Earlier menopause could increase risk for poor cardiovascular outcomes

Women who experience menopause earlier are at greater risk for cardiovascular issues such as heart disease and stroke and even have greater all-cause mortality rates than women who experience menopause nearer the average age of 51, according to a new study published in the Journal of the American Medical Association Cardiology.

The meta-study divided up more than 310,000 women from 32 studies into two groups: those whose menopause had started before the age of 45 and those whose had started after. This distinction was made because premature menopause is considered to occur before age 40 and early-onset menopause is defined as menopause beginning between ages 40 and 44.

According to these results, the study authors pointed out, “[w]omen with premature or early-onset menopause may not only be at risk from a younger age but may also live more years of their lives at an increased risk of adverse outcomes.”

Previously, estrogen had been hypothesized to have a protective effect on organ systems, and losing that effect earlier in life could be detrimental.

Women are already at an increased risk for poor heart health, possibly because they live longer and cardiovascular issues are often associated with age.

The researchers found that women who saw the onset of menopause before age 45 were had a 1.12 relative risk for all-cause mortality, cardiovascular or not. The same women had a relative risk of 1.19 for cardiovascular disease mortality, 1.11 relative risk for coronary heart disease mortality and 0.99 risk for stroke mortality. They were also at risk for cardiovascular problems, even if they were not fatal: There was a relative risk of 1.5 for all coronary heart disease and 1.23 relative risk for all incidence of stroke.

These women were compared to women who saw onset of menopause between ages 50 and 54. Those women saw a decreased risk of death from coronary heart disease with a 0.87 relative risk and no change in the relative risk of stroke incidence.

The study also examined the relationship between the time since the onset of menopause and the risk for developing cardiovascular issues immediately, but the results were inconclusive, according to the authors.

In addition to the possibility of a protective estrogen effect and other hormonal changes related to early menopause that could increase the risk of cardiovascular issues (and others, according to the all-cause mortality findings), it is also possible that the mechanism that lead to early menopause also lead to increased risk of poor heart health, and that is why the two appear correlated, the researchers speculated. They called for further research to better tease out the exact relationship between the two outcomes to allow for better understanding, detection and potentially treatment of the two outcomes.