Morag returns for another visit with her healthcare provider to go over the results from her last visit and discuss what they mean.
Results from Questions Asked
The notable results from the questions Morag was asked by her healthcare provider were:
- Her last menstrual period was 4 years ago, she has not experienced any bleeding after sex (post-coital bleeding), and she is not using a form of contraception.
- She has not had a hysterectomy and she has no personal or family history of breast, ovarian, or uterine cancer.
- Morag is up to date on her smear tests (cervical cancer screening) and mammograms (breast cancer).
- She reports a family history of cardiovascular disease as her father had a heart attack (myocardial infarction) at 64 years old. Morag indicated that her father recovered well and is now in his early 80s.
- Morag smokes up to 20 cigarettes per day on average.
- She eats a diet high in salt, carbohydrates like white pastas, breads, and rice. She does not eat the recommended amount of fruit and vegetables.
- She drinks about 10 units of alcohol per week.
- She doesn’t exercise, but she notes she is very active from looking after and playing with her grandchildren and from the physical labour of her cleaning job.
The following results are from the examinations done:
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The menopausal transition can impact different aspects of health, including cardiovascular health. Understanding the relationship between menopause and cardiovascular health is very important for supporting overall wellbeing during and after this stage of life.
Research has shown that the transition to menopause is associated with a higher likelihood of developing certain cardiovascular disease risk factors, and therefore cardiovascular disease. Additionally, the risk for cardiovascular disease is even greater for individuals who experience early menopause (menopause before 45 years old).
Why does this happen? It is because oestrogen has a protective effect on the heart and during menopause the levels of oestrogen fall.
Click on the different cardiovascular disease risk factors associated with menopause to learn more about them.
- For a refresher on the risk factors for developing cardiovascular disease, refer back to this page in the module.
Menopause is when an individual’s period (menstrual cycle/menstruation) stops (amenorrhea). This is because their ovaries no longer release an egg (ovulation) and there has been a decrease in hormone levels (oestrogen levels) in their body.
Disclaimer: Menopause affects anyone who has periods (menstrual cycle)
Please click on the categories below to learn more about menopause.
In Morag’s scenario, she is a woman experiencing menopause and has cardiovascular disease risk factors. She sees her healthcare provider to discuss her symptoms, receive a diagnosis, and explore treatment options.
While Morag goes over her symptoms, her healthcare provider reassures her that these symptoms are normal, and things can be done to help manage them. Following their initial discussion, she is assessed for menopause.
The results of the assessment and examinations indicate that Morag is menopausal and is at high risk for developing cardiovascular disease . The healthcare provider explains this to Morag and also goes over cardiovascular disease and how menopause can affect it.
After discussing treatment options, Morag works with her healthcare provider to create a comprehensive treatment plan that addresses her menopause symptoms and cardiovascular disease risk factors. She receives a treatment plan that is tailored to her health and personal preferences to promote her cardiovascular health while improving her menopause symptoms. She is given information and resources to educate herself about her health and options available for her.
Overall, this scenario:
- Defines menopause and identifies the symptoms
- Explains the cardiovascular disease risk factors that are associated with / affected by menopause
- Identifies treatment options for menopause and their correlation with cardiovascular health
- Explains how cardiovascular disease risk factors associated with menopause can be managed
- Discusses how menopause can be diagnosed
- Provides resources for additional information
- Signposts to relevant health services
Image credits: onewomanhealth.com
From hormone therapies to lifestyle changes and alternative treatments, there are various options available to help manage menopause symptoms.
It is important that people experiencing perimenopause and menopause have regular check-ups with their healthcare provider to:
- Monitor and manage symptoms
- Tailor treatments to individual needs, ensuring both relief of symptoms and promotion of long-term health.
- Assess the risks and benefits of hormone replacement therapy
- Screen for heart disease and osteoporosis
Click on the different treatment options below to explore what is available for menopause and perimenopause symptoms.
After Morag and her healthcare provider have the initial discussion about Morag’s symptoms, her healthcare provider gathers more information to assess if Morag is menopausal and what treatment options may be suitable.
