Linda Braucht
A new study suggests that women who experience intense menopausal symptoms like hot flashes and night sweats may actually have a health advantage — they may be protected from heart disease, stroke and even death years after the Change.
That's good news for menopausal women who haven't had much to celebrate in recent years. Studies show that the best treatment for the symptoms of menopause, which can be severe enough to cause embarrassment and interfere with daily activities, may increase the risk of breast cancer and possibly even heart disease. So doctors have been using the drugs, which include the hormones estrogen and progestin, sparingly and only in women who aren't at high risk of developing cancer or heart problems.
Now, the new study, which involved more than 60,000 women aged 50 to 79 who had experienced menopause, suggests menopausal symptoms have a silver lining. The study found that women who had their worst hot flashes and night sweats around the time of menopause had an 11% lower risk of having a heart-related health problem and an 8% lower risk of dying from any cause over the study's nearly 10-year follow up, compared with women who reported no menopausal symptoms.
That's a double relief for the thousands of women who suffer through menopause each year, since previous studies had hinted that hot flashes were associated with some of the strongest risk factors for heart attack. These studies suggested that women experiencing hot flashes and night sweats, which signify an instability of the blood vessels close to skin in response to hormonal changes, were more likely to have high cholesterol, elevated blood pressure and increased hardening of their arteries. All of these factors have been linked to a higher risk of heart disease, so it seemed reasonable to assume that women with menopausal symptoms might be a greater risk of having a heart attack.
But the new analysis shows that may not be the case. “We saw a different story, and saw that women who have symptoms when they are most common, which is early on in menopause, seem to have a lower risk of cardiovascular disease, stroke and death,” says study co-author Dr. Emily Szmuilowicz, an endocrinologist at Northwestern University. “These findings should be reassuring to many women who experience these symptoms.”
What may be happening, she says, is that women who experience flushing during menopause could have blood vessels that are responding appropriately to the change in hormone levels occurring at that time, helping them to ward off the hardening of the arteries and plaque-building associated with heart disease. But further studies need to confirm whether that's the case.
The association was true only for the 50% to 80% of women who experienced symptoms early in the course of menopause. Those who reported continued hot flashes or night sweats did not show a heart benefit, and women who started feeling symptoms more than a decade after menopause actually showed an increased risk of heart-related problems. These women, who on average had experienced menopause 14 years earlier, showed a 23% increased risk of heart events and a 30% greater risk of dying during the study period.
The difference, says Szmuilowicz, may have little to do with menopause or its symptoms. Because there was such a lag between when these women experienced menopause and the onset of their symptoms, it's not at all clear that the hot flashes and night sweats they reported were due to menopause. While the study did not address what could be causing the symptoms, Szmuilowicz says “one idea is that perhaps having symptoms later in life represents something else. Symptoms of heart disease, for example, could be mistaken for menopausal symptoms.”
So what about women taking hormone replacement therapy to control their symptoms? Are they negating any of the symptoms' cardioprotective benefits? The current study doesn't support that idea, and the authors say the findings should not change current practice, which is to use hormone therapy to control intense symptoms in the lowest possible dose for the shortest possible time, soon after menopause starts.
Szmuilowicz also notes that by reaching menopause, all women, regardless of whether they experience flushing or not, are at increased risk of heart disease as their estrogen levels, which are normally protective of the heart, decline. “All menopausal women should make every effort to reduce their risk of heart disease by exercising, eating a healthy diet, stopping smoking, lowering their blood pressure and reducing their cholesterol,” she says. “We know these measures decrease heart disease and shouldn't be lost in the picture.”
At least now, women who flush and sweat their way through menopause can feel somewhat comforted knowing that their suffering isn't in vain.