The arrival of heart palpitations and high blood pressure as we approach our menopause transition is not only frightening, but also becomes frustrating when we get them checked out and we are told ‘everything seems normal’.
Time and time again I hear this from women on the MyMT™ online programmes. It happened to me as well. But I explain to them that whilst everything may be ‘normal’ with respect to various diagnostic tests, looking after our heart and blood vessels cannot be ignored as we approach menopause (peri-menopause) and move into our post menopause years (when our periods have stopped for a year or more). You see, when I learnt how the natural decline in oestrogen levels affected my ageing heart, suddenly my own palpitations, hypertension (high Blood Pressure) and feelings of exhaustion, made so much more sense. I, like many women, didn’t realise that our menopause transition is a risky time for our cardiac health. [Kateepe-Arachi & Sharma, (2016)].
The women’s health literature is full of studies reporting the changes in cardiac function as we age. And I’m not talking about when you are over 70 years. I’m talking about your menopause transition – the time when your biological and reproductive ageing is occurring. With the decline in oestrogen levels as we move through menopause, risk factors for coronary heart disease (CHD) become more apparent in women, especially hypertension or high blood pressure. If your blood pressure has shot up as you approached mid-life, you’ll know what I mean. Furthermore, the onset of hypertension can cause a variety of symptoms that are often attributed to the menopause – if you are experiencing fatigue, hot flushes, aching muscles after exercise, migraines, tinnitus and/or palpitations, then join the club – it could well be your changing blood pressure and blood vessels. So please, go to your Doctor and get your blood pressure checked out when you can, because there’s a little statistic I want to share with you.
Worldwide, 25% of adult women are hypertensive, and in the United States, more than 75% of women older than 60 years of age are hypertensive. [Lima et al., 2012]
Hypertension is a major risk factor for cardiovascular disease in women and men. Whilst it is well controlled and treated with medications in many countries throughout the world (Lancet 2019), what we all need to know, is that cardiovascular disease, which includes high blood pressure, is the leading cause of death in women – especially as we move into post-menopause.
Your Blood Pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood through your body.
If your blood pressure is high, your heart works harder with every heartbeat. What happens then is that constant high blood pressure puts extra strain on your heart and blood vessels which can increase your risk for other heart and organ problems as you age. If you are still getting hot flushes and night sweats and you’ve moved through menopause, then it could well be your changing blood pressure as well. When we don’t sleep and because our blood vessels are ageing, then this disruption to our circadian rhythm affects hot flushes and night sweats also.
I know that many of you will have had your blood pressure measured over the years, we need to understand that as we age and lose oestrogen, this makes us particularly vulnerable to a high blood pressure – it’s ‘high’ when the top number (systolic pressure) is over 140 mmHg and the bottom number (diastolic pressure) is over 80 mmHg. The exciting thing for us to remember is that if you can reduce your systolic blood pressure by around 10 mmHg, your risk of having a stroke is lowered by up to 40% (Angeli, Riboldo et al, 2019).
Whilst our blood pressure is typically lower during peri-menopause, after menopause, the prevalence of hypertension in women is higher than it is in men. And yes, you can blame your changing oestrogen levels, as well as the fact that you are ageing, which means your heart and blood vessels are ageing too. As such, they accumulate changes that may predispose us to changing blood pressure – including the deposition of fatty plaques (atheromas) in our arteries.
As Maas & Frank, (2009) reiterate – ‘With the decline in endogenous oestrogen production after 40 years of age, women gradually develop atherosclerotic lesions with fibrous cap formation. After menopause, atherosclerosis becomes more extended with the involvement of inflammation and the appearance of calcified atheromas (fatty plaques) in the vessel wall.’ – yes ladies, your blood vessels are ageing and changing.
