Introduction
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Menopause is a reproductive physiological process that happens in female individual. It means the exact time that presents the ending of the menstrual cycle in the female body. Before going into the depth we need to understand the menstrual cycle. Basically it is a chronological series of hormonal changes and structural changes in the uterus, ovaries in the female body at a certain time (Al et al, 2018). The easiest diagnosis of menopause is going through consecutive twelve months without a proper menstrual period cycle. Generally, menopause happens in later forty to fifty of age in females.
However, the age varies based on physical and hormonal changes in the female body. Average age of menopause in UK is fifty one, but in some research articles we find out that some females get to the process of menopause in their forties. At menopause the female hormone Estrogen reduces and falls down to lower level which is the major cause of coronary heart disease in females after menopause. The female hormone Estrogen is well known to protect coronary vessels (estrogen prevent to buildup of plaque along vessels wall which leads to narrowing and blockage of vessels), other causes being the high blood pressure, increasing levels of low density lipoprotein (LDL) and decreasing levels of high density cholesterol (HDL), extra saturated fatty acids, additional excessive hormonal changes that a female body undergoes after menopause (El et al, 2020). These are the major determinants of cardiovascular diseases in female body after menopause. Mood change and some other psychological issues may also play a role in determining the cardiovascular diseases in females. In this research study the discussion is about the factors and their role in determining cardiovascular disease after menopause.
This study directly focuses on major factors or determinants of cardiovascular disease after the end of the menstrual cycle for a few months which may last up to 12 months.
There are a few adverse impacts that may arise in the female body after menopause. This study contains that information regarding the adverse impacts of menopause in the late forty ages in the UK.
This study has took under consideration a lot of research articles of menopause and articles related to its effects and impacts on body of females. This study contained those ideas from Pub med, research gate, goggle scholar etc. In this study some Bioinformatics software’s like PyMol, PDB, Swiss models for homology modeling of some particular proteins were utilized. The recent articles up to last 5 years were studied for drawing the interpretation (Madonna et al., 2019). This study avoided those research articles which do not have relevant data. In some articles some relevant ideas were used regarding cardiovascular disease after menopause but in young girls which hit menopause much earlier in their life. Hence, this study went through the collection of some information from papers those were peer reviewed and written in a scientific way. Focusing on inclusion and exclusion criteria, four studies were selected with 2 qualitative studies and 2 quantitative studies to understand chances of heart diseases after menopause.
Here, this study contains two qualitative research including interview and observation in some females in the UK (Vakhtangadze et al, 2021; Marlatt et al. 2018). According to Vakhtangadze et al, 2021, females with menopause are suffering from diabetes as well as cholesterol increase due to efflux from HDL. During menopause, females are prone towards coronary heart disease with higher chances of stroke due to increment of cholesterol (Marlatt et al. 2018). In case of menopause, there is no exact age in female at which they start to suffer from menopause. In some cases, females start to suffer at the age of fifty. From both the studies, information only gained regarding metabolic changes during menopause condition; however, females with menopause are majorly suffering from hormonal changes, which are not included in these studies.
Cardiovascular disease is one of the front line causes of death in the UK. As per the requirement this study contains some quantitative information that describes the fatality rate of a mass population in the UK to heart disease has decreased nearly too about 25% in females. The rate of coronary heart disease has also decreased from the previous rate (Savonitto et al., 2018). The mortality rate due to coronary heart disease has declined near about 72% and the fatality as well as co morbidity rate due to stroke has also decreased by almost 68% in the UK up to the year 2018 [Refer to appendix 1]. Here this graphical diagram describes the chronological decrease of cardiovascular disease, stroke and coronary heart diseases in females with age. Age is here a mark of menopause.
According to studies most of the female cases after menopause suffers from various chronological steps of hormonal changes, hot flushes, high blood pressure, distribution of saturated fatty acids, increasing high density lipoprotein, increasing cholesterols, psychological changes etc.
Due to sudden discontinuation of menstrual cycle up to twelve consecutive months the whole hormonal system in the female body undergoes change. The two main female hormones are estrogen and progesterone. After menopause there is a lack of production in estrogen and estrogen declines to lower level (Zhu et al, 2019). One of the roles of estrogen is protecting and maintaining the coronary vessels preventing narrowing of vessels due to plaque. Narrowing of vessels leads to stroke, heart attack etc. Thereafter, an insufficiency of estrogen is unable to maintain the normal circulation, leading to blockage of the vessels thus reducing the functional ability of heart and hindering circulation of blood.
