menopause

When we think of the menopausesocial and medical conversation is usually limited to obvious and short-term symptoms, such as hot flashes, mood swings, insomnia or the closure of the fertile period. However, this phase in the life of any woman has implications that go much further in terms of health as it involves a great metabolic and, above all, vascular change. A new vision. Now, the largest international study carried out to date has confirmed a reality by pointing out that when menopause comes early, the risk of suffering a myocardial infarction or stroke increases drastically, remaining stable independent of other traditional risk factors. The magnitude of the study. The research, to reach these conclusions with practically unwavering solidity, has resorted to the PURE-based macro-study, closely following a massive cohort of 111,619 women from 26 different countries, recording their clinical evolution for an average of 14.6 years. And the experts already point out that we are facing a methodological turning point in female cardiology. In figures. The findings evident in this study clearly segment the risk based on the age at which the end of menstruation occurs: When menopause occurs before the age of 40, it is called ‘premature menopause’ and carries between 27% and 30% greater risk of suffering major cardiovascular events such as heart attacks. In the case of a menopause between 40 and 45 years of age, it is called ‘early’ and registers a 14% higher risk of presenting cardiac complications. It is a risk factor. The most robust and worrying data provided by the research is that this increase in cardiovascular risk persists practically unchanged even after the researchers statistically adjusted the models to isolate some classic variables such as high blood pressure, diabetes, smoking or a sedentary lifestyle. This means that early loss of ovarian function is an independent risk factor in itself for these serious problems to occur. Because? The medical explanation behind this phenomenon lies in the abrupt loss of what cardiologists call the “estrogen shield.” It must be kept in mind that during the fertile age, estrogenic hormones exert a fundamental protective role in the circulatory system through various mechanisms, such as keeping cholesterol and triglyceride levels at bay. But estrogens also keep veins and arteries in good condition, promoting vascular relaxation and inhibiting the accumulation of body fat in arterial walls. Additionally, when estrogen levels fall prematurely, the process of forming lipid deposits in the arteries progresses at a much faster rate. The economic gap. One of the most innovative and alarming points of the PURE study is how the geographical context radically alters the impact of early menopause. And its conclusions show how the impact on cardiovascular health is almost double in low-resource countries compared to rich nations. For example, in countries such as Pakistan, Tanzania, Bangladesh, India and Zimbabwe, an overwhelming 43% of postmenopausal women had experienced early menopause. But in rich nations like Canada or Sweden the figure drops to 23%. A nuance. The authors introduce an important warning, since in countries with very precarious economies, chronic malnutrition usually causes what is known as hypothalamic amenorrhea, since the body prioritizes living over maintaining other functions such as reproductive functions. And although this confusion could partially inflate the statistical gap between rich and poor countries, the study clarifies that it does not in any way invalidate the main conclusion of the study: on a global level, without estrogen, the heart suffers. Images | Molly Wichman In Xataka | Nuria Marín, menopause expert: “Women continue to look for answers outside the health system”