Menopause, Hormones & How to Stay Heart-Healthy During Menopause Featuring Dr. Jayne Morgan

When you think of menopause, you think of hot flashes, mood swings, and other annoying symptoms. But are they just annoying? Or dangerous? You might not be aware that there are cardiac consequences to menopause. 

We’ve wanted to do a webinar with Dr. Jayne Morgan for a while. Dr. Morgan is a cardiologist and executive director of health and Community education at the Piedmont Healthcare Corporation in Atlanta, the largest healthcare system in Georgia. Within this role, she works to serve health literacy and information both internally to the 35,000 employee system as well as to external stakeholders. She is the recipient of several awards acknowledging her work and providing accurate science and medicine to all communities, including the NAACP Award, the National Women's Empowerment Award, the Atlanta Business Chronicle Award, and the Medical Association of Georgia Humanitarian Award. Dr. Morgan is published in the areas of congenital heart disease, interventional cardiology, and COVID-19. 

We were so lucky to be able to have her on with Alloy community manager Rachel Hughes. Watch the whole interview on our YouTube, and check out some of the highlights (edited for length and clarity) below!

Rachel Hughes:

Welcome, Dr. Morgan. It's a pleasure to meet you, to sit with you and to learn from you today. There's a lot to get into, so I'm just going to dive in. My first question is a broad strokes one. Could you explain the relationship between menopause and heart health? How does menopause affect the cardiovascular system in women?

Dr. Jayne Morgan:

Rachel, thanks for having me back and it's a pleasure to be here. It's such an important topic and we, including physicians, are still learning. This is a journey that begins with the Women’s Health Initiative. The trial started almost 30 years ago, and the purpose was to look at cardiac outcomes in women who were taking Menopausal Hormone Treatment. When the trial was stopped, we stopped learning, and we stopped prescribing MHT.

So now we need to go back. And so when we look at heart disease, one of the things that is very clear is that prior to menopause, during a woman's reproductive life, her risk of heart disease is half that of a man's. Once you transition through menopause, her risk becomes equal to that of a man. Once she’s in her seventies, it actually surpasses that of men. Why?

We know now that estrogen is cardioprotective. It decreases your cholesterol, and it’s anti-inflammatory. And we can talk about that, how cardiology and heart disease is increasingly being recognized as an inflammatory process as well. 

Rachel Hughes:

Fantastic. Thank you so much. That's a wonderful place to start. I just want to clarify, are there any specific symptoms or signs that women should be aware of during menopause that could be indicative of heart problems or issues? I’ve already heard from several people who have questions about their palpitations. Are they a symptom of heart problems?

Dr. Jayne Morgan:

The answer is yes and no. Palpitations in women are often misunderstood. You can have them during perimenopause, which generally starts around the age of 41, when your estrogen levels are beginning to fluctuate. And they can be scary, and can send you to the emergency room. And if you have them, you should get a cardiac workup, an EKG, but if nothing is found, we can begin to consider them as a symptom of fluctuating levels of estrogen, and you might want to think about something like Menopausal Hormone Treatment. On the other hand, you might find something in an EKG, and in that case, they can be a symptom of heart disease.

And as a woman, you should not be treated as a man. There are going to be sex differences. And after your cardiac workup is done and it is negative, then there's another step that we need to consider in the treatment paradigm just as we do in any other algorithm through which we work for any patient. As we get to ruling things in, ruling things out, what's the next step that we go to? MHT has to be something that is considered as a part of that cardiac workup, especially if the cardiac workup is negative and that person is in the right age range.

Rachel Hughes:

Fantastic. Could you speak a bit more about cardiovascular screenings of women approaching or going through menopause? Someone asked specifically about tests or assessments recommended that women should request as they're approaching or going through menopause. 

Dr. Jayne Morgan:

Let's have this conversation. Let's start with a woman's reproductive years. So during the time when you are having pregnancies, if during your pregnancy you have been diagnosed with preeclampsia, eclampsia, pregnancy induced hypertension, high blood pressure, gestational diabetes, or even an older term toxemia, if any of those terms have ever been applied to your pregnancy, the cure for these risks is to deliver the baby safely. So that's how we've been trained. Once you deliver the baby, then these symptoms resolve. Mother is safe, baby is safe, everything is fine. Hooray, let's clap.

What we now know is that if you have been diagnosed with any of those conditions, then you have declared yourself as having an increased risk of heart disease over your lifetime. In fact, a twofold increased risk of heart disease. And pregnancy serves as your first stress test, and if you have any of these diagnoses, then you have failed that first stress test. And a cardiologist would view that patient as a volume overloaded patient with a failed stress test.

But often we don’t do anything about it. There should be a handoff from the OB-GYN to a cardiologist, just like any other patient who fails a stress test would be sent to a cardiologist. That happens rarely, and it almost never happens in populations of color. So, imagine you already have a twofold increased risk of heart disease and it’s time for menopause. Do you see where this is going? 

