Severe Menopause Symptoms Linked to Risk of Heart Disease, Study Finds

As more research is dedicated to women's health, there's a growing body of evidence on the relationship between menopausal symptoms, like hot flashes, night sweats, and brain fog, and certain health outcomes, like heart disease.

For example, a study published in 2019 found that women usually develop heart disease about 10 years later in life than men do, on average; but in 2020 a study noted that life events that affect women’s hormones, specifically menopause, can elevate a woman’s risk of cardiovascular disease (CVD).

A more recent study, published in the December 2022 issue of Menopause, closely examined the link between the severity of common menopausal symptoms and the rate of long-term heart disease and death. Researchers observed a group of more than 80,000 post-menopausal women for eight years. They looked specifically at the experience of night sweats, waking several times at night, joint pain or stiffness, heart racing or skipping beats, dizziness, feeling tired, forgetfulness, mood swings, feeling restless or fidgety, and difficulty concentrating — which covered all three types of menopausal symptoms: cognitive, somatic, and vasomotor. The women enrolled in the study had no known CVD before menopause.

They discovered that the severity of menopausal symptoms was significantly associated with heart disease and a shorter life span. The symptoms most associated with CVD were moderate or severe heart racing or skipped beats. Meanwhile, moderate or severe dizziness was most associated with an overall shorter life span, regardless of CVD status.

“What sets this study apart is the result showing the significant associations of mortality and [heart disease] risks among menopausal women with worsening severity of many individual menopausal symptoms,” says Matt Nudy, MD, an assistant professor in the division of cardiology at Penn State University in Hershey, who helped lead the study. “It is interesting and somewhat surprising to consider that the severity of a broad range of menopause symptoms may enhance sex-specific risk predication of [heart disease] and all-cause mortality.”

Dr. Nudy says women and their providers might want to consider the severity of their menopause symptoms when gauging their risk of heart disease. “It is important, however, to apply caution, as severe menopause symptoms may also indicate different health diagnoses and conditions not related to menopause.”

Unsnarling Menopause’s Impact on Heart Health

According to Erin Michos, MD, a preventive cardiologist at Johns Hopkins University in Baltimore who was not involved with the study, the relationship between menopause symptoms and heart health has not been widely discussed beyond specialists with expertise in women’s health. “A lot of patients and clinicians don't know about this link [between CVD and menopause], and women don’t bring it up because they are embarrassed.”

Most research prior to the Menopause study has focused on symptoms such as hot flashes and night sweats, also called vasomotor symptoms. One such analysis, published in the Journal of the American Heart Association in January 2021, looked at the relationship between the frequency of vasomotor symptoms and heart disease risk in 3,302 women. The women were 42 to 52 years old at the beginning of the study and underwent up to 16 in-person visits over 22 years. The analysis found that more frequent vasomotor symptoms (those that occurred on at least six days out of every two weeks) were associated with increased heart disease risk.

“So, this link [between menopause and CVD] has been described before as an association,” Dr. Michos says. “But what this new study adds is looking at a broader range of symptoms, like joint pain, heart racing, dizziness, as well as cognitive symptoms like feeling tired, forgetful, and so on.” And cognitive symptoms are commonly reported among menopausal women, she says.

While cognitive and somatic symptoms, such as a racing heartbeat or joint pain, are not as commonly studied, Nudy says they do appear on validated menopause symptoms checklists and questionnaires. In the study, all five individual cognitive symptoms — tiredness, forgetfulness, mood swings, feeling restless or fidgety, and difficulty concentrating — were associated with death and heart disease in some way.

So, while this recent study does not necessarily mean menopause causes heart disease, it echoes what previous research has shown about a link between the two. And it helps bring cognitive and somatic symptoms into the wider conversation about menopause symptom severity as a marker for CVD.

What’s Next for Menopause and Heart Health Research?

“The problem with these studies that find associations is that women with severe symptoms might have other reasons for them,” Michos says. For example, racing and skipping heartbeats were linked to CVD in the study, but those may or may not be symptoms of menopause. In some cases, they may actually have been a sign that something else was going on — such as an autonomic malfunction. “But while the symptoms [assessed in the study] may not be caused by menopause, they can be related to menopause.”

Michos is eager for researchers to explore the mechanisms that create this link between menopause and CVD. “Once you understand mechanisms, you can think about therapies and targets for prevention.”

At present, there are no established guidelines for a heart-health protocol for women with menopausal symptoms. “We focus on lifestyle and screening for risk factors, but we need more information on how to incorporate [menopause symptoms] into prevention guidelines,” she says.

Have Your Heart Checked During Menopause

If you’re going through menopause, now is a good time to have your heart checked. Unfortunately, most women don’t discuss menopause with their providers. According to an article in Obstetrics and Gynecology Clinics of North America, up to 80 percent of women experience vasomotor symptoms, but other research shows only about 25 percent seek treatment for them.

“In our society, there is somewhat of a stigma around menopause,” says Michos. “Many women are embarrassed to talk about it, so they may not know there are therapies that can help or that it’s linked to cardiovascular risk. But menopause is a normal transition in women's lives.”

And according to Nudy, over the past two decades since the landmark Women's Health Initiative Hormone Therapy clinical trial, researchers have learned much more. “It is important for women to know that the treatment of [more severe symptoms] is not only safe and able to help improve their quality of life, but also may interact with other health benefits in the process.”