Women with premature or early menopause are at an increased risk of heart disease, but that risk can be offset with a healthy lifestyle, according to new research using the Sax Institute’s 45 and Up Study.
The study, conducted by researchers from The University of Sydney and Westmead Hospital, found that women with premature menopause (reaching menopause before the age of 40) had a 36% increased risk of cardiovascular disease (CVD), compared to women who reached menopause at the average onset age (50 to 52).
A healthy lifestyle can counterbalance this increased risk, however. The study also found that within the premature menopause group, those who had the healthiest lifestyle reduced their risk of CVD by more than 50%.
Lead author Anushriya Pant says the study shows that menopause is an ideal time to screen women for cardiovascular risk factors. “This is an opportunity to intervene with healthy lifestyle advice, especially for women with earlier menopause,” she says.
Heart health checks are free to anyone over 45, but there are no heart health screenings specifically for women going through menopause. The current cardiovascular risk score also does not account for menopause before age 45.
This is the first Australian research to assess the effect of overall lifestyle on CVD in a population-based cohort of women who have reached menopause. Researchers analysed data collected from 46,000 women from the 45 and Up Study over 15 years.
Previously published research has shown that the earlier the onset of menopause in women, the higher the risk of CVD. Oestrogen provides cardioprotective effects in women, but once menopause occurs, oestrogen decreases and the likelihood of CVD increases.
Subheading/ 45 and Up brings new insights into women’s health
The 45 and Up Study has been following a quarter of a million Australians since 2005, with regular surveys covering health, wellbeing and lifestyle behaviour.
Survey responses were used to determine participants’ age of menopause onset as well as tracking their reported heart-related outcomes over 15 years.
Women were grouped according to age of menopause onset: premature menopause (before the age of 40), early menopause (between 40 and 44), and then menopause at ages 45-49, 50-52, and above 52. More than 13% of women reported experiencing menopause before the age of 45.
Healthy lifestyle was assessed at the beginning of the 15-year period using five factors: smoking, physical activity, sitting, sleep and diet. Women given the highest lifestyle score reported at least 4 of these 5 behaviours:
- Non smoker
- Did at least 300 minutes of moderate-to-vigorous physical activity each week
- Slept between 7 and 9 hours a night
- Spent less than 7 hours a day sitting
- Ate a diet high in fruit, vegetables and fish, with little red meat and no processed meat
A high healthy lifestyle score had the greatest impact on women with premature menopause, but the impact was still significant across all groups (23% lower risk of CVD on average).
Importantly, women with a moderate lifestyle score – adhering to at least 3 of the healthy lifestyle behaviours – still had a 15% lower risk of CVD on average.
“An overall healthy lifestyle is multifactorial and there are many indicators of health that can be hard to cover in cohort studies,” says Ms Pant. “The strength of the 45 and Up Study is the broad variety of questions that assess variables like sleep and sedentary lifestyle in more depth.”
Ms Pant says that the 45 and Up Study has the potential to increase female representation in population-based cohort studies.
“Not only is the 45 and Up a cohort of Australian women, but the regular follow ups and diverse range of questions on general and women’s health has allowed us to answer important research questions about selective populations.”
This research was funded by a Heart Foundation 45 and Up Research Grant, which has supported research projects since 2020.