Atheroschlerosis refers to the inflammatory changes in your arteries, characterised by the deposition of fatty material on their inner walls. As I used to say to physiology students, ‘Athero’ means ‘fatty and ‘Schlerosis’ means narrowing. Hence, fatty plaques which build up in your arteries, which narrows the blood flow. When your blood flow in your arteries is impeded, this can lead to a range of symptoms from dizziness, fainting and migraines or even a stroke (if it is your carotid arteries which supply blood to your brain) and if your cardiac (coronary) arteries are affected, your symptoms can range from angina (cardiac pain) to weakness, breathlessness, palpitations, fatigue, heavy and aching legs or for many women, a heart attack – yes, indeed as you move towards post-menopause and beyond, getting your blood pressure checked regularly, should be part and parcel of your Doctor’s visit.
The changing role of oestrogen in your heart and blood vessels:
Hypertension from loss of oestrogen isn’t the only contribution to changing heart health as we age – you can add smoking, being sedentary, family history of heart disease, kidney problems, poor diet and being overweight or obese to the list as well.
Some of these factors are lifestyle-related which means that you can make changes that help to reduce your cardiac risk with age, whilst some factors, like your genetic predisposition, you can’t change. But no matter what the other factors are that may be contributing to blood pressure changes, the one that is most important to understand is that your biological ageing and loss of oestrogen as you move through menopause, is a factor too.
Your loss of oestrogen matters in affairs of the heart – as does your lack of sleep and the inflammation you carry into this stage of life (e.g. from excessive exercise, other health problems, and a diet that doesn’t suit your changing hormonal environment). This is why most Coronary Heart Disease (CHD) events occur in women after 63 years of age, (Wofford & Reckelhoff, 2012).
When oestrogen levels decline naturally during our menopause transition, the walls of our blood vessels are altered. For years, your higher oestrogen levels have assisted in the dilation of the endothelial lining in the wall of the arteries, keeping them well dilated, allowing blood which is carrying oxygen and other nutrients, to be delivered to every organ around your body (Babika, Windt et al, 2002). As we lose the role of oestrogen then the risk for constriction of our blood vessels further increases the risk of fatty plaque formation, worsening their stability. Plaque instability is a major risk for heart attacks and stroke as we get older. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. If your blood pressure has increased, then yes, you need to lose weight, change your diet and manage your sleep and stress. It’s that important.
Those of you with increased risk for hypertension and the formation of plaques, need to manage the build-up of inflammation in your body.
If you don’t know your levels of inflammation, then ask your Doctor to check your C-Reactive Protein (CRP. CRP is a protein made by your liver. It’s sent into your bloodstream in response to inflammation. Inflammation is your body’s way of protecting your tissues if you’ve been injured or have an infection, or for those of you who have higher levels of oxidative stress building up in your muscles, from high levels of exercise in the past or if you aren’t sleeping or if you have high levels of emotional and physical stress. CRP is an indicative test of inflammation levels in the body and for women going through menopause or who are in post-menopause, it’s important.
Keeping your blood pressure under control:
The good news is that we can do something about our blood pressure. Yes, medications help and are important for management, but so too are lifestyle changes. Studies resulting from the Asia Pacific Cohort Collaboration clearly showed a progressive reduction in the risk of stroke and cardiovascular disease in both men and women between the ages of 47-70 years when blood pressure values were held around 115/75 mmHg. Notably, the researchers reported that just a 10 mmHg decrease in systolic Blood Pressure (the top number) was associated with a 41% lower risk of stroke (Angeli, Riboldi et al, 2019). Impressive stuff.
My 3 top-tips for managing your blood pressure:
- Change your diet. Don’t get fooled by diets that aren’t designed with our blood pressure in mind. All of the women who come on board into the MyMT™ programmes learn how important it is to follow a Mediterranean influenced, anti-inflammatory diet which is evidenced for helping our heart health – and yes, grains are important too. Click HERE to read my blog about this.
