For many women, menopause brings hot flashes, sleep changes and mood swings. What’s talked about far less is what’s happening to the heart.

Before menopause, women tend to have lower rates of cardiovascular disease than men, along with healthier cholesterol profiles. But as estrogen levels decline during and after menopause, that protection begins to fade, triggering changes throughout the body that can raise the risk of heart disease.

The loss of estrogen affects blood vessels, cholesterol, metabolism and inflammation — all key players in cardiovascular health. Blood vessels can become stiffer and less flexible, cholesterol levels may rise and the body becomes more prone to plaque buildup in the arteries.

Here, the experts at Novant Health Lowcountry OB-GYN - Mullis explain more about estrogen's role in heart health.

Beyond hot flashes

Women tend to think hot flashes and night sweats are the worst menopause doles out. But there are serious, long-term health risks some doctors aren’t even aware of. Women with frequent and persistent hot flashes have substantially increased cardiovascular disease risk.

Women who entered menopause early — by age 42 or earlier — and/or had extreme night sweats and hot flashes have a 32% increased risk of cardiovascular events.

That’s because the thickness of our arteries increases with persistent hot flashes and night sweats. And if you start having them early, you have twice the risk of a cardiovascular event, like a heart attack, compared to women with later-onset symptoms.

In other words: They’re big red flags.

Be your own advocate

That’s not their fault. The connection between menopause and heart health is barely touched on in medical schools — not intentionally, but because most cardiac research has historically focused on men.

Fortunately, the menopause-cardiac health link is beginning to get more attention.

A recent CNN headline read: “More than a dozen states consider laws around menopause care and training for doctors.” And NPR reported, “Doctors don’t get much menopause training. State lawmakers are trying to change that.”

Gender and heart disease

Heart attacks can present very differently in women. Instead of the classic clutching-your-chest moment, it can be as vague as nausea, fatigue, even jaw pain.

Women who have heart attacks are at a distinct disadvantage. Men are more likely to survive a first heart attack than women are.

More women die from a first heart attack than do men, owed to women's smaller coronary arteries that start to thicken with estrogen loss.

Women are also less likely to be treated for cardiovascular disease with a statin, like Lipitor and Crestor, to help lower LDL (or “bad”) cholesterol.

Lessen your risk.

Early intervention is key to addressing potential heart disease. If you’re going through menopause — and it can last for several years — and have extreme symptoms, here are some tips to guard your cardiovascular health:

• Manage your blood pressure. Eat healthfully, get aerobic exercise and do weight-bearing exercise. Pharmacology can’t overcome a bad diet and sedentary lifestyle.
• If you’re concerned about the menopause/cardiac health connection, make an appointment with your OB-GYN to discuss the issue.
• Ask your primary care doctor for an EKG. And chances are, you’ll have to ask.
• Depending on the results of your EKG, consider asking for a referral to a cardiologist.
• Ask your provider about menopausal hormone therapy (formerly referred to as hormone replacement therapy or HRT). If you start it before the onset of cardiac symptoms, you can decrease your risk of cardiovascular events, such as heart attack and stroke.
• If you and your doctor determine hormone therapy isn’t right for you, aggressively treat any other risk factors you have for cardiovascular disease. If you’re on medication for high blood pressure, for instance, stay faithfully compliant.
• If you’re in, or approaching, menopause and looking for a new OB-GYN, look for one certified by the Menopause Society.