What is 'Vascular Aging' in Menopause? How Estrogen Affects Your System

Vascular Aging in Perimenopause and Menopause: What Every Woman Should Know

The hormonal shifts you’re experiencing in midlife can have a major impact on your heart function. As estrogen declines, your blood vessels lose elasticity, which can lead to arterial stiffness, higher blood pressure,  and an increased risk of stroke or heart disease from arteriosclerosis. So, now’s definitely the time to pay attention to your vascular system and heart by taking action to stay healthy. 

What Is Vascular Aging?

Think of your blood vessels like garden hoses that have been working perfectly for decades. Vascular aging is what happens when those hoses start to lose their flexibility and ability to dilate as needed over time. It’s a normal change that occurs as we age and means our arteries are less responsive to increases in blood flow leading to hypertension, but menopause speeds up this process. As estrogen levels decline during perimenopause and menopause, your blood vessels can become even stiffer and more prone to inflammation due to impaired endothelial function. These changes really accelerate in the 5-10 years following menopause. 

“Some of my patients over the years have reported elevations in their blood pressure or LDL and total cholesterol levels even before having symptoms that would indicate menopause transition. These findings during routine  heart health screenings can sometimes be a marker of lower circulating estrogen levels and impending menopause.” 

How Estrogen Loss Affects Your Vascular System

Estrogen is the superstar in biological women’s bodies that gives them a heart health advantage over biological men for their premenopausal years. It’s been quietly protecting your heart and blood vessels for decades. However, that advantage doesn’t last forever and evidence has shown that women experience higher increases in blood pressure and more significant declines in vascular function after menopause compared to men of the same age. When estrogen levels start to fluctuate in perimenopause and dramatically decline in menopause, several things happen:

• The walls of your blood vessels lose elasticity, making them stiffer and  it harder for them to respond to changes in blood flow. This is why many women notice their blood pressure rising during midlife, even if they've never had high blood pressure before.

• Chronic, low-grade inflammation starts to adversely affect the whole body including damage to the blood vessel inner walls, known as impaired endothelial function. 

• Cholesterol levels rise during perimenopause, with the total cholesterol and  LDL (“bad”) cholesterol sometimes increasing and HDL (“good”) cholesterol decreasing. These changes contribute to a higher risk of plaque buildup in arteries.

Recognizing the Signs of Vascular Aging

You may not experience any of these symptoms, as vascular aging is usually silent, but it’s good to be aware of what you should watch out for: 

• New or worsening high blood pressure

• Heart palpitations or a racing heartbeat

• Feeling winded more easily during exercise or unexplained fatigue

• Limb pain, coldness or discoloration, particularly of lower extremities

• Cognitive impairment causing issues with memory and focus and signs of vascular dementia

The symptoms above and even vasomotor symptoms (hot flashes and night sweats) can be markers for underlying vascular dysfunction and a higher cardiovascular event risk.

As mentioned earlier, the progression of vascular aging is primarily driven by just normal aging in our bodies, so chronological age is a factor. However, other factors put you at higher risk for accelerated vascular aging: early menopause (before age 45), family history of heart disease, high cholesterol, smoking, or having had preeclampsia during pregnancy. Even if you don't have obvious symptoms, knowing your risk factors helps you make informed decisions about screening and prevention.

How to Assess Your Own Vascular Health in Midlife

What you do now can have a major impact on your heart health for many years. Here are some ways you can evaluate your heart health.

Get routine screenings.

Regular blood pressure checks and cholesterol panels are essential. If you have multiple risk factors or a family history of heart disease, talk to your doctor about earlier and more advanced screening like coronary artery calcium (CAC) scoring, which can detect early signs of artery disease even before symptoms appear. The CAC CT is advised for all who are higher risk as early as age 45, and for all who are lower risk, no later than age 58.

Make lifestyle changes.

Diet and exercise play a big part in heart health. Consider a Mediterranean-style diet (rich in vegetables, whole grains, healthy fats, and lean proteins). Regular physical activity (aerobic exercise and strength training) helps maintain blood vessel flexibility and supports healthy blood pressure. Even small changes make a difference: a 30-minute daily walk can improve your vascular health, especially for women.