The aims of screening and evaluating for menopause are to:
- Screen and diagnose menopause-related issues and age-related diseases
- Assess general condition of the individual through clinical examination and basic laboratory tests to understand how the organs are functioning
- Create a treatment plan to manage symptoms that is tailored to the individual’s medical history and personal preferences.
Disclaimer: It is important to note that the use of laboratory tests, including blood and urine, to help diagnose menopause varies based on the individual’s health and symptoms as well as the health care professional’s preference.
- Blood or urine tests can help to measure levels of hormones including: oestradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).
During and after the menopause transition it is highly recommended that individuals get regular physical, pelvic, breast, colorectal, and skin exams to monitor their health.
Due to the risks associated with hormone replacement therapy, if it is being considered a treatment option for menopause symptoms, then a few examinations are recommended to be completed. These examinations include:
- Measure blood pressure
- Calculate Body Mass Index (BMI) by measuring height and weight
- Ensuring that smears (cervical cancer screening) and mammograms (breast cancer screening) are up to date
After reviewing the results with Morag, her healthcare provider explains that she is considered menopausal because she is over 45 years old, her last menstrual period was 4 years ago, and she has been experiencing menopausal symptoms for the last 5 years.
Her healthcare provider goes on to explain that Morag has risk factors for developing cardiovascular disease. These risk factors include:
- High Blood Pressure
- High Cholesterol
- Family history of cardiovascular disease
- Overweight body mass index
- Smoking
- Diet high in salt and refined carbohydrates, but low in vegetables.
Morag’s healthcare provider reviews what cardiovascular disease is. They go on to explain how menopause affects heart health and can impact the cardiovascular risk factors that Morag has. The healthcare provider stresses the importance of managing cardiovascular health and menopause symptoms to improve her overall health and quality of life.
Reassurance and Opportunity for Questions
Morag is reassured that there are treatment options that can help both her menopausal symptoms and her cardiovascular disease risk factors. Before they go on to discuss next steps, her healthcare provider answers any questions that Morag may have and ensures she understands what has been discussed so far.
Additional Information Provided
She is also provided with information and resources to take home with her about menopause as well as cardiovascular disease. By providing Morag with information about conditions that affect her own health, she is given the opportunity to educate and inform herself further with appropriate, relevant resources in her own time. This can promote and improve Morag’s confidence in understanding her body and her health.
As mentioned earlier, the lower levels of oestrogen due to menopause can affect heart health by increasing the likelihood of developing cardiovascular disease.
Managing menopause symptoms can in turn help promote cardiovascular health.
The cardiovascular risk factors associated with menopause can help to be managed by:
- Maintaining a healthy weight
- Not smoking
- Eating a healthy, balanced diet
- Reducing alcohol intake
- Increasing activity levels
Hormone replacement therapy (HRT) can help treat menopause symptoms, but there is also evidence that it can reduce the risk of developing cardiovascular disease (CVD). However, the effect of hormone replacement therapy can vary based on the following factors:
- The time the therapy was started based on age and/or time since menopause
- Underlying health
- How long the therapy was
Research suggests that if hormone replacement therapy is started in individuals who are younger than 60 years old and/or near/at menopause, then it can significantly reduce cardiovascular disease risk.
However, hormone replacement therapy does also have risks including blood clots, stroke, and breast cancer. It may not be suitable for those who have a history of cardiovascular disease.
When assessing the suitability of hormone replacement therapy (HRT), there is the following approach:
Important things to take into consideration for HRT and people who have had a heart attack:
- The starting dose is very important, it needs to be appropriate for the age of the patient.
- The type of progestogen may be important (non-androgenic progestogens preferred).
- The route of administration of oestrogen may be important.
- Non-oral administration being preferred in those with any perceived risk of thrombo-embolism.
- Tablets are higher-risk compared to patches.
- The co-administration of a statin may bring further synergistic benefits.
- Supervision from a specialist menopause clinic is recommended.
