Postmenopausal Women Can Dance Their Way to Better Health

Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

As a result of all these changes, postmenopausal women often suffer from decreased self-image and selfesteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of comradery from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

Source: The North American Menopause Society

Menopause Before 40 Tied to Higher Stroke Risk

Thor Christensen wrote . . . . . . . . .

Early menopause could mean an increased risk of stroke caused by blocked blood vessels, according to a new study. Yet for each year of menopause delay, stroke risk fell by 2%.

Stroke is the second-leading cause of death worldwide, and women have a 4% higher lifetime stroke risk than men. Some studies show women who experience menopause at an earlier age have a higher risk of heart disease in general. But research has produced mixed results on the relationship between stroke and the age menopause started.

The study, published Thursday in the American Heart Association journal Stroke, looked at data from 16,244 postmenopausal women, ages 26-70, in the Netherlands.

After following the women for about 15 years and adjusting for various factors, researchers found women whose menopause occurred before age 40 had 1.5 times higher risk of ischemic stroke than women who experienced it between ages 50-54. Researchers also discovered a 2% lower stroke risk for each year menopause was delayed.

The risk between earlier menopause and stroke was limited to ischemic stroke, which is caused by a vessel blockage, and not hemorrhagic stroke, which occurs when a weakened vessel ruptures. The study also found the link between age at menopause and stroke was stronger for women who experienced natural menopause than for those who experienced menopause after surgery to remove the ovaries.

“It is of utmost important for all women to try and achieve optimal cardiovascular health before and after menopause, but it is even more important for women with early menopause,” said Dr. Yvonne van der Schouw, the study’s co-author and a professor of chronic disease epidemiology at Utrecht University in the Netherlands.

The results point to the need for new research into the link between early menopause and stroke risk, van der Schouw said, adding that further studies “may eventually lead to new, still unknown pathways and new clues for preventive measures.”

Scientists already have been studying how hormone replacement therapies in early menopause might improve cardiovascular health. According to an AHA scientific statement published last year in its journal Circulation, certain hormone replacement therapies have cardiovascular benefits, decrease the risk of Type 2 diabetes and protect against bone loss.

A growing body of research also is looking at how estrogen impacts a woman’s brain health.

A 2019 study in the journal Menopause found giving women estrogen early – within the first five years of menopause – might protect against cognitive decline. It also showed women exposed longer to natural estrogen because of longer reproductive periods had better cognitive function later in life.

Dr. Samar El Khoudary, who was not involved in the new research, said the study was limited by the use of data that relied on participant questionnaires to report details on menopause.

Still, she said, “this study as well as other similar studies help make us better aware of the risks related to menopause when it comes to cardiovascular health.”

She called for more studies to examine how hormone replacement therapy impacts age at menopause and stroke. “It’s the big elephant in the room (since) midlife women use hormone therapy to treat menopause-related symptoms,” said El Khoudary, an associate professor of epidemiology at the University of Pittsburgh’s Clinical and Translational Science Institute.

But whether or not they use hormone replacement therapy, women experiencing menopause need to educate themselves about the risk of stroke and what they can do to prevent it, El Khoudary said.

“During midlife when women transition through menopause, women need to maintain physical activity, have a healthy diet and a healthy weight, stop smoking, and get enough sleep,” she said. “At this stage, reducing their risk becomes very important.”

Source: American Heart Association

Lots of Belly Fat at Menopause Could Boost Heart Risks

Denise Mann wrote . . . . . . . . .

If you are approaching menopause and you have some extra belly fat, new research suggests you might want to shed some inches now.

Women who carry weight around their midsection during menopause may be more likely to develop heart disease even if their overall weight remains the same, researchers report.

For every 20% increase in belly fat, the thickness of the carotid artery lining grew by 2%, according to their study. The carotid arteries carry blood to the head and neck, and carotid artery thickness is considered an early sign of heart disease.

The new findings held even after the researchers controlled for other heart disease risk factors such as weight and BMI, a measure of body fat based on height and weight.