After menopause, Renin-Angiotensin converting enzyme system becomes deregulated. This Renin-Angiotensin-Aldosterone system (RAAS) helps in maintaining the proper blood pressure in human body and it is a part of our defensive immune system. Along with estrogen the RAAS plays role in maintaining cardio metabolic homeostasis (physiological response to trauma and infection).Thus low estrogen and deregulated RAAS leads to blood pressure variation within a small range of systolic and diastolic pressure and coronary infection due to mal-functional RAAS and excessive load on the inner wall of the artery.
After menopause due to the many hormonal changes the level of LDL (bad proteins) in the female body increases and level of HDL (good proteins) decrease. Lipoprotein is a term which comes from the addition of lipids and proteins. From the word high density conveys the reader about the concentration of the lipoprotein (Gersh and Lavie, 2020). High levels ofLDL are linked to heart diseases as this lipoprotein binds cholesterol to the coronary vascular walls(Keck medicine 2017).
The other related factors are cholesterol and saturated fatty acids. Standard daily intake of cholesterol is near about 280 milligrams per day. After menopause the cholesterol biosynthesis process is overlapped and just because of this the level varies towards the higher range (Song et al, 2018). Saturated fatty acids don't have double bonds in their chemical structures so they are linked to cardiovascular diseases (Techatraisak et al, 2021).
Headache also increases blood pressure, which was already discussed previously (Shenet al, 2020). Luteinizing hormone (LH) level also decreases after this non-periodical phase. Hence, some mothers become depressed due to being unable to feed milk to their baby. [Refer to appendix 2]
Two further quantitative study reports are also mentioned here to specify determinants that contribute towards heart diseases among menopause women (Savonitto et al. 2018; Shen et al. 2020). In some females they are suffering in heart disease after menopause due to their genetic hereditary role (Savonitto et al, 2018). Some other fact is that unhealthy dietary source. For these two reasons, heart diseases also may start after menopause (Shen et al. 2020). The authors in some articles also published the data about already existing physical and behavioral strength based on their survey. After menopause women gets depression, insomnia, headache and hot flushes. Generally, due to the hormonal changes and mental pressures regarding their mating life with their partner women gets some behavioral changes. As per quantitative ideas some mass survey based reports show that the irritability, anxiety and clinical depression are increased after menopause (Savonitto et al. 2018). While conducting quantitative study, questionnaires are used to gather information; therefore, no information is received, whether it is natural menopause or artificial menopause through hysterectomy (Shen et al. 2020). In some cases the physical strength is declined. Hence, some women feel physically inactive but in parallel case some women does not get physical inactivity.
This study contains an elementary epidemiology over the heart disease after menopause. All the readers can acquire some knowledge regarding the fatality rate and co-morbidity rate of cardiovascular disease after menopause after reading this article. The present study contains a brief description of the determinants of heart disease after menopause (Anagnostis et al, 2020). The level of main two hormones e.g. Estrogen and progesterone are inversely proportional to heart stability. Low Density Lipoprotein level also increases after menopause in the female body, LDL binds lipids to the vascular walls. As a result women have to face fatal clinical health issues due to accumulation of excessive lipids in the body. Saturated fatty acids may hamper the condition of the heart. As this type of fatty acids doesn’t have double bonds they are stable molecules and are unable to break. Leading to increase in low density lipoproteins is occurred. Cholesterol brings other clinical issues into the body that need to be treated clinically through a proper medicinal guidance. Frequent intake of red meat may help to raise the level of fatty acids in the human body. Indigestion is also responsible for heart disease (Minkin, 2019).
This study describes the basic idea of the menstrual cycle and the end of this menstrual cycle. As per the main objectives of this study the overall condition of the heart, impact of menopause on heart as well as overall health of the woman has been observed. At last a few b recommendations can be provided in this study like major reproductive hormone replacement therapy, injection of low dose antidepressants, good and healthy dietary food intake for every woman. Smoking and consumption alcohol should be avoided.
Articles
Al-Dujaili, A.N.G. and Al-Kraity, W.R.H., 2018.Assessment of CD-147 Level in women with coronary heart disease after menopause.Research Journal of Pharmacy and Technology, 11(1), pp.317-320.
