1. Heart Disease

Nearly a third of women develop cardiovascular disease, the AHA says, and the rate of heart attacks in women begins increasing roughly a decade after menopause. A key reason is that estrogen helps keep blood vessels flexible, so they contract and expand to accommodate blood flow. Once estrogen diminishes, this benefit is lost. Coupled with other changes, such as the rise in blood pressure that can thicken artery walls, women’s hearts suddenly become vulnerable.

A study in the Journal of the American Heart Association (Feb 2021) found that frequent and persistent hot flashes were associated with future cardiovascular disease. In particular, women who have a family history of heart disease combined with significant hot flashes should ask their healthcare provider if they need additional screenings for cardiovascular disease.

Of course, you cannot control your family history, which influences your risk, but you can lower your overall risk by following a heart-healthy lifestyle. This includes eating a diet with lots of vegetables and low in sugar, exercising for 150 minutes or more each week, and not smoking.

2. Osteoporosis

Women are 4 times as likely as men to develop osteoporosis, a disease in which bones become thin and weak and fracture more easily. Before menopause, women’s bones are protected by estrogen, but in the year before the final menstrual period and continuing for about three years after, bone loss can be fast. You may not even notice that your bones are weakening, as osteoporosis may not cause symptoms for decades. A bone fracture can be the first sign of the disease.

To keep your bones strong, use lifestyle approaches such as movement and food choices. Do weight-bearing exercises, such as brisk walking and light weights, because they allow your bones to work against gravity to get stronger. Choose foods high in vitamin D — or 15 minutes of sun exposure several days a week — and calcium (dark leafy greens, and canned fish such as salmon and sardines).

3. Weight Gain

Menopause has a definite effect on a woman’s metabolism. Menopause causes your body to gain fat and lose lean tissue mass approximately two years before your last menstrual period until two years into your postmenopausal period. And this is a problem. Because excess weight, especially around the abdomen, can boost your risk of type 2 diabetes and puts you at greater risk of heart disease.

Unfortunately, menopause is linked to an increased risk for metabolic syndrome — a collection of health conditions including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels – that increase your risk for heart disease, stroke, and type 2 diabetes (September 2020, Menopause).

The reason for this increased risk of abdominal fat is because of lower estrogen levels, which shifts fat from the hips to the midsection. Women in perimenopause who have sleep problems, night sweats, and mood issues often find these symptoms interfere with eating a hormone healthy diet or exercising.

Cutting back on food can help. Eating your biggest meal at noon is a great tip – avoid snacking. And keeping a positive mindset with mindful meditation or yoga to help to shed weight and be positive.

4. Breast Cancer

The risks of breast cancer during and after menopause are increased by excess weight, smoking, alcohol, lack of exercise and poor food choices. The change in hormones leaves the body vulnerable to cancer and if these other factors are at play, the risk of contracting cancer increases. Hereditary factors also play a role.

To reduce the risk of breast cancer, it’s recommended to have a health weight, enjoy regular exercise, eat hormone healthy food, limit alcohol and do not smoke. There is also a link between cancer and synthetic hormone replacement therapy (HRT). But the newer body identical varieties have far fewer problems, except for women with estrogen related conditions.

5. Urinary Incontinence

Difficulty controlling the bladder can begin in perimenopause and continue for years after. Approximately half of postmenopausal women experience urinary incontinence. The most common type is stress urinary incontinence, where coughing, sneezing, or physical activity causes leakage. Urgency incontinence is when leakage is accompanied by an uncontrollable urge to get to the bathroom immediately. Many women have a mix of the two.

The tissues of the bladder and urethra contain estrogen and progesterone receptors and are thickened by those hormones. After menopause, these hormone levels drop, and the tissue thins and weakens. In addition, the muscles around the pelvis may lose tone with aging, which is a process known as “pelvic relaxation.”

The pelvic floor has 3 layers of muscles. For one of the layers it helps to do Kegel exercises, contracting and relaxing the muscles of the pelvic floor. The key to proper Kegels is to work the subtle muscles controlling the stream of urine, rather than the butt muscles. Hold each contraction for two to three seconds, building up to five sets of 10 repetitions per day. If problems persist, seek a physical therapist with expertise in working the pelvic floor.

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