This study is the largest, single study to date of diverse heart disease risks relative to age at menopause. It used the UK biobank to examine data on over 144,000 postmenopausal women with an average age of 60. It included approximately 4,900 women who experienced menopause naturally before age 40 and about 640 who entered menopause before age 40 after their ovaries were removed surgically.
Researchers followed participants during an average of seven years and found that women who had experienced premature menopause were significantly more likely to develop conventional heart disease risk factors. These include high blood pressure, high levels of “bad” cholesterol, and type 2 diabetes.
After accounting for conventional risk factors, women who experienced premature menopause still had a significantly increased risk of heart failure, coronary artery disease thickening and narrowing of the aortic valve, atrial fibrillation (an abnormal heart rhythm), and blood clots forming in the legs or lungs.
It was also found that heart disease risks were higher for women who had menopause due to surgery compared to natural menopause. Women who took hormones for menopausal symptoms did not change the cardiovascular risks.
“Our study reinforces the importance of menopause history in informing a woman’s risk of future heart disease,” said Michael Honigberg, lead author of the study and a cardiology fellow at Massachusetts General Hospital and Harvard Medical School in Boston. “Women should make sure their physician knows their menopause history, particularly if they experienced menopause before age 40. History of premature menopause should prompt physicians to refine the patient’s estimated future risks for heart disease and to work toward lowering their heart disease risks.”
Increased Risk with Younger Age
The study did find that menopausal age prior to age 50 had a dose-dependent effect on cardiovascular disease risk, meaning that the risk continued to increase with younger menopausal ages. Honigberg spoke about how early evaluations could lead to intervention and medication recommendations saying, “Whether or not medications are warranted, eating a heart-healthy diet and exercising regularly may be especially important for women with a history of premature menopause.”
A report published in 2018 by the American College of Cardiology and the American Heart Association on the management of cholesterol and guidelines put forward in 2019 on the prevention of heart disease both recommended that physicians consider a history of premature menopause when making decisions about patient’s health care.
They advise physicians to consider their menopause history when making decisions about prescribing a statin medication for middle-aged women who have not yet developed heart disease or stroke. Since increased cardiovascular risks can last for decades after menopause, it is important for all health care providers to look at each patient’s menopause history before making any medication decisions.