Heart disease is the No. 1 killer of women in the United States, and it’s not necessarily your weight but where it goes that affects your heart disease risk, said study author Samar El Khoudary, an associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

Exactly what makes belly fat so dangerous is not fully understood yet. But “it has been shown that this fat is metabolically active and can secrete inflammatory markers that may raise risk for heart disease,” she explained.

The researchers measured fat surrounding the abdominal organs (visceral fat) with CT scans and the thickness of the internal carotid artery lining using ultrasounds in about 360 women from Pittsburgh and Chicago who participated in the Study of Women’s Health Across the Nation (SWAN) Heart study. Women in the study were about 51, which is the average age for entering menopause in the United States.

In addition to increases in carotid artery thickness associated with belly fat, the investigators found that visceral belly fat goes up with aging and that the rate of increase picks up at the time of the menopause.

Importantly, these changes may not be reflected by your weight or BMI, El Khoudary said.

“Two women can have the same BMI, but if one stores her weight in her abdomen and the other in her thighs, the woman who stores fat in her abdomen is at higher risk for heart disease, and that would be missed if we just focused on BMI,” she said.

You don’t need pricey CT imaging scans to measure belly fat either, El Khoudary said. Regularly tracking waist circumference with measuring tape can pick up increases in abdominal fat.

“Women need to be careful and monitor where fat storage changes occur as they transition to menopause,” she noted. It’s also important that women with more belly fat control other risk factors for heart disease such as high cholesterol, high blood pressure and insulin resistance, a precursor to diabetes, El Khoudary said.

More research is needed to see if certain diet, exercise or other lifestyle changes can reduce belly fat and carotid artery thickness as well as whether there is a clear cutoff point where waist circumference becomes a threat, El Khoudary said.

The study was published March 3 in the journal Menopause.

The findings should serve as a wake-up call for women approaching menopause, said Mercedes Carnethon, vice chair of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

“It is important for women to know that their body composition is shifting with aging and that these changes start two years before menopause and continue with aging,” said Carnethon, who was not involved in the new study.

“Maintaining a healthy lifestyle and balanced diet to prevent overall weight gain may be one strategy to prevent these aging-associated shifts in body composition that can increase the risk of having a heart attack,” she said.

Source: HealthDay

Heart Disease Risk in Women Increases Leading Up to Menopause; Early Intervention is Key

The menopause transition, the years leading up to menopause, is a time of increasing heart disease risk for women. Monitoring women’s health and lifestyle, while integrating early intervention strategies for good cardiovascular health, are important, especially during midlife and during menopause to help prevent heart disease, according to a new Scientific Statement from the American Heart Association, “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing for Early Prevention,” published today in its flagship journal, Circulation.

“Over the past 20 years, our knowledge of how the menopause transition might contribute to cardiovascular disease has been dramatically evolving,” said Samar R. El Khoudary, Ph.D., M.P.H., FAHA, chair of the statement writing committee and associate professor of epidemiology at the University of Pittsburgh’s Graduate School of Public Health and the Clinical and Translational Science Institute. “We have accumulated data consistently pointing to the menopause transition as a time of change in cardiovascular health. Importantly, the latest American Heart Association guidelines that are specific to women, which were published in 2011, did not include the data that is now available on menopause as a time of increased risk for women’s heart health. As such, there is a compelling need to discuss the implications of this accumulating body of literature on this topic.”

For many women, the menopause transition — the change from the reproductive to the non-reproductive phase of life marked by changes in menstruation — begins when they are in their late 40s to mid-50s. Before this transition, women produce estrogen, the female sex hormone, which may also have cardio-protective effects. When women go through the natural menopause transition, their ovaries stop producing as much estrogen. This can also occur through surgical menopause (a partial or full hysterectomy, which includes removal of one or both ovaries). Significant changes in a woman’s cardiometabolic and vascular health, which lead to higher heart disease risk, occur during the menopause transition.