Manage stress and sleep.

Chronic stress and poor sleep increase inflammation and blood pressure, especially if you’re in menopause. (3)  Stress management techniques (meditation, yoga, listening to music) can all help with better sleep and less circulating inflammatory chemicals and hormones.

Consider Menopausal Hormone Therapy ( MHT). 

In addition to relieving common menopause symptoms like hot flashes, night sweats, and cognitive and mood changes, MHT can help improve your cholesterol levels and slow vascular aging!

When to Talk to Your Doctor

Ideally, you don't want to wait for a heart event or blood pressure crisis to discuss your cardiovascular health, but unfortunately sometimes that is the first time we get warnings from this often silent disease. However, if severe cardiovascular symptoms occur, like chest pain, jaw pain, extremity numbness or other signs of stroke, you should seek urgent medical attention or call 911.  Also, discuss with your doctor if you ever experience:

• New or worsening high blood pressure

• Chest pain or unusual chest sensations

• Heart palpitations that feel unusual

• Unexplained shortness of breath or fatigue

• Limb pain, coldness or changes in color

• Cognitive changes 

Even if you don't have symptoms, certain situations warrant a proactive conversation: you experienced early menopause, have a strong family history of heart disease, or have multiple risk factors like high cholesterol, diabetes, or obesity.

Having a doctor who is comfortable addressing your cardiovascular risks that come with midlife is essential. If your doctor dismisses your concerns about your heart health or is not listening to your  request for cardiovascular screening, you may have to strongly advocate for yourself.  All of the doctors at Alloy are menopause experts who understand midlife women’s heart health and even if we cannot order the heart and vascular health screening tests for you, we can support you throughout this phase. You can also consult with us to see if you are a good candidate for hormonal or non-hormonal treatments of your menopausal symptoms.

The Takeaways

Your vascular system changes during perimenopause and menopause: that’s a biological reality. But this knowledge is power and so it's also an opportunity. This is your chance to make choices that will protect your heart and blood vessels for the rest of your life. 

Frequently Asked Questions:

Why is my blood pressure increasing now when it was never an issue before?

As estrogen levels decline during perimenopause and menopause, your blood vessel walls lose their elasticity. This makes it harder for them to respond to changes in blood flow, which can cause blood pressure to rise even in women who have never had high blood pressure in the past.

What are the subtle signs that my vascular health might be changing?

Vascular aging is usually asymptomatic, but you might notice new or worsening high blood pressure, heart palpitations or a racing heartbeat, feeling winded more easily during exercise, unexplained fatigue, cognitive changes or aching, cold or discolored limbs.

How does the loss of estrogen specifically impact my cholesterol?

Estrogen helps maintain favorable cholesterol levels while it is circulating at premenopausal levels. When it declines during perimenopause and menopause, LDL (“bad”) cholesterol can increase, while HDL (“good”) cholesterol often decreases. These shifts combined with endothelial damage from higher levels of inflammation in the body,  contribute to a higher risk of plaque buildup in your arteries.

If I have a family history of heart disease, what advanced screenings should I ask for?

In addition to routine blood pressure checks and cholesterol panels, you may want to ask  your doctor about more advanced screenings like a coronary artery calcium (CAC) CT scans. This non-invasive and low cost test is not perfect, but can detect early signs of artery disease even before you experience any physical symptoms. It should be considered for higher risk women as early as age 45 and for women without additional risk factors  at or beyond age 58.

Reference:

1. Dzaye, O. et al. Modeling the recommended age for initiating coronary artery calcium testing among at-risk young adults. J Am Coll Cardiol 2021;78:1573-83. 

2. Wheeler, M, et al. Effect of Morning Exercise With or Without Breaks in Prolonged Sitting on Blood Pressure in Older Overweight/Obese Adults: Evidence for Sex Differences. Hypertension 2019;73(4): 

3. Fahraeus, L. The effects of estradiol on blood lipids and lipoproteins in postmenopausal women. Obstet Gynecol 1988 Nov:72(5 Suppl):18S-22S.