High Blood Pressure and Menopause

A few decades ago, we had a totally different definition of “high.” Today, as Baby Boomers, we often associate “high” with body temperature (translation: hot flashes), numbers when we step on the scale and, for some of us, blood pressure.

While it’s easy to spot rising body temperatures (red faces and sweat-drenched clothes) and expanding waistlines (busted buttons and zippers and snaps — oh my!), an increase in your blood pressure may not be so apparent.

Not tonight, dear, I’ve got a headache

Take, for example, the recent experience of one of my colleagues. One night, she woke up in the middle of the night with a horrific headache at the base of her skull. So she popped an ibuprofen and managed to go back to sleep. The next night, deja vu. On the third night, she woke up and entered “headache base of skull lying down” in the web search engine.

Now we all know it’s not usually a great idea to self-diagnose based on Internet search findings. My colleague found everything from migraines (she had these before, but told me that this headache felt different) to an abundance of spinal fluid to brain cancer to high blood pressure.

Hypochondria or hypertension?

Trying not to panic (after all, it could raise her blood pressure), she called her doctor the next morning and managed to get an appointment the same day, citing her concern over elevated blood pressure. Even though she had low blood pressure her whole life, monitors her salt intake and exercises regularly, high blood pressure was the only diagnosis that seemed plausible.

Turns out, her self-diagnosis was spot on.

My colleague is not alone.

According to the National Institutes of Health, hypertension is by far the most important risk factor that affects women in the early postmenopausal years. About 30 percent to 50 percent of women develop hypertension before the age of 60. While you may experience many of these symptoms from menopause alone, mild to moderate hypertension may cause complaints such as non-specific chest pain, sleep disturbances, headaches, palpitations, hot flushes, anxiety, depression and tiredness.

The Mayo Clinic concurs, noting that blood pressure generally increases after menopause. This could be attributed to the hormonal changes of menopause or an increase in body mass index (BMI).

Is HRT the MVP?

While some types of hormone replacement therapy (HRT) for menopause may contribute to increases in blood pressure, many doctors prescribe transdermal (meaning through a cream or a patch) estradiol HRT for women early in their menopausal journey — under age 60 to help keep cholesterol levels down. Remember, there is no risk of thrombosis (blood clots) with transdermal HRT — it is the oral estrogen with progestin that increases the risk of thrombosis. When started more than 10 years after menopause, oral estrogen is more likely to cause a stroke or heart attack in the first year after starting HRT. According to the National Insititutes of Health, in women with severe menopausal complaints and who are at low risk for cardiovascular heart disease, the use of HRT in the years proximal to menopause may be very helpful.

It is also important to note that for women who only took oral estrogen, who did not take progestin and were younger than age 60, the risk of heart attack, stroke and death from any cause decreased. A Women’s Health Initiative trial showed that women who start HRT before age 60 decreased their overall mortality by 35 percent.

The Endocrine Society also stated in its 2010 Scientific Statement on HRT: “Menopausal hormone therapy was associated with a 40 percent reduction in mortality in women in trials in which participants had a mean age below 60 years or were within 10 years of menopause onset.”

It is important to note that throughout these studies it is clear that the sooner you start estrogen therapy after menopause, the better.

Take control of your health during menopause

To control your blood pressure both before and after menopause, the Mayo Clinic recommends:

• Maintain a healthy weight.
• Eat heart-healthy foods, such as whole grains, fruits and vegetables.
• Reduce the amount of processed foods and salt in your diet.
• Exercise on most days of the week.
• Limit or avoid alcohol.
• If you smoke, stop.

Your doctor will consider prescribing medicines if your blood pressure is 140/90 or higher — the threshold for high blood pressure. However, you may want to opt for beta blockers instead of calcium-channel blockers, as the latter have been linked to an increased risk of breast cancer.

A study reported in the Journal of the American Medical Association noted that in women aged 55 to 74, use of calcium-channel blockers for 10 or more years was associated with higher risks of both ductal and lobular breast cancer. (My colleague mentioned this to her doctor, who wasn’t even aware of this study. She is now taking a low-dose beta blocker.) Other medications used to treat hypertension include enzyme inhibitors, receptor blockers and diuretics.

“The risk of developing high blood pressure over a lifetime is extremely high if a person lives long enough,” said Dr. Deepak Bhatt, professor of medicine at Harvard Medical School, and director of the Integrated Interventional Cardiovascular Program at Brigham and Women’s Hospital. For post-menopausal women, this is particularly true. By the time they reach their 60s and 70s, 70 percent of women have high blood pressure. After age 75, that figure rises to nearly 80 percent, according to the Centers for Disease Control.

If left untreated, high blood pressure can lead to stroke and heart failure. It also can also contribute to dementia, kidney failure, vision problems (especially for those with diabetes), and sexual dysfunction.

As patients — and particularly as women patients — we’ve got to be our own advocates. If you suspect that something’s amiss with your health, get professional advice. Politely (but firmly) insist that you need an appointment. In most cases, physicians will work to accommodate you. It’s important to be in tune with your own body and in touch with medical updates so that you can make informed decisions when it comes to your health.

Suffering in silence is OUT! Reaching out is IN!