Relationship Between Hypertension and Menopause.

Do we know that women after menopause (post menopausal) are more at risk of hypertension than premenopausal women? I will be focusing on hypertension from a post menopausal view in this article. 

Menopause is said to be attained when there’s lack of Menstrual flow for 12 month completed. The average age for menopause is 51yrs, although some women attain it early, this is called Premature menopause, usually at age less than 40yrs.

What is hypertension? It is the force in the blood vessels the heart needs to overcome to pump blood through the body. It can be likened to increased pressure in pipes of water making the pump work harder and harder to get water to the sight it is needed. The pipes are blood vessels while the pump is the heart. It’s that simple.

Now, according to American College of Cardiology 2018, someone is judged to have normal blood pressure with values less than and elevated blood pressure at a value of 120-129/<80.

Anything above these values is termed hypertension. Some years back it was the value greater than 140/90 that is termed hypertension, but it was discovered that even at this value, stroke and kidney damages may occur.

Who are those at risk of hypertension?

  1. African American descent. 
  2. Men above 40 years. 
  3. Women at menopause. 
  4. Those with Family history of hypertension. 
  5. Obese persons. 
  6. Person with Sedentary lifestyle. 
  7. Those who take alcohol. 

There are other risk factors of hypertension including some diseases that can themselves lead to hypertension, like kidney diseases, congenital or acquired heart disease and some blood vessel diseases.

Hypertension and Menopause 

A woman at menopause with a family history of hypertension and Sedentary lifestyle is more likely to develop hypertension than another woman who has no added risk even though she’s at menopause.

Likewise a premenopausal woman with risks despite still menstruating can develop hypertension. Hence being post menopausal is not a direct cause of hypertension, it most time exits as a part of many risk factors.

Hypertension generally also is most times multifactorial, meaning it occurs in presence of many risk factors. I have seen a woman of 31yrs with hypertension, likewise there are children with hypertension. Now being post menopausal is just an added risk since not all menopausal women are hypertensive.

There’s something clearly missing at postmenopausal life that makes it a risk for hypertension. In menopause transition or at menopause, many women have symptoms related to blood vessels which may affect their normal daily activities. With the decline in oestrogen levels however, risk factors for heart and vessel diseases become more apparent, especially hypertension. Oestrogen level is more optimal in premenopausal life but at menopause, it gradually declines.

Estrogen is one hormone that sustains blood vessels integrity and preserves their elasticity. Once it is reduced, there may be manifestations of blood vessels diseases including hypertension and heart disease. 

When taking menopause as a risk factor for hypertension, the root cause therefore is absence of estrogen however we must note that it is possible there are other risk factors abinitio.

Symptoms of hypertension at menopause are the same as premenopausal period. Most of the time, it is asymptomatic and only discovered incidentally or when complications arise.

Symptoms may include.. 

  1. Headaches 
  2. Chest pain or tightness 
  3. Weakness of one side of the body
  4. Hearing of heart beats

Other symptoms are usually as a result of the complication that arises. Most people are usually in denial at discovery because they did not experience any symptoms. 

These complications include:

  1. Heart failure 
  2. Stroke
  3. Kidney failure 
  4. Brain damage 
  5. Blindness 
  6. Blood vessels diseases

 What’s the treatment for menopause induced hypertension? 

Hormonal replacement is the goal, Oestrogen replacement. This is done in cases where other risk factors have been ruled out. Your doctor will guide you further after careful evaluation. Risk factors for breast cancer and any other cancer should be ruled out. 

What we actually do is to place menopausal women on antihypertensives and monitor them to avert the dangers that may go with hormonal replacement.

It is worthy of note that in menopause, adequate exercise, quality diet and avoidance of Sedentary lifestyle and weight gain (basically lifestyle modifications) can prevent hypertension.

This not only in menopausal women but in everyone generally. Note that I said it can prevent and not cure. Only your doctor can say you can discontinue your medication when the situation calls for it.

Everyone hypertensive should be careful with the idea of willingly discontinuing their medications.

I will strongly advise anyone menopausal with other risk factors or not to regularly check their blood pressure. I mentioned earlier that hypertension can be without symptoms until complications are coming up already, hence regular checking of blood pressure will be of benefit.

In order not to get confused by values because they change with activities, time of the day and diet. 

I hereby suggest the following tips.

  1. Take your blood pressure early in the morning, when you have not done any activity. 
  2. Avoid coffee for some few hours close to the checking of blood pressure. 
  3. Take a comfortable posture before taking measurements. 
  4. Avoid shouting and getting so angry before taking values. 
  5. Use an appropriate sized cuff (the part around the arm), a smaller cuff can exaggerate values while a bigger cuff can give a false lower reading. 
  6. If you are getting doubtable values of blood pressure, take the reading 3 times and find the average. Add all the upper values together and find the average, do this to the lower values too. Your final answer is your blood pressure. 
  7. If you get unreasonably higher or lower value, you may want to check with a skilled health personnel or visit a health centre.

In summary, being post menopausal is a risk factor for developing hypertension due to significant reduction in estrogen and it can be handled by hormone replacement therapy in the absence of other risk factors for hypertension.

It will be very good for patients to follow the advice of their medical doctors and Adhere strictly to medications and clinic attendance.

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