Changes in sex hormones during menopause increases risk of cardiovascular problems

According to a study published in the European Journal of Preventive Cardiology, a publication of the European Society of Cardiology, changes in sex hormones during menopause lead to an increase in bad cholesterol levels. According to researchers from the University of Jyväskylä, Finland, this increases the risk of cardiovascular problems in women going through menopause.

Most women go through menopause between the ages of 48 and 52. This leads to a drop in estrogen levels and an increase in follicle-stimulating hormone (FSH). Researchers already know that menopause predisposes women to heart disease, but this study shows for the first time that it’s because there’s a change in female sex hormones. These changes were partially blocked by hormone replacement therapy (HRT).

“Menopause is inevitable, but it’s possible that negative metabolite change can be decreased by eating a healthy diet and being physically active,” said study author Dr. Eija K. Laakkonen of the University of Jyväskylä, Finland. “In particular, women should pay attention to the quality of fat in their diet and exercise enough to maintain cardiorespiratory fitness. HRT is an option that women should discuss with healthcare providers at this stage in their lives. »

The study involved 218 perimenopausal women not using HRT. The team measured levels of 180 compounds, including cholesterol, lipoproteins and lipids, as well as estradiol and FSH at the start of the study and then every 3 to 6 months until the onset of postmenopause. . Menopause was assessed using menstrual diaries and FSH blood levels. Early postmenopause was defined as absence of menstruation for six months and elevated FSH levels on two consecutive measurements. During the study, 35 women started HRT.

“Our study investigated whether the hormonal change of menopause modulates the metabolite profile measured in blood samples taken before and after menopause. Because the menopausal transition, i.e. the period with varying hormone levels and irregular periods, varies greatly from person to person, the times of assessment were individualized,” said Dr. Laakkonen.

The results showed that menopause was associated with a significant change of 85 percent of all metabolites measured, including low-density lipoprotein (LDL) (“bad”) cholesterol, triglycerides and fatty acids. Basically, the researchers showed that these changes were mainly caused by changes in sex hormones. In contrast, women on HRT had higher levels of high-density lipoprotein (“good”) cholesterol and lower levels of LDL cholesterol.

“This study links hormonal changes during menopause to metabolic alterations that promote heart disease. Previous studies did not confirm menopausal status with hormonal measurements, meaning they could not differentiate the effects of menopause from aging,” Dr. Laakkonen said.

“With regard to HRT, very strong conclusions cannot be drawn based on our observational study alone because the number of women starting treatment was low and the type of drug was not controlled. Nevertheless, our results indicate that initiating HRT at the onset of menopause, i.e. during the menopausal transition, provides the greatest cardioprotective effect. Women considering HRT should discuss this with their healthcare professional as there are many choices and some potential contraindications such as a history of cancer or stroke that need to be considered.

Karppinen JE, Törmäkangas T, Kujala UM, et al (2022) Menopause modulates the circulating metabolome: evidence from a prospective cohort study. Eur J Prev Cardiol. doi:10.1093/eurjpc/zwac060


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