Zaporožskij Medicinskij Žurnal (Oct 2024)
Perimenopause period and menopause: cardiovascular and metabolic risks
Abstract
The number of mature and elderly women is increasing all over the world. According to the World Health Organization, in most countries of the world, the life expectancy of women after the age of 50 ranges from 27 to 32 years. Thus, approximately one third of a woman’s life is lived after menopause. Aim. To analyze and summarize scientific data on cardiovascular and metabolic risks in perimenopausal and menopausal women based on the use of scientometric databases. Menopause should be considered as a risk factor for the development of cardiovascular diseases (CVDs), which triggers a whole cascade of pathological changes in a woman’s body, including the development of arterial hypertension, dyslipidemia, abdominal obesity, insulin resistance, an increased sympathoadrenal tone, endothelial function disorders, and inflammatory vascular reactions. CVD is known to be the leading cause of death among postmenopausal women associated with the loss of estrogenic protective effect on the cardiovascular system. Women with premature menopause have a 33 % higher risk of heart failure and a 9 % higher risk of atrial fibrillation. Metabolic syndrome is more common in postmenopausal women than in premenopausal women. It is defined as a cluster of disorders characterized by impaired glucose metabolism, high blood pressure, central obesity, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol and triglycerides. It is the activity of low-density lipoproteins and an increase in the level of triglycerides that have serious consequences in the etiology of cardiovascular diseases and the development of atherosclerosis. Osteoporosis ranks fourth among non-communicable diseases after CVD, cancer and diabetes. Estrogen deficiency during menopause results in increased osteoclast resorptive activity, while osteoblast function remains relatively constant, ultimately resulting in bone loss. In the first postmenopausal years, a woman can lose up to 9–35 % of bone mass, postmenopausal osteoporosis affects between one third to a half of all women. Conclusions. Menopause is a difficult period in a woman’s life, during which the risk of developing cardiovascular diseases and metabolic disorders increases, as well as almost all somatic diseases are exacerbated. Therefore, proper assessment of such risks is mandatory to improve long-term CVD outcomes. Given this, it is the interdisciplinary interaction that is central to early detection of symptoms and diagnosis of climacteric disorders for the timely prescription of treatment. Physicians working with this contingent of women should apply a comprehensive approach to health care and quality of life preservation during the menopause transition, menopause and postmenopause.
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