During “The Change,” the odds of heart disease and osteoporosis surge. We asked Kindra’s expert OB-GYN to explain why.
Every year, more than a million women (and some trans men) experience menopause, meaning going without a period for more than 12 consecutive months. But tens of millions more go through perimenopause — some as early as their 30s. That’s the shift as the body transitions into menopause. These are natural processes as we get older, and that’s something worth celebrating. Aging, after all, is a privilege.
However, plenty of research shows there are certain health risks that can increase during this life stage — specifically related to cardiovascular (heart) disease and osteoporosis. So we asked Kindra’s medical advisor Dr. Suzanne Gilberg-Lenz, an OB-GYN and advocate for integrative women’s health, for background on why there’s an uptick in certain health risks at this time, and ways we can monitor symptoms, or avoid certain conditions altogether.
Below, Dr. Suzanne tells all: the reason for those increased health risks, her take on the best ways to prevent them, and what to do if your doctor won’t acknowledge your health concerns.
KCM: Which health risks increase during and after menopause?
Dr. Suzanne Gilberg-Lenz: As women age and lose estrogen (and other hormones), we see a big increase specifically in heart disease, osteoporosis, urinary incontinence, dementia, and Alzheimer’s. So it’s very, very important for us to initiate healthy lifestyles as early as possible, to diminish those risks.
An estimated one in four women will die of heart disease and one in three will have heart disease after menopause. That’s a huge amount of people. And women are four times as likely to have osteoporosis as men in the same age group — four percent of elderly men versus 16 percent of women, which is a lot.
What type of healthy routine should we be following to cut down on some of these health risks?
Sleeping, eating well, and exercising regularly are the most important things we can do to lessen the risk for all of those. But I’m not advocating for a joyless life. I think some people think I’m saying you can’t eat any fun things — that’s not true. But it’s about eating nourishing foods and maintaining a balanced diet. I always tell people, “Eating well 70 percent of the time is really good.” We know what that means: a diet that’s more plant-based. Not necessarily vegan, but just more plants than anything else, which can be especially impactful when it comes to heart disease and osteoporosis.
In the end, your lifestyle really is the most important thing. There are medications we can use (and hormone-replacement therapy can be really beneficial for the prevention of osteoporosis), but in the end, how we live is the most important factor.
What other conditions are affected by menopause?
One that people don’t talk about as much is urinary incontinence, which is a condition and not a disease. Fifty percent of elderly women have incontinence, and that can cause a lot of suffering. Many think there’s nothing to do about it, but that isn’t necessarily true.
What can you do to fight urinary incontinence?
A lot of it is maintaining the strength of the pelvic floor, and acknowledging vaginal dryness — but it’s not just about vaginal dryness. The whole urogenital tract requires moisture and as estrogen declines, that changes dramatically. It’s a myth that certain conditions — breast cancer or heart disease — limit your capacity to use systemic hormones throughout the whole body, like for hot flashes. There is no woman on Earth who can’t use vaginal estrogen.
For vaginal symptoms, it’s not evidence-based to say that there are women who can’t use estrogen-based products. The estrogen is not getting absorbed into the body that way, and people are really doing themselves a disservice by not treating vaginal dryness. So fighting incontinence is about getting moisture, increasing muscle tone, treating estrogen loss, and then using the right products. Kindra’s daily vaginal lotion is an amazing hormone-free solution that combats vaginal dryness (and it comes with an easy-to-use applicator). People are also really embarrassed about using incontinence pads, but there’s a lot of well-designed stuff that’s available now.
Medically speaking, why does the risk for things like heart disease, osteoporosis, and Alzheimer’s increase after menopause? What’s happening in the body that would make these risks increase?
It’s a number of things. Estrogen loss specifically changes the way we metabolize things in our body. Bones are constantly remodeling throughout our whole lives: We’re building bone, breaking it down, building it, breaking it down. And we stop building bone in our thirties — much earlier in life than people realize.
When we do weight-bearing exercises, when we’re putting pressure on the bones, we’re encouraging it to respond to the stress by creating more strength. The estrogen supports that process. So as estrogen declines, you have more turnover of the bones.
There are other medical reasons for bone loss — thyroid-related, steroid use, family history, small stature, being white or Asian. For those who have longtime eating disorders, this is where people really get into trouble, because a lot of times they’ll be developing bone loss much earlier in life.
Also, if you have long-term gastrointestinal issues, celiac, Crohn’s, and Colitis — those people aren’t absorbing the material that they need to make the bone. But as we age, it’s all accelerated by the loss of estrogen. Research shows that incorporating pycnogenol (a potent and natural plant extract) into your daily supplement routine can reduce inflammation and improve osteoarthritis symptoms by over 20 percent. That’s why Pycnogenol is the hero ingredient in all of Kindra’s supplements (I highly recommend using Kindra’s 24-Hour-Relief Bundle as a daily regimen to relieve and mitigate menopausal symptoms).
How does heart disease affect women differently than men?
We know that women present different symptoms of heart disease — they present with fewer symptoms, or symptoms that get misdiagnosed or blown off. And they delay getting help because they’re taking care of everybody else.
In women, there are not always classic heart-attack symptoms. Our disease is different, and it affects the smaller vessels, which is called endothelial disease. Endothelial is the lining of the vessel, and it’s an inflammatory response. The thinking here is that estrogen is protective as an anti-inflammatory in some ways. So as we lose estrogen, we have increases in incidents of these injuries and inflammation in the lining of the vessels, which then promotes heart disease.
High cholesterol increases and high blood pressure also increases during menopause. Weight gain increases insulin resistance. It’s like a perfect storm.
Unfortunately, we don’t have great evidence to show that hormone therapy has the impact we’d like, in terms of diminishing that risk. That’s why lifestyle is so important — and staying on top of your health. You really have to make regular visits to your primary care doctor.
Are there specific symptoms you should look out for to help identify heart disease early on?
Yes, any kind of radical change in exercise tolerance (including walking) and obvious chest pains are both key. Research also shows that women who have more bothersome and severe hot flashes have an increased risk of developing serious cardiovascular disease — and that’s not something to ignore.
The other category of people is women who’ve been pregnant and had preeclampsia — they’re at a much higher risk for developing serious cardiovascular problems later in life. The same goes for diabetes. If you’ve had gestational diabetes during your pregnancy, you’re at a much higher risk for developing diabetes, and maybe heart disease, later in life.
What’s the best way to make sure you’re staying aware of any diseases or conditions that could develop?
You should be having an annual visit with your primary care doctor. If you go to a primary care doctor and you’re a 45-year-old woman and they blow off your concerns, then you need a new doctor. I know for a fact that women’s questions and complaints get dismissed — and their concerns get dismissed as “anxiety.” And yes, you might be anxious, but that doesn’t mean you don’t have heart disease, too.
I think it’s unconscionable to not look deeply at someone’s cardiac status, in men or women, knowing that it’s the number one killer. So why would you not look into prevention?
