![]() ![]() Oestrogen deficiency can lead to early, intermediate and long-term health problems. As oocyte quality and number decline gradually, changes related to lowering levels of oestrogen may commence a number of years beforehand. The average age at natural menopause varies between countries and is affected by factors such as genetics, nutrition, smoking and age of menarche in Europe it is around 51 years. Menopause affects all women and occurs when the ovaries either naturally stop producing oestrogen due to the decline and cessation of oocyte development and ovulation, which is essential for the production of both oestrogen and progesterone, or when the ovaries are removed or damaged by other therapies. The health risks that women were most concerned about at menopause were physical menopausal symptoms, osteoporosis and breast cancer. 5 Sadly and surprisingly, awareness of this major health risk to women appears to be very low, with a recent survey showing that only 31% of healthcare professionals and 38% of women were aware that menopausal women are at an equal or greater risk of CVD than men, and that only 31% of women associate menopause with heart disease. Figures from 2005 show that in Europe 55% of women died from CVD as opposed to 43% of men. As oestrogen levels drop, often from the mid-40s onwards, the protective effect is lost and changes occur that lead to an increased risk of heart disease in the ensuing years. 4 This delay is thought to be due to the protective effects of oestrogen that occur in the years before the menopause. 3 CVD is traditionally thought of as being a problem of middle-aged men, but in fact CVD affects just as many women as men – if not more – albeit on average a decade later (see Figure 2). ![]() 1,2 Although many women perceive that one of the leading risks to their health is breast cancer, globally women are nine times more likely to die of CVD than of breast cancer. ![]() Cardiovascular Disease in Women – How Big a Problem?ĬVD is the leading cause of death in women after the menopause and in fact more women die from heart disease and stroke than from the next five causes of death combined, including breast cancer (see Figure 1). This article aims to examine the extent of the problem of CVD in women, summarise the physiology and effects of menopause, explore the link between menopause and CVD risk factors and offer suggestions to reduce the risk of CVD in menopausal women. Cardiovascular disease (CVD) is the leading cause of death in both men and women, yet the extent of the problem in women is frequently underestimated and, compared with men, women are less likely to be offered interventions, are less likely to be represented in clinical trials and have a worse prognosis. ![]()
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