From Menopause to PCOS: Delhi-based doctor explains how hormones impact women’s heart health — and 5 ways to cut risk

to the highest degree individuals consider bosom disease as a "man's job," but it is, in fact, the leading cause of death for women globally. Women are more prone to heart disease because of the hormone changes during their life cycle, such as menstruation, pregnancy, perimenopause, and menopause. It is essential to understand the effects of hormones on heart health to prevent and treat heart disease early.

Dr Tripti Raheja, Director - Obstetrics & Gynaecology at the CK Birla Hospital, Delhi, reveals that the principal hormone affecting women's heart health is estrogen.

“Throughout the reproductive years, estrogen balances cholesterol, prevents artery hardening, and improves circulation by its anti-inflammatory effect. It increases HDL (the good cholesterol), decreases LDL (the bad cholesterol), and diminishes the inflammation in the blood vessels,” says Dr Raheja.

As women approach perimenopause and menopause, estrogen levels fluctuate and eventually decrease. This transition leads to a series of alterations that elevate heart disease risk.

According to Dr Raheja, one of the major changes with age is an increase in LDL cholesterol, often accompanied by a decrease in HDL cholesterol. At the same time, blood vessels become less elastic and blood pressure tends to rise. In addition, fat accumulates around the waist, a recognised risk factor for heart disease.

Post-menopausal, heart health may be affected by other hormonal disorders. For instance, Polycystic Ovary Syndrome (PCOS) leads to insulin resistance and increased levels of male hormones (androgens), and these two factors raise the likelihood of getting diabetes, being overweight, having high blood pressure, as well as heart problems. Problems with the thyroid gland, especially an underactive thyroid, can lead to high cholesterol, slow metabolism, and, as a result, the heart must work extra hard.

Pregnancy issues like gestational diabetes, high blood pressure, and preeclampsia are strong warnings of possible heart diseases that women might face in the future. Women who have such problems during pregnancy suffer more from heart disease later in life, says Dr Raheja.

Women’s heart disease symptoms can be different from men’s. Instead of the typical sharp pain in the chest, women may experience fatigue, breathlessness, nausea, dizziness, jaw pain, or back discomfort. These signs are often confused with stress, anxiety, or digestive issues, which can delay diagnosis and treatment.

Moreover, women often prioritise their family’s health over their own, resulting in fewer routine screenings, says Dr Raheja. This can lead to late detection of risk factors like high blood pressure, cholesterol issues, or insulin resistance.

Women can prevent many heart risks related to hormonal changes with the right lifestyle choices and medical care.

Women should regularly check their blood pressure, lipid levels, blood sugar, and waist circumference, especially after age 40 or earlier if there’s a family history or pregnancy complications.

A clean diet of whole fruits and vegetables, grains and lean proteins, nourishing nuts or healthy fats can help provide the vitamins needed to ward off changes in the body caused by metabolic hormones. Limiting processed foods, added sugars and trans fat will help control both cholesterol and inflammation.

Physical activities decrease insulin resistance, help maintain a healthy weight, lower blood pressure, and optimise hormone function, to name just a few.

When you’re constantly stressed, it drives up cortisol levels in the body, leading to belly fat, elevated blood pressure, and insulin resistance. Indeed, interventions such as mindfulness, yoga, a good night’s sleep and relaxation techniques are all important ways to actively protect our hearts.

Women with early menopause, PCOS, a thyroid disorder or severe symptoms should talk to their providers for an individual risk assessment. “In some cases, hormone treatment can help improve symptoms for women, but not every woman is an appropriate candidate for this type of treatment,” says Dr Raheja.

Hormone changes are part of the natural order of life as a woman, but they can take their toll on heart health.

By identifying risk factors early and treating them through healthy lifestyle choices, women can reduce their chances of developing cardiovascular disease later. Ageing is not the only thing that shapes women’s heart health; hormones do, too, and if you’re going to do something about your hormones when they matter for your heart, you need to do it when they count.

(The author, Nivedita, is a freelance writer. She writes on health and travel.)

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