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Hormones and heart health: When to get a heart check

Women's Health Week
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Heart disease is one of the leading causes of death in Australia, and for women, heart disease risk rises around menopause. Here, we look at why the hormone oestrogen matters and the best ways to care for your ticker at midlife.

To the heart of the matter!

Most of us know that good eating habits and plenty of exercise are great for our heart. But what you mightn’t know is that the hormone oestrogen is another key player in the heart health game.

Oestrogen is not only important for reproductive and bone health, it can also help keep our cholesterol levels in check, according to Prof Garry Jennings, Chief Medical Adviser at the Heart Foundation.

The hormone is believed to be one of the reasons younger women are somewhat protected from heart disease – they have relatively high levels of oestrogen. However, come menopause, oestrogen levels naturally fall and a woman’s risk of heart disease increases.

More to the story

According to Prof Jennings, this drop in oestrogen can lead to a rise in LDL or ‘bad’ cholesterol and fall in HDL or ‘good’ cholesterol. It’s also worth mentioning that women’s hormone levels aren’t the only factor affecting heart health at midlife. Prof Jennings says that blood vessels can become less flexible and more prone to plaque build-up. “Together, these changes can lead to high blood pressure and sometimes high blood sugar (glucose) levels, which are important risk factors for heart disease.”

Weight gain generally occurs around this time, which can have an impact too, adds Jean Hailes endocrinologist Dr Sonia Davison. “[It] tends to be around the abdominal or tummy region, and is linked with increased risk of heart disease,” she says.

Then there’s the effect of menopause on exercise levels. In an ideal world, we’d keep the heart in good shape with plenty of physical activity. But, according to Dr Davison, “those women who have bothersome menopausal symptoms that impact mood or sleep may do less exercise as they may not feel [up for] exercise”.

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The power of heart health checks

So at what age should women visit their doctor for a heart check?

According to Dr Davison, women are encouraged to get regular heart health checks from age 45. Aboriginal and Torres Strait Islander women have a higher risk of heart disease, so checks should ideally start from age 30-35.

Prof Jennings adds that all women should see their GP for a heart check earlier than these recommended ages if they have a family history of heart disease at a young age or any of the ‘women-specific’ risk factors for heart disease. “These include premature or early menopause, polycystic ovarian syndrome (PCOS), or a history of pregnancy conditions like pre-eclampsia or gestational diabetes,” he says.

Time to take action

“Menopause [including the years leading up to it] is generally associated with symptoms that bring [women] to their GPs for information and advice, plus general screening,” says Dr Davison. So for many women “this time is a great opportunity to talk about cardiovascular health and plan for the future”.

As for ways to protect your heart at midlife, beyond getting it checked, Prof Jennings says “following a heart-healthy eating pattern, being physically active, quitting smoking, cutting down on alcohol and maintaining a healthy weight [all count]. Looking after your mental health is also important for heart health because we know depression and anxiety are risk factors for heart disease”. This is partly because it can be difficult to maintain heart-healthy habits, like regular exercise, when you are struggling mentally.

Ultimately, Dr Davison says it’s about understanding your risk, and finding healthy ways to reduce that risk.

What to expect from a heart health check…

  • A 20-minute consultation – This gives your GP time to assess your risk of heart attack or stroke within the next five years.
  • Different tests – These include a check of your cholesterol, blood pressure and blood sugar levels.
  • A conversation about your lifestyle and medical history – Your doctor will want to know about your diet, if you smoke, your drinking habits, exercise levels, weight, family history and medical history.
  • Forward planning – If needed, your doctor will explain what steps you can take to reduce your risk of heart disease and stroke. This may involve your GP prescribing medication to help lower your blood pressure or cholesterol levels if they are high. They may also suggest seeing other health experts for additional help, such as a cardiologist or dietitian.
  • Regular checks – Your GP can tell you when you need to have your next heart health check – commonly once every year or two.
  • Medicare subsidy – Women aged 45+, and Aboriginal and Torres Strait Islander women aged 30+, are eligible for an annual Medicare subsidised heart health check. This means the check is free at practices that bulk bill this service. However, it’s worth calling your doctor’s office ahead of your appointment to check if there will be other out-of-pocket costs.
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