Since the increase in heart disease risk during menopause is associated with a decrease in the production of the hormone estrogen, health care professionals and scientists have studied if hormone therapy might help reduce cardiovascular risk. There is research indicating potential cardiovascular benefits of certain combinations of hormone therapy when initiated in early but not late menopause. Further research is needed to evaluate the role of other hormone therapies, and how long these interventions impact cardio-metabolic health.

Additionally, some studies show the benefits of hormone therapy, including a decreased risk of type 2 diabetes and protection from bone loss, seem to outweigh the risks for most women in early menopause. Current recommendations from leading professional medical societies endorse the use of hormone therapy for women who have recently begun the menopause transition, with appropriate indications.

“This Scientific Statement aims to raise awareness for both health care professionals and women about the significant adverse cardiovascular health changes accompanying midlife and the menopause transition and point out the importance of adopting prevention strategies early during this stage,” said El Khoudary. “As such, it emphasizes the importance of monitoring women’s health during midlife and targeting this stage as a critical window for applying early intervention strategies that aim to maintain a heathy heart and reduce the risk of heart disease. Thus, health care professionals may consider an aggressive, prevention-based approach for women during this stage in their lives to decrease the probability of a future cardiovascular disease occurrence, such as heart attack or stroke.“

In addition to summarizing research focused on the use of hormone therapy, the Scientific Statement provides an overview of risks related to the stages of menopause, age at menopause and lifestyle factors that affect women’s risk during this time.

Key takeaways in the statement include the following:

  • Some of the common symptoms felt with menopause have a correlation with cardiovascular disease. Hot flashes and night sweats are associated with worse cardiovascular disease risk factor levels. Depression and sleep disturbances, linked in some studies to an increased risk of heart disease, are also common among women during this time.
  • Physiological changes during menopause, such as increased abdominal fat and visceral fat (body fat around the organs), are associated with a heightened risk of all-cause, cardiovascular disease and cancer mortality, even among those with normal body mass index levels.
  • Cholesterol levels, metabolic syndrome risk and vascular vulnerability appear to increase with menopause beyond the effects of normal aging. Metabolic syndrome is diagnosed when a person has three or more of the following measurements: abdominal obesity, high triglycerides, low HDL cholesterol (the good cholesterol), high blood pressure and/or high blood glucose levels (blood sugar).
  • Novel data show a reversal in the associations of HDL cholesterol (the good cholesterol) with heart disease risk over the menopause transition, suggesting higher good cholesterol levels may not consistently reflect good heart health in all stages of life in women.
  • Data about the use of cholesterol-lowering medications remains limited for women going through the menopause transition and requires further study so evidence-based recommendations can be developed.
  • Women who experience menopause at an earlier age have a higher risk of heart disease. A woman’s age at menopause can be influenced by factors such as length of menstrual cycle, poor cardiovascular risk profile during reproductive years and socioeconomic factors. Race and ethnicity also play a role, with many Hispanic and Black women experiencing menopause at younger ages.
  • Physical activity and nutrition may play a role in the timing of menopause for all women. Women who drink little to moderate amounts of alcohol may have later onset of menopause, and those who smoke cigarettes are likely to start menopause about a year earlier than non-smokers.
  • There is, however, limited information on what is ideal in terms of lifestyle changes (such as the AHA’s Life’s Simple 7) for women during menopause. Data does indicate though that only 7.2% of women in menopause meet physical activity guidelines, and fewer than 20% of those women consistently maintain a healthy diet.

“Lifestyle and behavioral interventions are critical to maintaining cardiovascular health and reduce heart disease. However, we do not have adequate randomized clinical trials testing these interventions specifically during the menopause transition,” said Matthew A. Allison, M.D., M.P.H., FAHA, vice chair of the statement writing committee and professor and chief of the Division of Preventive Medicine in the Department of Family Medicine and Public Health at the University of California San Diego. “Similarly, we need randomized clinical trials of therapeutic interventions, like cholesterol-lowering medications and menopause hormone therapy, in women who are transitioning through menopause. This at-risk population has not been the focus of previous clinical trials, thus leaving us with questions about how the results from these studies might apply to women during this earlier phase of menopause.”

