Every year, more than one million women in the United States experience menopause, the point in time where a woman has stopped having a period for 12 months.

During menopause, hormonal levels fluctuate widely, causing uncomfortable symptoms like hot flashes, disrupted sleep, night sweats, and mood changes.

Menopause also comes with an increased risk of heart disease, the No. 1 killer of women, causing 1 in 3 deaths each year, according to the American Heart Association.

NYU Langone cardiologist Harmony Reynolds, MD, spoke about what’s behind the connection between menopause and heart disease risk, the biggest misconceptions about menopause, and what women can do to protect their hearts during this life transition.

Everyday Health: Why is menopause linked to a higher risk of heart disease?

Harmony Reynolds: As both men and women get older, there is an increased risk of heart disease. This is a time where the risk of high blood pressure and cholesterol increases, both of which are major risk factors.

But whether or not something magical happens during menopause that puts women at a higher risk of heart disease, we still don’t know yet. The current belief based on research is that there is an independent contribution of withdrawal of female hormones that comes with menopause to an increase in cardiovascular risk. But what exactly the mechanism is, I don’t think that’s known.

There are other risk factors at play, as well. For women, in particular, I think that one of the key mediators is that the metabolism tends to slow around menopause, and that facilitates weight gain. Certainly obesity is a risk factor for cardiovascular disease.

So it appears it's something both about female hormone withdrawal, and about the changes in risk factors that happen around age 50.

EH: Many women experience disrupted sleep during menopause. How might that affect heart health?

HR: Getting good sleep is now one of the key indicators of cardiovascular health and one of the American Heart Association's Life’s Essential 8. We used to have Life’s Simple 7, and that was to manage blood pressure, control cholesterol, reduce blood sugar, manage weight, maintain a healthy diet, exercise, and avoid smoking. Now, sleep is considered the eighth metric of cardiovascular health.

To the extent that menopause disrupts sleep, it's presumed that it makes cardiovascular health worse, at least in that time frame while the sleep is disrupted. The effects of poor sleep are related in part to the nervous system. So we have the sympathetic (“fight or flight”) and the parasympathetic (“rest and digest”) nervous system. When we don't sleep enough, we tend to have more of the sympathetic nervous system response, which may make you feel more irritable, and you may make poor food choices, which could result in weight gain. So oftentimes risk factors will feed into one another.

EH: What do you think are some of the biggest misconceptions around menopause and heart health?

HR: One of the biggest misconceptions is that weight gain and a rise in blood pressure are inevitable with menopause. That’s not really true. It is an important time to be attentive to calorie intake and energy expenditure. It's a time when we need to make sure that we are eating healthy and exercising, because it’s a time when we are prone to weight gain, and we want to stave that off. So some people think that you're just going to gain that weight and there's nothing you can do about it. It turns out if you are careful about eating healthy and exercising, you may be able to avoid the weight gain or at least reduce the amount of weight gain.

EH: What else can women do during menopause to protect their hearts?

HR: The American Heart Association has focused for a long time on aerobic exercise, or cardio, because we know that it's good for the heart. And that’s still very important, but it turns out that it's also important to do muscle strengthening exercises. Muscle strengthening is particularly helpful in regulating metabolism and helping us not gain weight because muscles store glycogen, which is basically starch, and can help prevent diabetes. So I think it’s important to make sure that you’re doing cardio, but also get strength training into your routine. You don't have to get jacked, but you do have to have good muscle tone in order to help regulate metabolism and make your heart as healthy as possible.

EH: Are there any supplements you recommend women take during menopause?

HR: I don’t recommend any supplements. If you have a risk factor like high blood pressure or high cholesterol and your doctor recommends medication for it, then take that medication. But in terms of supplements, there’s nothing else to take. Your medicine is healthy food and exercise and getting enough sleep.

EH: In light of Heart Month, what message would you want to get out to women in terms of taking care of their heart health?

HR: Women need to know that heart disease is the leading killer of women. I say this not to frighten people, but to point out that this is our disease and we need to be careful about it. Just like we go for mammograms, we need to also make sure that we're taking care of our hearts by eating healthy, exercising, and watching our risk factors every day.

Equally important is that heart disease is preventable and treatable. People worry that if they get heart disease, that's it, it's over, or they'll say things like, well, if I have a heart attack, that's the end of it. That's not the way it works. Heart disease can be disabling, but people survive through it all the time. And fortunately, heart disease is preventable. We know what the risk factors are, and we can address them. So if we haven't been as attentive to reducing cardiovascular risk as we should, maybe menopause is a good time to think about that so we can continue to feel well and be here for our families.

Menopause and Your Heart: Q&A With Dr. Harmony Reynolds