Menopause and Hypertension - Definition, Symptoms, Management

Diagram illustrating how the uterus lining builds up and breaks down during the menstrual cycle Photo credit: Diagram in Wikipedia

Menopause is a major transition in a woman's life. It is a natural process, so no treatment is mostly required. That being said, for millions of women, it is followed by hypertension, which may be obvious or benign and may pose a substantial risk for health.

A report released in September 2012 by the Center for Disease Control and Prevention (CDC) found that nearly a third of American adults have high blood pressure, 40% being unaware of their condition. Half of these don’t have their high blood pressure under control, although a large proportion of them have medical insurance. The risk of developing high blood pressure over a lifetime is extremely high, by the time women reach their 60s and 70s, 70% of women have high blood pressure, according to the CDC.

Before further diving into the topic, let me talk a little about what is menopause and hypertension.

What is Hypertension

Hypertension - High blood pressure

Although in plain English, hypertension is simply "condition of high blood pressure", according to ICD-11 Beta Draft, hypertension definition is as follows:

Defined through the measurement of the blood pressure using cuff method with a sitting systolic blood pressure above 140 mmHg or a sitting diastolic blood pressure above 90 mmHg in three consequent measurements.

In 95% of the cases secondary cause of the condition can not be identified and is named as essential hypertension, while the rest is known as secondary hypertension.

Hypertension Symptoms

Hypertension is usually identified only when seeking healthcare for an unrelated problem, as it is rarely accompanied by any symptoms, and its identification is usually through screening only. There are a number of conditions (potential signs of hypertension) that are reported by patients, but they are rather related to associated anxiety, than to symptoms of hypertension.

Secondary hypertension is quite different in that respect, as most of the conditions (be it Cushing's syndrome, Hyperthyroidism, Renal artery stenosis, etc.) have symptoms of their own. These may be considered hypertension symptoms as well, as they aid identification and treatment of the disease.

Hypertension Treatment

A major part of patients are actually unaware of their condition, so identification is the first and foremost step towards management of condition. It also is of paramount importance, as according to a review, reduction of 5 mmHg in the blood pressure can reduce the risk of stroke by 34%, of ischaemic heart disease by 21%, and decrease probability of dementia, heart failure and mortality from cardiovascular disease. In the case of hypertensive crisis (a systolic pressure of 180 or diastolic of 110), there may be a direct damage to an organ.

Lifestyle changes should be the first go to option when trying to get hypertension under control. Things to concentrate most should be engagement in aerobic activities, reduced body weight, lower sodium and alcohol consumption, as well as higher consumption of fruits and vegetables (aka hypertension diet). There are also a number of medications available, referred to as antihypertensive medications (mainly thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers).

What is Menopause

Menopause Photo credit: Menopause

Menopause (aka climacteric) happens in most women's lives between ages of 45 and 55. A woman can't get pregnant and give birth to a child after this transition (at least naturally). Although it may sound terrifying at first, menopause is not an illness. A number of researches and surveys show that life quality of most women either don't decline or improve in post menopause life.

Andropause (aka male menopause) is the male variation of the transition and is mainly driven by gradual drop in testosterone. The whole concept is currently being debated and is not recognized by World Health Organization (WHO).

Menopause Symptoms

This transition is mainly driven by changing hormone levels (more specifically of estrogen and progesterone) and may lead to different symptoms (of varying severity):

  • Irregular periods: Prior to menopause, menstrual periods of most women become irregular (longer or shorter, heavier or lighter).

  • Hot flashes (or hot flushes): Getting warm in the face, neck and chest with and without sweating. Mostly doesn't take more than 5 minutes. When hot flashes happen in bed, they are called as night sweats.

  • Vaginal dryness or dyspareunia (pain during sex): Vagina may become thin and dry, thus making sex a huge pain.

  • Sleeping issues: A common condition during menopause transition.

  • Mood changes: Mostly driven by issues related with sleeping.

Menopause Treatment - Recommendations

Welcome to Menopause lane

As has already been said earlier, menopause isn't a disease or disorder. As such, generally no treatment is required (there's no cure, but time), statistically only 10% of menopausal women seek medical advice. However, when effects of perimenopause are too strong, there are some medical therapies that can be called upon. Most important ones are Hormone replacement therapy (HRT) and Selective estrogen receptor modulators (SERMs), but there are a number of others, including SSRIs, SNRIs, alternative therapies (e.g. coumestrol, femarelle, black cohosh), etc. Most women are on several medications to manage the transition, but simple dietary changes (e.g. quitting sugar) may reduce it to merely one.

Generally speaking, menopause has a number of effects that can make lives of women going through it, as well as those around them tough. A lot of women confessed that it took them to go through menopause themselves to understand memories from childhood, when their mother went from a kind person to an abusive monster. When combined with mid-life crises for men, the results of menopause may be devastating both for the professional and also for personal lives of both women and men. Luckily by tackling some of the basic effects, the transition may become a lot more manageable.

