Article – Heart & hormones: this is what every woman wants to know about cardiovascular disease during & after menopause

You would say that with such alarming figures, all alarm bells should go off for both women and doctors when there are heart complaints. Yet many women do not think of a heart problem when they experience chest pain and do not quickly call 911. On average, women call 21 minutes later than men, even though those first minutes are so important.

LESS ESTROGEN, MORE CARDIOVASCULAR PROBLEMS

What is also very strange, according to gynecologist Dorenda van Dijken and cardiologist Janneke Wittekoek, is that medical research and also in the doctor’s office often do not look at the impact of hormones on the female body. They therefore wrote a book together: Heart & Hormones, fit into menopause.

What about those hormones again? Hormones are signaling substances made by hormone-producing (endocrine) glands. These substances reach cells or organs where they do their work via the blood and other body fluids. Most hormones are a kind of regulatory cousins: they can initiate, accelerate or slow down processes. They also influence each other. In addition to a lot of other hormones, the sex hormone estrogen is essential for women. Estrogen is secreted by your ovaries and fat cells can also produce this hormone. It ensures that you become sexually mature, can become pregnant and can give birth. In addition, estrogen is the largest collagen builder: collagen is a protein that ensures that the skin, mucous membranes, ligaments, tendons, muscles, bones, cartilage and also blood vessels remain supple and elastic.

When we enter menopause, the amount of estrogen decreases dramatically; by 80 percent in five to ten years. This decrease causes the typical menopausal symptoms such as mood swings, ‘brain fog’ and loss of concentration, night sweats, hot flashes, etc. The risk of cardiovascular disease also increases. It works like this: the inner lining of the blood vessels contains receptors for estrogen, through which the hormone can be absorbed. Estrogen ensures that the vessels remain flexible and elastic, it has a vasodilatory effect, keeps cholesterol levels and blood pressure low and protects against arteriosclerosis. When this hormone largely disappears during menopause, the vessels become stiffer and stiffer. Arteriosclerosis (clogging of the blood vessels) and contractions: spasms of the blood vessels can occur. This can cause pain or a tight feeling in the chest.

The sooner you enter menopause, the greater the risk of cardiovascular disease. Women who enter menopause (too) early are therefore always urgently advised to use hormone supplementation, i.e. a pill or a patch that supplements the estrogen deficiency.

OVERWEIGHT AND UNDERWEIGHT, HORMONES AND YOUR HEART

In her HeartLife clinic, which Wittekoek founded ten years ago, she stands for a holistic approach, by which she means that the entire patient is looked at, not just cardiovascular problems.

“While talking, I and the woman find out where the pain points are. I always include lifestyle and risk factors, while also being alert to stress. For some of my patients – the majority of them women, often who have been struggling in the medical circuit for a long time, often also looking for a second opinion – you can let go of the usual protocol, home-garden-and-kitchen cardiology: they have a rhythm disorder, a valve problem, a clogged blood vessel. A large number of my patients go off the rails due to hormonal disruption. This starts around the age of fifty. Then you can gain weight in a short time – on average two to four kilos in the first four years of menopause. Especially if you were already overweight, extra belly fat can cause inflammation in your body, which in turn has a bad effect on your blood vessels. Being overweight also means that your heart has to pump harder, causing high blood pressure to develop. Being too thin is also not good, as estrogen levels that are far too low can cause cardiovascular disease and osteoporosis. So it is better to have a size 38/40 than a size 34.”

SLEEPING, HORMONES AND YOUR HEART

Wittekoek: “Fifty-plus women often sleep less well due to night sweats or stress. And if you don’t sleep well, the incinerator does not work properly and the hormones that regulate your feeling of hunger – ghrelin and leptin – can become disrupted. You also see this among people who work night shifts. And because you are tired during the day, you exercise less and perhaps eat more comfort food. If high blood pressure and increased cholesterol are added, you may develop vascular problems. Especially if you belong to the risk groups (see box), you can have a closed vessel within two years.”

Because losing weight is so terribly difficult, Dorenda and Janneke say: make sure you are fit and without excess weight for that transition in time. So start eating healthy, drinking very moderately, not smoking, and exercising a lot around the age of forty. Janneke: “Prevention is the magic word.”

STRESS, HORMONES AND YOUR HEART

What Janneke sees remarkably often in her patients: that they suffer from excessive stress. “It is often a little bit of everything: a little high blood pressure, a little too high cholesterol, a little too heavy, a little too little exercise. If you add a lot of stress, you can have a stress attack. Stress releases large amounts of the hormones adrenaline and norepinephrine. These cause cramping of the small vessels around the heart. Then there is a lack of oxygen in the heart muscle without clogged blood vessels. Much more research needs to be done, but we already know that hormone balance plays an important role in this type of heart attack. That is why it is so important for doctors that we do not focus on our own small field of expertise, but look at the woman with all her facets, including her head and her hormones. We really need to move towards integrated women’s care.”

Wittekoek is convinced that the current times, with all their stimuli, cause much more stress than, say, thirty years ago. “Because of the 24-hour society, our screens that constantly distract us, because of a lot of light and sound stimuli, we are constantly on. This has an effect on our brains: we can hardly read a book anymore, we have an attention span of nothing. Women seem to be less able to cope with this than men and suffer more from stress than ever. I don’t think it’s surprising that this is causing new heart diseases. Chest pain due to stress is what I call neuro-vascular angina pectoris. I really think that is a new disease. This is also confirmed by the scientific literature that already exists on this theme. Sleep also plays a major role in this. A person can be quite stressed, as long as you recover sufficiently. Eight hours of sleep is not an unnecessary luxury. That is why I often refer people to a sleep clinic to have their sleep quality examined.”

What can you do for patients suffering from excessive stress?

“Sometimes the stress is caused by great sadness or trauma, which of course I cannot treat. At most I can refer these women to a psychiatrist. I also refer women in whom I suspect ADHD – and many more women than was previously assumed – have them. Women with ADHD often suffer from hormonal mood swings or depression and cardiac complaints. With the rest of these patients I talk about the importance of sleep, relaxation, yoga, mindfulness, walking and looking at art, saying no more often, and regaining control of your own time. I listen carefully and ask: what do you really like in life? You should not underestimate what attention and care can do for a person. Once they have been here for a few hours, they have had all kinds of tests and I can assure them that there is nothing wrong, but that the palpitations do indicate that they are in overdrive and they should take it easy, then they are often so relieved and reassured. At HeartLife I really had to learn to do nothing sometimes. Reassuring, explaining that the heart is good, but of course reacts if you are an overworked woman with a job and children and informal care responsibilities and only sleeps four hours because of the stress. If I succeed, I will arrive at what, for me, is the core of being a doctor. That makes me so happy.”