2. Add beetroot/beets to your diet. There is always a flurry of activity in my coaching groups when someone announces that they have added some beetroot juice to their dietary routines. I recommend it to them all (unless they have low BP) and I especially mention it to women who are exercising or training daily. Beetroot (or Beet) has compounds (nitrates) which help blood vessels to dilate. Dietary inorganic nitrate from vegetables such as beetroot is absorbed rapidly and completely in the small intestine with 100% bioavailability. So many women get put on anti-hypertensives in mid-life, but I wonder how many know to have their beetroot as well. But it’s not just beetroot that’s important – there are other vegies too. The vegetables with the highest nitrate contents (>250 mg/ 100 g fresh weight) are celery, cress, chervil, lettuce, red beetroot, spinach and rocket so go on, add these to your diet as well.
3. Sleep all night and reduce the inflammation that arrives as we age (this includes those of you who participate in heavy physical activity). As the first generation of women to be participating in so many different forms of sport and exercise, it’s important to manage the inflammatory changes that accumulate in your muscles and joints during menopause. If you aren’t sleeping, then you aren’t healing overnight and your immune system doesn’t recover nor does your cardiac muscle. If you aren’t sleeping, then you must turn this around and in the MyMT™ programmes, I have an emphasis on the circadian rhythm. Our heart and blood vessels are under the regulation of our day/night cycle as well as our seasonal cycle. Sleeping all night matters to your cardiac health and your blood pressure, (Douma & Gumz, 2019) as well as recovery from any exercise or sports you might be undertaking too.
For thousands of women world-wide, menopause arrives with a jolt. It did for me as well. That’s why I designed MyMT™ for you because it started out just for me. When nobody had the answers that I was looking for as to ‘why’ all the health changes were occurring and how to turn these around, I decided to look into what was really going on at this life-stage. If you are confused then please listen to my online Masterclass on Menopause which is 2 hours long but because it’s pre-recorded you can watch it anytime and ‘pause’ me when you like as well. Alternatively, come on board with me for 3 months. I would love you to learn what I now know about my changing heart and other organs in menopause and most importantly, what to do to look after ourselves better at this life-stage.
When you arrive into your private member area within either of the MyMT™ 12 week online programmes and put my powerful lifestyle strategies into action to help you re-balance your hormones in menopause, you’ll re-discover the joy of sleeping all night and feeling like your old self again. Thousands of women around the world have done these programmes and if you re struggling to get on top of menopause changes, then I want you to join me too. Whether you choose MyMT™ Circuit Breaker (for thinner/ leaner women) or you want to understand how to lose your menopause belly fat with MyMT™ Transform Me, then these powerful, scientifically evidenced programmes are for you. You only need 60 minutes a week over the 12 weeks to listen to each module that opens up in your private learning hub. As well, my private coaching community is where I post regular updates for you and you stay connected with me through here or via email if you have questions.
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Bonilla Ocampo DA, Paipilla AF, Marín E, Vargas-Molina S, Petro JL, Pérez-Idárraga A. (2018). Dietary Nitrate from Beetroot Juice for Hypertension: A Systematic Review. Biomolecules. 8(4):134. doi:10.3390/biom8040134
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Douma, L. G., & Gumz, M. L. (2018). Circadian clock-mediated regulation of blood pressure. Free radical biology & medicine, 119, 108–114. https://doi.org/10.1016/j.freeradbiomed.2017.11.024
Jones, T., Dunn, E. L., Macdonald, J. H., Kubis, H. P., McMahon, N., & Sandoo, A. (2019). The Effects of Beetroot Juice on Blood Pressure, Microvascular Function and Large-Vessel Endothelial Function: A Randomized, Double-Blind, Placebo-Controlled Pilot Study in Healthy Older Adults. Nutrients, 11(8), 1792. https://doi.org/10.3390/nu11081792
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Lima, R., Wofford, M., & Reckelhoff, J. F. (2012). Hypertension in postmenopausal women. Current hypertension reports, 14(3), 254–260. https://doi.org/10.1007/s11906-012-0260-0
Zhou, B., Danaei, G. … Ezzati, M. (2019). Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. The Lancet, 394 doi: 10.1016/S0140-6736(19)31145-6