Rachel Hughes:

Yes, absolutely. You mentioned cholesterol earlier. You're speaking about the protective qualities of estrogen. Someone asked about cholesterol, heart and hormones. Could you expand on that and also speak a bit more about how estrogen plays a role in heart health and inflammation?

Dr. Jayne Morgan:

Estrogen and cholesterol are intertwined in this sort of dance and we are still working to unravel that. We have to have research that is specific to vulnerable populations and women at midlife are an underrepresented vulnerable population. The way we practice medicine in the United States, these companies do these big trials, and mostly white men are enrolled and recruited into these trials. We gather great data, the data goes before the FDA, and it’s approved. We get a new drug, and then we extrapolate it to the rest of the populations.

And even though most of the world is not white men, most of our drugs are developed for them and by them. We’re not included in the trials, and we don’t have trials that are specific to our interests. There have been no clinical trials doing head to head comparisons of statin therapy versus MHT in perimenopausal women, in menopausal women. 

But here’s what we know. Cholesterol is the building block of estrogen. The foundation of estrogen is cholesterol. When we look at perimenopausal women, (by and large, women in their forties), we see increased cholesterol levels. And what a doctor may do is prescribe them a statin. And the question is, should we be treating with hormones to bring your cholesterol back into a normal range as opposed to allowing your estrogen to continue to drop and giving you statins? There’s some data that says that this can be more effective. But these are early studies, not big trials. 

Rachel Hughes:

Fantastic, thank you. Can you share more about the anti-inflammatory effects that estrogen has on blood vessels?

Dr. Jayne Morgan:

I love this conversation. Let’s get into it. Acute inflammation is when you injure yourself and your body reacts to address the injury and to promote the healing process. That’s an inflammatory process that’s helpful to us. There’s also chronic inflammation, which is a problem. Our body recognizes we’re injured and responds, but we’re not actually injured. And it responds with this chronic inflammatory process, which causes all kinds of problems including increased rates of cancer and increased risk of autoimmune disease. And there are a lot of things that can contribute to chronic inflammation. Artificial sweeteners, artificial color, and processed foods are considered pro-inflammatory. Obesity is also a chronic inflammatory process. Smoking is another one.

When it comes to heart disease, what we see is that chronic inflammation can cause a proliferation of the plaques in your arteries. Plaques can build up in the arteries that are bringing blood and oxygen to your heart, and those plaques can be caused by high cholesterol levels or high blood pressure that's gone untreated, accelerated aging. But they then add to those plaques and those plaques get larger. They can occlude the artery, meaning they're so big that they block the artery, you don't get blood supply. That's what causes a heart attack. Or they can loosen the plaque and it can dislodge and move upstream and cause a stroke. So that's how inflammation impacts the arteries in our body.

Now, let's get back to menopause. When we look at data, women who've had a life or at least many years of eating a diet that has lots of fried foods, lots of processed things, lots of packaged foods, artificial sweeteners, we see that they enter menopause a year and a half earlier.

Rachel Hughes:

Wow.

Dr. Jayne Morgan:

When we talk about food being medicine, it's something that you've got to do over the course of your lifetime because it's going to impact when you enter menopause. Menopause is going to impact when your estrogen levels decrease. Estrogen levels dropping are going to increase when your rate of heart disease will begin to equal that of a man. All of it starts with food.

Rachel Hughes:

That's amazing. I want to touch on food, I want to touch on exercise, and I am going to get to people's questions. It sounds so funny to have gone through 35 minutes of a conversation and have not mentioned hot flashes. I didn't realize until I spoke with Dr. Sharon Malone, our Chief Medical Advisor, that the frequency and severity of hot flashes were tied with heart disease. My father died from heart disease. And when I made that connection, I’d been having horribly unreasonably frequent, and increasingly severe hot flashes. And I said, “I’m done. It’s time for MHT.” 

Dr. Jayne Morgan:

I'm so glad you brought that up. Let's talk about symptoms like insomnia, night sweats, the hot flashes, brain fog, fatigue. Did you know that insomnia, or sleeplessness, has a direct correlation with heart disease? Both the duration of sleep and the quality of it. And we know during menopause, sleep is frequently interrupted. So now we have women whose estrogen levels are dropping, their risk of heart disease is increasing and, they've got an independent risk factor also as one of the symptoms of menopause going on. What is another one that we talk about with menopause and perimenopause? And then there’s hot flashes. The severity and intensity of hot flashes is also correlated with heart disease. We know that black women tend to have hot flashes of longer duration, greater intensity, and over longer periods of time. So there’s a further increase in heart disease. And so for us to have this sort of lexicon of let's just suffer through, it begins to be something that's almost intolerable for me as a cardiologist because I'm recognizing that the symptoms of menopause are also independent risk factors for heart disease and so they need to be addressed and need to be taken care of. They're absolutely not innocuous. 

Wondering about the best foods to eat to avoid heart disease? Are eggplant and tomatoes good for you? Questions about tachycardia? Want to know when to go in for a cardiac workup? 

There’s WAY more from our interview with Dr. Jayne Morgan. Watch the whole interview on our YouTube!

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