Hot flashes treatment

A couple of short recommendations:

  • One of common problems during and after perimenopause is lack of natural lubrication, which can be simply managed by usage of vaginal moisturizers in daily life and lubricants to aid lubrication issues during sex.

  • Another recommendation for menopausal women is to consider minor lifestyle measures (e.g. staying in cool rooms, drinking cold liquids, using fans, removing excess clothing and avoiding hot flash triggers like spicy foods, hot drinks, etc.) for management of hot flashes.

  • Some symptoms like constant hunger may require prescription of medicine (mostly Yaz). Of course, if you don't want to deal with getting rid of unwanted weight later on.

It may not be obvious, but a lot of issues in menopause are rooted in insomnia. There's a reason why CIA uses sleep deprivation as an interrogation (or personality breakdown) technique.

Night sweets, insomnia... There are ways to make menopause manageable

Progesterone is the first hormone to diminish in menopause, followed by neurotransmitters such as serotonin ("the happiness hormone"), dopamine ("the reward hormone"). Progesterone produces GABA (calming neurotransmitter, nature's Valium) in the brain. When menopause hits and progesterone declines, insomnia, irritability, night sweats can all happen. Estrogen, on the other hand, increases the brain's production of serotonin, without which, depression usually shows up. Some women even may have memory issues (which is deeply rooted in sleep issues and depression).

  1. The first thing to do is to get your blood work done and work on good sleeping hygiene.

  2. Supplements may also make your life easier.

  3. Some sources recommend making use of alcohol to fight insomnia. It apparently makes you fall asleep quicker, but the sleep will be considerably shallower, so pain can "break through more easily".

  4. Some doctors may advice to take Zolpidem (mainly used for the treatment of insomnia and some brain disorders).

  5. HRT is yet another way to deal with the issue. It comes with risks of its own, but they are sufficiently well researched. Regular mammograms, pelvic exams and awareness will prevent anything serious from getting out of hand.

Doctor

General practitioners (GPs) are not a very good choice for menopause related questions. In very many cases, (s)he will try different medications to see which works better for you. Depending on where you live, you may have Menopause Center nearby. In the worst case, it is better to visit a gynaecologist instead.

Menopose and Hypertension

Menopause and Hypertension - Is there any correlation?

Health risks increase for everyone as they grow older and menopause doesn’t cause any of these and even more so, menopause and high blood pressure are not directly related. That being said, a number of major changes happen in woman's body during and after premenopause, that hugely contribute to the latter one. As most people are unaware of the hypertension condition, they don't even try to get it under control; consequently condition takes its toll on blood vessels and (potentially) organs, making treatment a lot more difficult. That’s why a significant increase in heart attacks is observed in women roughly ten years after the menopause. Heart diseases are the most frequent causes of death for women.

  • Hormonal changes and increase in body mass index (BMI) are some of these, both of which are known to contribute to the hypertension. Hormones themselves may not be responsible for resultant high blood pressure condition, but some types of hormone therapy (HT) may include medications that directly affect blood pressures. On the other hand, as triglycerides (a type of fat) increase, this extra weight again puts extra strain on your arteries. It is then that you become more prone to high blood pressure condition.

  • It is also said that, during menopause LDL or “bad” cholesterol levels tend to increase while the HDL or “good” cholesterol goes down. These make you more susceptible to suffering from heart diseases.

  • When your body refuses to make any more estrogen, your arteries lose some of their elasticity. They need to be flexible to accommodate blood flow. Research has shown that estrogen also helps prevent build-up of plaque inside the walls of your heart. Therefore, as estrogen levels sharply decrease during the menopause, you are likely to become more susceptible to heart diseases. However, the exact connection between estrogen levels and blood pressure are not fully known yet.

  • You are also likely to experience stress and anxiety during this time. This increases your chances of developing blood pressure. All in all you need to be extremely careful about your heart health in your late 40s.

  • Women are also likely to become more hostile to insulin, the hormone that converts blood sugar into a useful form for the body. Therefore they are more liable to get diabetic after the onset of the menopause. This increases your risks of a stroke and other heart related problems.

  • The risk of some cardiovascular diseases (e.g. acute myocardial infarction) rises sharply after menopause. Hypertension is one of the main risk factors for both of these (along with tobacco smoking, increased blood lipids and body weight), and managing it can substantially reduce the risk.

It is an important time, so you must take care of your health and especially your heart. Your doctor might prescribe you medications to lower your blood pressure, but a healthy lifestyle may be although a difficult but definitely the most effective strategy. As was explained in the "Hypertension Treatment" part, the best way to fight postmenopausal hypertension is through lifestyle changes. A little more active life and (for some) weight loss, healthier diet (concentrate on whole grains, vegetables and fruits), lower consumption of alcohol and stopping smoking are steps to a lot better quality of life. If you have a family history of heart diseases, you have to be a lot more careful.

Further read

Menopause - Further read

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