Premenopausal women and cardiac symptoms

23 Jul
by Carolyn Thomas      @HeartSisters

Most of you throughout your adolescent and adult lives have no doubt observed that hormone fluctuations during a menstrual cycle can affect certain body parts on certain days of that cycle. These fluctuations cause symptoms ranging from bloating to cramps, vivid dreams, fatigue, acne breakouts, food cravings, or irritability. (That word ‘irritability’ is doctor-speak to describe the act of threatening spouses with homicide if they leave that freakin’ toilet seat up one more time…)

For decades, scientists have also observed that women’s risk of heart attack increases after menopause. One theory for this age-related delay (compared to male heart patients, who generally tend to have their heart attacks a decade or so before we do) was the drop in female hormones at menopause, particularly estrogen. That timing seemed to intuitively make sense. Estrogen levels go down, heart attack rates go up. It’s why physicians believed for a long time that hormone replacement therapy in postmenopausal women could actually prevent heart attacks. (PLEASE NOTE: it doesn’t.*)

Still, there appears to be evidence that the hormones surging through our bodies during our menstrual cycles can worsen the symptoms of a number of health conditions (including, of course, the health of all those spouses who are now anxious about using the toilet properly!)

Although the precise cause of worsening symptoms isn’t clear, researchers point to complex interactions between our immune and neuro-endocrine systems. The impact of a woman’s menstrual cycle on the severity of chronic symptoms is well documented, including those of migraine(1), asthma(2) and cardiac arrhythmia.(3)  About half of women with Crohn’s disease (a chronic inflammatory disease of the intestines) report that their bowel symptoms get far worse just before and during their periods(4). And menstrual cycles have also been identified as a trigger for worsening bouts of depression(5).

In one Japanese study on women diagnosed with a coronary spasm disorder, researchers found that chest pain caused by the non-obstructive coronary disease called Prinzmetal’s Variant Angina was significantly affected by menstrual cycles.(6) The study suggested that painful angina spasms were most frequent (3.9 episodes per day) early in the menstrual phase, and least frequent (0.3 episodes per day) for the rest of the month.

There’s even some evidence that treatment decisions have been modified because of reported menstruation-linked changes in cardiac symptoms. A different team of Japanese researchers published their results in the International Heart Journal, based on an interesting case study of a 38-year old woman living with the arrhythmia condition called atrial fibrillation (7), for which she had been taking three different daily medications.  But after the researchers monitored her heart rhythms over a 22-month period, they found that her palpitations increased only during and just after her monthly period started. Her medication regimen was changed from daily to periodic administration for just one week, beginning a couple of days before her expected menstrual time each month. The study concluded that “the patient did not feel symptomatic variation in her menstrual cycle.”

Researchers from the Québec Heart Institute also wondered if hormones affected the cardiac risk of premenopausal women. This study, published in the American Journal of Medicine, looked at female heart attack survivors within 48 hours following hospital admission. All of the women studied had experienced a heart attack within the first half of their menstrual cycles, compared with no events during the second half of the menstrual cycle. More than half of the women, in fact, had their heart attack within six days after their periods started, rather than later during the menstrual cycle.(8)

Other research has suggested similar results. A U.K. study, for example, published in the cardiology journal Heart looked at premenopausal women (mean age 38.8 years) who lived with established coronary heart disease and symptomatic angina.(9)  Researchers found that the week during or immediately after a period starts (known as the early follicular phase, when levels of the sex hormones estrogen and progesterone are lowest) produced the quickest time to exercise-provoked angina pain (290 seconds) compared to any other weeks of the monthly cycle.

They called this  increased pain “menstrual angina”.

* What Science Says About Hormone Therapy to Prevent Heart Disease

As cardiologist Dr. Nieca Goldberg explains:

“Menopause isn’t a disease, nor does it cause cardiovascular disease. It’s a natural phase of a woman’s life cycle. Estrogen decline isn’t the only reason women face a higher cardiovascular disease risk after reaching menopause. Assorted changes in the body occur with menopause. Blood pressure starts to go up. Triglycerides (certain types of fats in the blood) and LDL (‘bad’) cholesterol tend to increase while HDL (‘good’) cholesterol declines. It’s important for women, as they approach menopause, to really take stock of their health.”

