbalance
For both men and women experiencing a hormonal imbalance, there are many treatment options available. Hormone replacement therapy (HRT) is the most common form of treatment. For men with symptoms, the cause is normally a loss of testosterone that happens naturally over time. By using the latest HRT testosterone, many men are able to reverse the affects of hormone imbalance and start living a normal, healthy life again. For women with changing hormones, HRT can be beneficial in lessening the strong side affects of menopause, helping them overcome depression, anxiety and other bodily changes. Using HRT can be life changing for many patients, and an excellent alternative to other strong prescription medications or mood altering drugs. If you think you are experiencing symptoms of a hormone imbalance, contact a doctor specializing in HRT to learn more about correcting your imbalance and stabilizing your hormones.