Middle-age is a time of transition for most people, and for women, it usually means the transition into menopause.  Outside of menstrual periods ending, menopause also signifies a major shift in hormones that make our bodies tick.  A large study of women moving from perimenopause through menopause has found that certain cardiovascular risks increase exponentially for women, but the good news is, there are things they can do about it.

Menopause
Menopause is the time when a woman has stopped having menstrual periods. In the few years leading up to that time, a woman’s periods are likely to be irregular and sporadic. Therefore, researchers say that menopause has officially occurred when a woman has gone without a period for 12 consecutive months.

According to the North American Menopause Society, more than 45 million American women have reached menopause. The average age at the time of menopause is 51.

The Metabolic Syndrome
The metabolic syndrome is the name for a group of conditions associated with an increased risk for cardiovascular disease. To meet the definition, a person must have three or more of the following risk factors:
 

• Abdominal obesity. This is described as a “large waistline” or an “apple-shaped body.” For women, that means a waist circumference greater than 35 inches.
• High blood pressure. High blood pressure, also known as hypertension, is defined as a systolic pressure (the first number) of 130 mm Hg or higher and/or a diastolic pressure (the second number) of 85 mm Hg or higher.
• Elevated triglycerides. Triglycerides are a type of fat in blood. High levels are defined as 150 mg/dL of blood or higher.
• Low HDL cholesterol. HDL (high density lipoprotein) is considered the good type of cholesterol. Lower levels of HDL are associated with an increased risk for heart disease, while high levels are believed to provide some protection from heart disease. For women, low LDL cholesterol is below 50 mg/dL.
• High fasting glucose. Glucose is a form of sugar derived from foods that the body uses to fuel the cells. If glucose levels are high, it may mean the body is unable to process or effectively use the glucose because of a lack of insulin or the inability to use insulin. A fasting blood sugar level of 100 mg/dL is considered to be high.

The American Heart Association estimates over 50 million Americans have metabolic syndrome. People with the condition are twice as likely to develop coronary artery disease and five times more likely to develop type 2 diabetes.

Women, Menopause and the Metabolic Syndrome
Men and women are both at risk for heart disease. However, age for age, women tend to develop the disease about ten years later than men. And researchers say, after 55, the rates of cardiovascular disease are actually higher in women than in men.

Hormonal changes associated with menopause may play a role in a woman’s risk for heart disease. The transition into menopause is marked by a dramatic decrease in the production of estrogen. At the same time, the production of male hormones, namely testosterone, increases. For some time, doctors believed hormone replacement therapy would decrease the risk for heart disease in older women. But that theory didn’t pan out. In fact, the estrogen and progestin replacement study was halted because researchers discovered women taking the hormones were at an increased risk for breast cancer, heart attack, stroke and blood clots.

To sort out some other potential risk factors for cardiovascular disease after menopause, researchers looked at women involved in the Study of Women’s Health Across the Nation (SWAN). The study, which began in 1996/1997, is following more than 3,300 women 42 to 52. So far, nearly half of the women reached natural menopause and researchers are starting to analyze some of the data.

Imke Janssen, Ph.D., Biostatistician at Rush University Medical Center, says it appears that as menopause nears, fat deposits on women’s bodies tend to change. Fat tends to accumulate more around the waist rather than more evenly throughout the body. This could change a woman’s metabolic profile and increase the risk of metabolic syndrome and cardiovascular disease.

To combat the changes associated with menopause, Janssen recommends women become more conscientious about starting and sticking to a program of regular exercise and a healthy diet. She says the goal should be to increase activity levels and raise the rate of metabolism. Some suggestions are walking at least 30 minutes a day at a quick pace (not necessarily jogging or running a marathon), dancing or walking on a treadmill. Women who find they are having a hard time sticking with an exercise program should find a buddy to work out with so they can provide support and encouragement for each other.

AUDIENCE INQUIRY
For information about menopause:
American Menopause Foundation, http://www.americanmenopause.org
National Institute on Aging, http://www.nia.nih.gov

For information on the metabolic syndrome:
American Heart Association, http://www.americanheart.org
National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov
National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov

For information on the SWAN study:
http://www.nia.nih.gov/ResearchInformation/ScientificResources/SWANdescription.htm