Many studies, notably the landmark Women’s Health Initiative(10), have since debunked the evidence behind the formerly-popular medical recommendation that hormone therapy prevents heart disease. Initiated in 1993, the WHI Hormone Therapy Trial was designed to test the effects of estrogen in women with an intact uterus on their risks of cardiovascular disease and breast cancer among 27,347 postmenopausal women in the U.S., ages 50–79 years.
 In May 2017, the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation warning against the use of combined estrogen and progestin therapy to prevent chronic conditions like heart disease. (This warning is considered a “D-recommendation”, meaning a “moderate or high certainty that this has no net benefit, or that the harms outweigh the benefits.”)
.
“This recommendation applies only to women who have gone through menopause and are considering hormone therapy to prevent chronic conditions,” said USPSTF member Dr. Ann Kurth. “It does not apply to women who are considering hormone therapy to manage temporary menopausal symptoms (like hot flashes or night sweats), or to women younger than age 50 who have experienced premature menopause or who have had their ovaries surgically removed before menopause.”
.
1. MacGregor EA, Chia H, Vohrah RC, et al. “Migraine and menstruation: a pilot study”; Cephalalgia, 1990.10:305-310.
2. Skobeloff EM, Spivey WH, Silverman R, et al. The effect of the menstrual cycle on asthma presentations in the emergency department”; Archives of Internal Medicine, 156:1996.18371840.
3. Rosano G, Leonardo F, Sarrel P et al. Cyclical variation in paroxysmal supraventricular tachycardia in women”. Lancet, 1996.347:786788.
4. Bernstein MT, Graff LA, Targownik LE, et al. “Gastrointestinal symptoms before and during menses in women with IBD.” Alimentary Pharmacology & Therapeutics, 2012;36:135-144.
5. Pinkerton JV, Guico-Pabia CJ, Taylor HS. “Menstrual cycle-related exacerbation of disease.” American Journal of Obstetrics and Gynecology. 2010;202(3):221-231.
6. Kawano H et al. Menstrual cyclic variation of myocardial ischemia in premenopausal women with variant angina. Annals of Internal Medicine, 2001Dec 4;135:977-81.
5. Bernstein MT, Graff LA, Targownik LE, et al. “Gastrointestinal symptoms before and during menses in women with IBD.” Alimentary Pharmacology & Therapeutics, 2012;36:135-144.
6. Pinkerton JV, Guico-Pabia CJ, Taylor HS. “Menstrual cycle-related exacerbation of disease.” American Journal of Obstetrics and Gynecology. 2010;202(3):221-231.
7. Sugishita, K et al., “Cardiac symptoms related to paroxysmal atrial fibrillation varied with menstrual cycle in a premenopausal woman.” International Heart Journal, 2013;54 (2):107-10.
8. Hamelin B et al. “Influence of the Menstrual Cycle on the Timing of Acute Coronary Events in Premenopausal Women”. American Journal of Medicine, May 2003. Volume 114, Issue 7, Pages 599–602 
9. Lloyd GW. “Does angina vary with the menstrual cycle in women with premenopausal coronary artery disease?” Heart. 2000 Aug; 84 (2):189-92.
 10. Women’s Health Initiative, 1992-2008

Q: Have you experienced a cardiac event or other serious condition that appeared to be impacted by your period?

See also:

 

8 Responses to “Premenopausal women and cardiac symptoms”

  1. jennifer July 24, 2017 at 8:26 am #

    That is a confusing post. It appears to hint at a direct link between women being at higher heart attack risks during and right after their periods when their hormones drop but then also says there is no link to hormones dropping during menopause?

    Like

    • Carolyn Thomas July 24, 2017 at 9:32 am #

      Hi Jennifer – What it actually says is that prescribing hormone replacement therapy to menopausal women in order to reduce risk of heart attacks is no longer recommended. Re-read the ‘What Science Says…’ section at the end and follow links for more info.

      Like

  2. Katelyn July 24, 2017 at 7:53 am #

    Wow, this is good information to know. My company recently wrote an article on the symptoms of CVD, including differences for men and women.

    Like

  3. Mag July 23, 2017 at 5:00 pm #

    I was on my menstrual cycle during my heart event. After my stents, every time of the month I had chest pain, fluttering, and angina. Plus, the heart meds did not help. The blood thinners make you bleed more. Overall, I felt terrible. I told my cardiologists (all men) about this and they ignored me saying “it didn’t have an impact”. I knew they were wrong. All along I knew that hormonal fluctuations did have an impact.

    Liked by 1 person

    • Carolyn Thomas July 23, 2017 at 9:28 pm #

      Hello Mag – as you can see from this article, it seems that many cardiac researchers agree with the validity of your own experience, but that’s not what most patients care about. Being listened to and believed by our cardiologists is likely far more important to us…

      Like

  4. Beth Bradley July 23, 2017 at 2:51 pm #

    I had a heart attack at 48. I was very healthy, normal weight and never expected this! During an angiogram, my main cardiac artery was bisected, and I almost died. I was kept alive on machines, and was put into a coma. I woke 3 weeks later completely confused. I spent 180 days in the hospital, was put on the list for a transplant, and now, 9 years later, am doing well with the heart of a generous man in my chest.

    Be a donor!
    Donatelife.net ❤️

    Liked by 1 person

    • Carolyn Thomas July 23, 2017 at 4:25 pm #

      Your story is such a profoundly important lesson on the need for organ donation, Beth! You are very lucky to have survived that. Thanks for the reminder!

      Like

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