Source: American Heart Association

Early Menopause Predicts Early Heart Trouble for White Women

Laura Williamson wrote . . . . . . . . .

White women who experience early menopause are three times more likely to also experience heart trouble at a younger age than their peers who undergo menopause later in life, new research shows.

The study compared heart disease risk in white and Black women who underwent menopause before age 40 with those who started afterward. Menopause most often begins between ages 45 and 55.

Researchers followed 2,136 women for a median of 14 years after menopause began and found more cases of coronary heart disease, peripheral artery disease, stroke and heart failure among white women who started menopause early compared to those who did not.

While there was no significant difference in premature heart disease between the two groups of Black women, the news wasn’t all good. Heart disease events still affected 5% of Black women who started menopause at or after the age of 40 and 7% of those who started menopause before 40.

The work will be presented at the American Heart Association’s Scientific Sessions, which begins Friday and is being held virtually. The findings are considered preliminary until published in a peer-reviewed journal.

Nearly half of all adult Black women in America have some type of heart disease. They are 60% more likely to have heart disease risk factors, such as high blood pressure, than non-Hispanic white women. And overall, Black people are 20% more likely to die from heart disease than white people.

But the new study’s finding that white women with early-onset menopause had a higher rate of early heart disease than all the other participants was “a surprise,” said lead researcher Dr. Ruth Misha, of the Northwestern University Feinberg School of Medicine Department of Preventive Medicine in Chicago.

Misha and her team also found Black women were more than three times as likely to experience premature menopause as white women.

While previous studies show women who undergo menopause prior to the age of 45 are at increased risk of dying from coronary artery disease and stroke, Misha wanted to look at what happens to these women long before they die, and to quantify “the magnitude of cardiovascular burden these women are facing.”

This study differed from previous research in that “the focus was on premature cardiovascular events that occurred before the age of 65,” said senior investigator Dr. Sadiya Khan, an assistant professor of medicine at Northwestern University Feinberg School of Medicine. “We also looked at Black and white women separately.”

But the study didn’t explore why the disparities they found existed. “Why this is happening is the next big question to answer,” Misha said.

Regardless of race, said Misha, women who begin the process of menopause prior to age 40 should be told it could impact their heart health, and be encouraged to make lifestyle changes to bring weight, cholesterol and blood pressure levels under control if too high.

“A lot of women do not realize that they are at risk, and that delays any help they could have gotten,” said Misha. “We hope that identifying such women while they are younger will lead to timely interventions that can help to extend their lives.”

Dr. Thomas Price, a reproductive endocrinologist and infertility specialist at Duke University in Durham, North Carolina, recommends women who experience early menopause receive estrogen therapy, which may help protect against heart disease, and, if they still have a uterus, progesterone therapy as well.

“This study reinforces the increased risk of heart disease in women who prematurely lose estrogen,” said Price, who was not involved in the study.

The use of hormone therapy for menopausal women has been debated, though some evidence suggests it can protect against heart disease when taken during the window of time prior to the typical age of menopause onset.

“The debate is what do they do once they reach the natural age of menopause,” Price said. “That’s when the recommendations are not nearly as clear because other risks, such as breast cancer and blood clots, start to increase as you age.”

Although the findings showed no significant statistical difference in premature heart disease between Black women who went through early menopause and those who went through regular menopause, “this should not be interpreted as lack of increased risk,” Price said. The overall increased risk of heart disease for all Black women “may make it less likely to see a dramatic difference between the two groups.”

Misha and Khan said they recommend women focus on lifestyle changes to reduce their risk of heart disease. “It shouldn’t be an either-or discussion regarding hormone therapy and lifestyle,” Khan said. “We want to emphasize that lifestyle modifications focused on heart-healthy diet and exercise are the right choice for all women.”

Source: American Heart Association