Early ‘menopause’ tied to heart problems before 60

NEW YORK, Oct 21, (RTRS): Women who go through menopause earlier in life may be more likely to have a heart attack or stroke before they reach age 60 than their counterparts who go through menopause later on, a recent study suggests.

Researchers examined data from 15 observational studies with a total of more than 300,000 women, including almost 13,000 women who survived events like a heart attack or stroke after menopause.

Compared with women who went through menopause at age 50 or 51, women who experienced premature menopause, before age 40, were 55% more likely to have events like a heart attack or stroke after menopause. With early menopause, from age 40 to 44, women had a 30% greater risk of cardiovascular events after menopause; with relatively early menopause, from age 45 to 49, the increased risk was 12%.

“Heart disease is a leading cause of illness and death for women,” said senior study author Gita Mishra of the University of Queensland in Brisbane, Australia.

Diagnosis

“These findings will help to identify women at most risk of cardiovascular disease for closer monitoring and earlier diagnosis and even prevention of the disease,” Mishra said by email.

Women go through menopause when they stop menstruating. As the ovaries curb production of the hormones estrogen and progesterone, women can experience symptoms ranging from mood swings to joint pain and insomnia.

Earlier menopause has previously been linked to an increased risk of heart disease, osteoporosis, diabetes and sleep problems. It can also leave women with fewer reproductive years, particularly when it’s preceded by premature ovarian failure, when the ovaries stop working before age 40.

In the current study, women were 50 years old on average when they went through menopause. Only 1.2% of the women in the study had premature menopause before age 40; and 4.7% experienced early menopause from age 40 to 44.

Among women who had events like a heart attack or stroke after menopause, an average of 13.5 years passed between menopause and these cardiovascular events, researchers report in the Lancet Public Health.

Compared to women who didn’t experience events like a heart attack or stroke, women who did were less likely to be educated, and more likely to be obese, and current smokers with a history of high blood pressure.

The study wasn’t a controlled experiment designed to prove whether or how menopause timing might directly impact cardiovascular health.

One limitation of the analysis is that many of the cardiovascular events were self-reported by study participants, not confirmed by medical records. It’s also possible that use of hormone therapy after menopause may have impacted the results, the study team notes.

Still, the results highlight a need for women to be hyper-vigilant about heart health if they go through menopause earlier in life, Mishra said.

“For women who are experiencing earlier menopause, active management of other risk factors for cardiovascular disease, such as avoiding cigarette smoking and maintaining a healthy body weight are all the more important for reducing their overall risk of cardiovascular disease,” Mishra advised. “These women may also consult with health professionals for regular monitoring of their risk of cardiovascular disease.”

C-sections: Low-risk pregnant women who deliver in a hospital and receive care from midwives have fewer interventions and fewer cesarean sections than similar women who receive care from obstetricians, a US study finds.

After analyzing more than 23,000 deliveries in 11 northwestern hospitals by women with no known medical complications or risk factors, researchers found that for births handled by a midwife, the C-section rate was 30% lower among first-time mothers and 40% lower among those who had previously given birth, compared to when women labored under the care of an OB-GYN.

“In the group of patients who had care from a midwife, there was a lower rate of interventions,” said Dr Vivienne Souter, research director at the Obstetrical Care Outcomes Assessment Program (OBCOA), a multicenter quality improvement collaborative of the Foundation for Health Care Quality, an independent non-profit organization based in Seattle.

“They were less likely to have an epidural, oxytocin (to speed delivery), or an episiotomy compared to those looked after by an obstetrician. It’s really important, however, to stress that we were looking at low-risk pregnancies in women giving birth in hospitals.”

Most of the women – 19,284 – were cared for by obstetricians, according to the report in Obstetrics & Gynecology.

Supervision

Among women who had given birth previously, Souter’s team found that babies born under the supervision of a midwife had a higher rate of shoulder dystocia, which happens when a woman has trouble pushing the baby’s shoulders out. The researchers weren’t sure why this happened, but Souter suggested it might be because in this study, babies born with a midwife in attendance tended to be somewhat larger than those born to mothers cared for by obstetricians.

There were some questions the researchers couldn’t answer because there were not enough data, Souter said. “We didn’t have a big enough study to evaluate all outcomes, particularly adverse outcomes,” she noted. “We need more data like this to better understand maternal care in the US and to derive strategies to improve it.”

Another issue the researchers couldn’t address was the possibility their results might have been affected by the women having chosen their providers.