High Blood Pressure & Menopause

Is high blood pressure linked to menopause?

Blood pressure is a measure of the amount of force the blood flowing through your blood vessels exerts against the wall of the blood vessel. High blood pressure is defined as a recorded pressure greater than 140/90 on two occasions, six hours apart. To determine this, we measure two numbers. The top number is called the systolic blood pressure and measures pressure of blood in the vessels as the heartbeats. The bottom number is called the diastolic blood pressure and measures the pressure of the blood between heartbeats. 90% of the time, the reason for high blood pressure is unknown and called essential hypertension. It is considered a chronic disease, and in most cases, medication is needed lifelong if not corrected by diet changes, lifestyle changes (stop smoking, alcohol) or loosing weight.

No conclusive studies have linked menopause alone with high blood pressure. However, a study published in the Journal of Human Hypertension says that the reduction in estrogen hormone seen during menopause may affect the blood vessels and their inner lining, causing them not to function properly. This may worsen the age-related increase in systolic pressure, possibly by making the walls of the larger arteries stiffer. This theory has not been proven. We do know that there seems to be some relationships with high blood pressure and the menopause, but whether menopause itself triggers high blood pressure remains uncertain. Estrogen withdrawal, weight gain, age, body weight, sodium balance and overproduction of pituitary hormones might be related to developing high blood pressure during this time.

Nevertheless, there are known risk factors for developing high blood pressure. Some are genetic and include race, gender, age and family history. Others risk factors we can change to reduce or prevent developing high blood pressure. Watch sodium (salt) intake, weight control, exercise regularly, quit smoking and prevent heavy drinking. Increase fruits and vegetables, low fat or nonfat dairy products. Reduce saturated fat and total fat intake. Potassium (>3,500 mg per day) and garlic are other supplements that may prevent or reduce high blood pressure. Untreated high blood pressure is very dangerous and can lead to an increased risk of stroke, heart attack, heart failure, visual disturbances or kidney damage.

How do you know when you are menopausal and when you’re done with it?

Natural menopause is a normal aging process at which time we move from a reproductive to a non-reproductive stage in life. During this time, the menstrual period has stopped for at least one year (some say 6 moths continuous), because the ovaries cease functioning. Your health provider for confirmation can, through a blood test, check your FSH level; it will be greater than 30IU/L. The average age is 51 but there can be a wide range. Therefore, the menopause occurs from the time you stop your periods until death. This is an important time however, as many women spend one-third of their life menopausal. Menopause can also occur if the ovaries are surgically removed and with some chemotherapy and/or radiation.

The peri-menopause occurs before the menstrual cycle ends completely. It last about 4 years on average. This is the time women usually develop signs and symptoms associated with the “change of life”. During this time, the menstrual cycles should become lighter and further apart. Your health provider should investigate heavier or more frequent bleeding. Women also experience “hot” flashes, which are considered the cardinal symptom. They are described as a warm feeling over the head, chest or neck that ends in profuse sweating. It last seconds to minutes, but some up to an hour. Their intensity is worsened with stress, alcohol, spicy foods and hot climates.

Other symptoms include irritability, anxiety, depression, insomnia, nervousness, fatigue, and decreased sexual desire. Women also complain of vaginal dryness, irritation, pain and tightness, especially during intercourse. Topical estrogen creams or slow-release estrogen vaginal rings may be helpful in lubricating the vaginal area, as well as natural over-the-counter lubricants. Also joint/muscle pain, decrease breast size, palpitations and loss of urine occur.

The thyroid should be checked during this time, as thyroid disease has many similar symptoms.

Hormone replacement therapy of peri-menopausal symptoms came under scrutiny when the Women’s Health Initiative in July 2002 correlated long term use of hormones with an increase risk of heart attacks, breast cancer, thromboembolism (blood clots in the legs) and stroke. However these patients also had decreased risks for osteoporosis (softening of the bones) that can lead to fractures and colon-rectal cancer. Hormone replacement does work well for some women, and can be used for limited time with close physician supervision and extensive counseling on the personal risk vs. benefits. Recent studies show hormone replacement in younger perimenopausal women (less than 70) who have had a hysterectomy may have a decrease risk of breast cancer.

Some studies show phytoestrogens (soy, Black Cohosh), red clover isoflavone supplements, grains, oats, wheat, brown rice, tofu, almonds, cashews, fish and fresh fruits/vegetables may be helpful in your diet.

Avoid caffeine (found in some coffee, tea, pop) and carbonated beverages. Reduce red meats; they are high in saturated fats and lower salt intake. Avoid alcohol, smoking and non-pharmaceutical drugs.

There are other areas of health concerns for women at this time. Bone loss occurs that leads to osteoporosis. Vitamin D (400-600 IU /d) and Calcium supplements. (1000-1500 mg/d) is suggested. Microcrystalline calcium hydroxyapatite calcium (MCHC) or calcium citrate is better absorbed than calcium carbonate. Magnesium (500 mg to 750 mg daily) increases the absorption of calcium. Weight-bearing exercise is advised. Pharmaceutical supplements to reduce bone loss can be discussed with your provider. Since there is an increased risk of heart disease at this time, life-style changes are important and medications to reduce high cholesterol are available. The cholesterol cam also is lowered by the diet, especially avoiding high saturated fats. Breast cancer risk is increased too so get your mammogram every year after 40.