How Menopause Impacts Heart Health

Disclaimer: Not Medical Advice. Opinions are my own.

In partnership with LMNT

Today's Newsletter at a Glance:

• Understanding How Heart Health Changes with Menopause

• Menopause and the Increased Risk of Cardiovascular Disease

• Lifestyle Modifications & HRT

• How to Stay Updated on New Information

How does heart health differ between men and women?

There are a handful of answers that come to mind, but hands down, one of the most significant differences is the effects of menopause and perimenopause.

Many only associate symptoms such as hot flashes, night sweats, and mood swings with menopause, but what is widely overlooked is the direct effects that menopause has on heart health.

In today's newsletter, we will discuss why menopause impacts heart health, its associated cardiovascular disease (CVD) risks, and tactical steps to intervene.

​How Menopause Affects The Heart

During menopause, estrogen levels plummet.

Estrogen is widely known for its role in reproductive purposes. However, estrogen plays a role in heart health as well.

Estrogen aids in the elasticity and flexibility of blood vessels.

Estrogen enhances the bioavailability of nitric oxide, a potent vasodilator, by upregulating the expression and activity of endothelial nitric oxide synthase (eNOS). This results in improved endothelial (inner lining of the blood vessel) function, which helps maintain vascular flexibility and reduces the risk of atherosclerosis.

Why is this so important?

Healthy blood vessels can expand and contract to circulate blood flow effectively.

When blood vessels become stiff, resistance increases as the blood travels through the body, increasing your chances of high blood pressure.

Menopause and the Increased Risk of Cardiovascular Disease

With the increased trends towards a longer life expectancy in the USA specifically, women will spend up to 40% of their lives postmenopausal. ​

Let's look at the primary risk factors for heart disease downstream post-menopausal.

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• Change in Body Composition

During the menopause transition, some women may experience weight gain due to a combination of factors, such as activity level and metabolism. However, the main concern is where the fat is stored. After menopause, fat distribution shifts towards the abdomen—particularly visceral fat. You can learn more about the risks of visceral fat in this previous newsletter.​

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• Increased Inflammation

Estrogen is a very powerful anti-inflammatory. As the predictable amounts of estrogen begin to drop, one can expect an increase in pro-inflammatory cytokines such as TNF-α, IL-6, and MCP-1. Inflammation is a known driver of chronic diseases such as heart disease.

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• Hypertension

As previously discussed, an estrogen drop leads to arterial stiffness and decreased flexibility. The increased stiffness requires more pressure or force from the heart to move blood throughout your body. This increased workload on your heart can lead to increased blood pressure. High blood pressure is a direct risk factor of heart attack.

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• Lipid Profile

Did you know that estrogen directly affects your lipid panel? Estrogen promotes LDL receptor expression in the liver.

What does this mean? LDL receptors help clear the LDL in your bloodstream. Lower estrogen results in fewer LDL receptors to help pull LDL out of your bloodstream, resulting in higher levels of atherosclerotic (bad) cholesterol.

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• Insulin Resistance

Estrogen aids in the process of absorbing and using glucose. In combination with the increased visceral fat and lower effectiveness of glucose utilization, post-menopausal women are more susceptible to developing Type-2 diabetes, a known risk factor of heart attack.

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All four of these pillars will increase your chances of cardiovascular disease.

Now that we have established the downstream effects of menopause, the most important question is, what can we do to address these inevitable changes head-on?

Stay Hydrated the Right Way

Hydration isn’t just about drinking more water — it’s about replacing what you lose.

When you sweat (from workouts, sauna sessions, or just daily life activities), you’re not just losing water — you’re losing electrolytes like sodium, potassium, and magnesium.

That's why I choose ​LMNT as my electrolyte replacement supplement.

LMNT has everything you need and nothing you don't. LMNT uses a science-backed electrolyte ratio of sodium, potassium, and magnesium with no sugar.

Electrolytes are used by every cell in your body. Even minimal dehydration can limit cognitive and physical performance.

LMNT tastes great and helps me replenish my electrolytes after a hard workout or sauna. I mix one packet of LMNT (usually Grapefruit Salt, my favorite flavor) in a 32oz water bottle to ensure I stay hydrated throughout the day.
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Lifestyle Modifications & HRT

Being aware that the natural decline in estrogen increases your chances of Type-2 diabetes, hypertension, higher volume of visceral fat, and LDL cholesterol is the first step.

Knowing how to combat this uphill battle with lifestyle modification and potential HRT is the next step.

​1. Physical Activity: Don't let your level of activity wane as you enter midlife. Double down on your favorite activities that break a sweat. This study suggests the powerful benefits of moderate intensity walking in post-menopausal women. In addition, mix in resistance training to maintain/promote muscle mass and bone density.​
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​2. Avoid Overconsumption: It's clear that body composition changes post-menopause, being more susceptible to a higher volume of visceral fat. Focus on a nutrition plan of nutrient-rich whole foods and limiting or avoiding processed and ultra-processed items. Confused by the spectrum of diets? Keep it super simple: meats, fruits, vegetables, and water.
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​3. Stop smoking and drinking alcohol: Smoking and alcohol both increase your chances of cardiovascular disease. Consumption of either is fully under your control. If you want to decrease your chances of CVD, control the controllable.​Lifestyle modifications can soften the blows and address the four buckets of risk we have defined today. However, lifestyle changes alone can't solve the root problem: a decline in estrogen.

Hormone Replacement Therapy (HRT) offers an avenue to replenish hormones that the body is no longer producing, typically estogren, progestone, and testosterone.

Early intervention has produced extremely promising results, relieving the symptoms we highlighted today.

Disclaimer: HRT should be personalized and tailored to each individual and administered by a qualified healthcare professional.

How to Stay Informed

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​I'm a firm believer that menopause treatment and intervention is going to continue to advance with further studies.

Since this is an evolving area of interest, it is important to stay informed with the latest updates. Two experts in the space I would encourage you to follow are Dr. Mary Claire Haver and Dr. Vonda Wright.

If you are interested in a deep dive into how to navigate menopause as a whole, check out this podcast with Dr. Mary Claire Haver.

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My only ask to you:

If you found this newsletter valuable, take a second and share this newsletter with someone you think would, too.

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Only the best,

Jeremy London, MD

P.S. Don't forget to follow my podcast for free on Spotify or Apple Podcasts​