High Blood Pressure and Menopause

Menopause has been described as the conclusive proof that God is a man, on the grounds that no woman would do such a horrible thing to another. Menopause has been incorrectly described as a disease that afflicts women. Menopause is better described as a stage or condition that marks the transition of a woman from being able (in theory) to bear children to being unable to do so. Menopause, then, is not an affliction or disease, or even, properly speaking a syndrome. However, during the transition through menopause, a large variety of ailments can afflict women. It is important to note, however, that not every woman experiences every ailment, and some women manage to get through menopause with very little discomfort.

Society itself may play some role in heightening the psychological and physiological traumas menopausal women endure. Preconceived cultural notions that tie a woman’s value to her fertility can make a woman going through the “change” feel less attractive, less useful, and less valuable. Moreover, the fact of the transition cannot help but make a woman more aware of her mortality – ultimately, the same psychological issue that afflicts men during the so-called “male menopause.”

The list of physical and psychological difficulties that afflict pre-menopausal, menopausal, and post-menopausal women seems endless: hot flashes, mood swings, depression, memory lapses, heart palpitations, feelings of suffocation, and loss of sex drive are all common conditions that occur during menopause. Among the more overlooked health consequences of menopause is an increased risk of hypertension, or high blood pressure. Until around age 50, men are at a much higher risk for hypertension; after 50, women are at greater risk. This elevated risk for high-blood pressure, in turn, increases the risk of stroke, as well as heart disease, the number one killer of women. In fact, some form of cardiovascular disease causes the death of nearly half of the postmenopausal women in the country, more than the deaths from all cancers combined.

The reasons for the increased risk for hypertension in menopausal and post-menopausal women are not altogether clear. Several factors may be involved; a loss of energy may lead to weight gain, thereby increasing the risk of high blood pressure. Depression, another risk factor for hypertension, afflicts some menopausal women. Some studies report an increase in alcohol consumption and smoking among menopausal and post-menopausal women, both of which are also known risk factors for high blood pressure, heart disease, and stroke. All of these factors may, of course, may work in combination to increase the risk.

Women going through menopause often experience a loss of elasticity in the carotid artery, the aorta, and other large arteries. This loss of elasticity makes it more difficult for the arterial wall to expand and contract with each heartbeat. Over time, this failure can lead to the enlargement of the heart: the heart muscle itself grows as a result of the difficulty in pumping blood through an inelastic arterial system. This in turn can lead to hypertension and heart disease. Some studies had also suggested that the activation of the renin-angiotensin system increased the risk of menopausal women contracting hypertension, but a recent study conducted in Canada and published in the journal Hypertension has argued that elevated levels of angiotensin II did not have play a significant role in menopausal high-blood pressure.

Menopausal and post-menopausal hypertension poses a significant danger for African-American women. For reasons not yet certain, African-Americans in general are at greater risk for high-blood pressure than the rest of the population. African-American women, by extension, are at greater risk than Caucasian or Asiatic women. On the other hand, African-American women, although as or more likely to have estrogen related symptoms of menopause (including hot flashes and night sweats), are in general less likely to experience certain other common symptoms of menopause, including accelerated heart beat, headaches, and difficulty sleeping).

Exposure to lead and lead poisoning may be responsible for an elevated risk of hypertension as well. According to a March article in JAMA (The Jounral of the American Medical Association), bone loss, which takes place at a much higher rate during and after menopause, releases led stored in the skeletal system. (Lead exposure and lead poisoning have long been known to increase hypertension risks in men.) The link between led exposure and hypertension is strongest among post-menopausal women. Women who live near certain types of electricity plants or live in or are renovating an older home are at particular risk for lead contamination in any case.

Younger women generally experience increased risks of hypertension only if they take oral contraceptives. That risk, however, is fairly minimal, representing an increase of 5-6 points in their systolic reading (the higher number in a blood pressure test). However, women taking oral contraceptives who also smoke may be 4 times more likely to suffer heart disease, hypertension, or stroke. On the whole, however, the risk still remains small, and young women must weigh the comparative risks of heart disease and pregnancy.

On a more positive note, menopausal and post-menopausal women may experience a drop in their diastolic blood pressure (the lower reading) by taking Hormone Replacement Therapy (HRT), provided they are not already on anti-hypertension medications. However, new recommendations from the American Heart Association suggest that HRT may be ineffective in reducing cardiovascular risks and should not be given to women solely to prevent heart attacks and strokes. Less drastic treatments for hypertension during and after menopause include changes in exercise and diet. A 40-minute per day walk can improve the elasticity of the arteries and reduce excess weight, both of which lower risks for hypertension. Giving up smoking and in general having a regular exercise regime is essential for post-menopausal health. Many women have lowered their blood pressure with a combination of walking and yoga, for example.

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