The transition to menopause is characterised by a decrease in circulating estradiol, relative androgen excess and a decrease in sex hormone-binding globulin concentrations. These hormonal changes are frequently accompanied by an increase in body weight, central obesity, dyslipidemia, insulin resistance and an increase in blood pressure. Aging, comorbidities, depression and inactivity further contribute to the increase in cardiovascular risk after the menopause. Beyond traditional cardiovascular risk, female specific risk factors consist of a history of preeclampsia or gestational diabetes, a history of PCOS and the presence of severe menopausal symptoms. The risk of ischemic heart disease and stroke increases steeply after the menopause, becomes equal to that of men after the age of 60 and is higher than the risk of men after the age of 75. Cardiovascular mortality in Europe is higher in women compared to men, as women are less aware of their risk and less likely to seek medical help. Life style adaptations including healthy eating patterns, physical activity, maintaining a normal body weight and quitting of smoking are the cornerstone of prevention. Menopausal hormone therapy (MHT), if commenced within the first 10 years after menopause, has a favourable effect on the cardiovascular system, as it promotes vascular compliance, prevents central adiposity and restores lipid and glucose metabolism. MHT, if properly customized, is effective and safe for the majority of women. Transdermal estrogens are the best option for women with risk factors for thrombosis, like obesity or a family history of venous thromboembolism. A metabolically neutral progestogen, like micronized progesterone, dydrogesterone or transdermal norethisterone should be chosen for women with dyslipidemia or impaired glucose metabolism.
18 - 21 May 2019
European Society of Endocrinology