Anagnostis, P., Bitzer, J., Cano, A., Ceausu, I., Chedraui, P., Durmusoglu, F., Erkkola, R., Goulis, D.G., Hirschberg, A.L., Kiesel, L. and Lopes, P., 2020. Menopause symptom management in women with dyslipidemias: an EMAS clinical guide. Maturitas, 135, pp.82-88.
Biernacki, T., Sandi, D., Kincses, Z.T., Füvesi, J., Rózsa, C., Mátyás, K., Vécsei, L. and Bencsik, K., 2019.Contributing factors to health?related quality of life in multiple sclerosis. Brain and behavior, 9(12), p.e01466.
El Khoudary, S.R., Aggarwal, B., Beckie, T.M., Hodis, H.N., Johnson, A.E., Langer, R.D., Limacher, M.C., Manson, J.E., Stefanick, M.L., Allison, M.A. and American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing, 2020. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation, 142(25), pp.e506-e532.
Garcia, M.C., Kozasa, E.H., Tufik, S., Mello, L.E.A. and Hachul, H., 2018. The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study. Menopause, 25(9), pp.992-1003.
Gersh, F.L. and Lavie, C.J., 2020. Menopause and hormone replacement therapy in the 21st century.Heart, 106(7), pp.479-481.
Madonna, R., Balistreri, C.R., De Rosa, S., Muscoli, S., Selvaggio, S., Selvaggio, G., Ferdinandy, P. and De Caterina, R., 2019.Impact of sex differences and diabetes on coronary atherosclerosis and ischemic heart disease.Journal of clinical medicine, 8(1), p.98.
Marlatt, K.L., Beyl, R.A. and Redman, L.M., 2018. A qualitative assessment of health behaviors and experiences during menopause: a cross-sectional, observational study. Maturitas, 116, pp.36-42.
Minkin, M.J., 2019. Menopause: Hormones, lifestyle, and optimizing aging. Obstetrics and Gynecology Clinics, 46(3), pp.501-514.
Savonitto, S., Ferri, L.A. and Colombo, D., 2018.Perimenopause vasomotor symptoms, coronary atherosclerosis and risk of myocardial infarction during menopause: the cardiologist’s perspective. Menopause Review/Przegl?dMenopauzalny, 17(2), pp.53-56.
Savonitto, S., Ferri, L.A., Piatti, L., Grosseto, D., Piovaccari, G., Morici, N., Bossi, I., Sganzerla, P., Tortorella, G., Cacucci, M. and Ferrario, M., 2018.Comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization. Circulation, 137(23), pp.2435-2445.
Shen, T.Y., b, C. and Yu, T., 2020. Age at menopause and mortality in Taiwan: A cohort analysis. Maturitas, 136, pp.42-48.
Song, L., Shen, L., Li, H., Liu, B., Zheng, X., Zhang, L., Liang, Y., Yuan, J. and Wang, Y., 2018.Age at natural menopause and hypertension among middle-aged and older Chinese women.Journal of Hypertension, 36(3), pp.594-600.
Techatraisak, K., Angsuwathana, S., Rattanachaiyanont, M., Tanmahasumut, P., Indhavivadhana, S., Wongwananurak, T., Leerasiri, P. and Jirakittidul, P., 2021. Compliance and health consequences of menopausal hormonal therapy after surgical menopause: A retrospective study in Thailand. Journal of Obstetrics and Gynaecology Research, 47(1), pp.208-215.
Vakhtangadze, T., Singh Tak, R., Singh, U., Baig, M.S. and Bezsonov, E., 2021. Gender differences in Atherosclerotic Vascular Disease: From lipids to clinical outcomes. Frontiers in Cardiovascular Medicine, 8, p.637.
Yang, S., Kwak, S., Kwon, S., Lee, H.J., Lee, H., Park, J.B., Lee, S.P., Kim, H., Han, K., Kim, Y.J. and Kim, H.K., 2019.Association of total reproductive years with incident atrial fibrillation, and subsequent ischemic stroke in women with natural menopause. Circulation: Arrhythmia and Electrophysiology, 12(11), p.e007428.
Zhu, D., Chung, H.F., Pandeya, N., Dobson, A.J., Hardy, R., Kuh, D., Brunner, E.J., Bruinsma, F., Giles, G.G., Demakakos, P. and Lee, J.S., 2019. Premenopausal cardiovascular disease and age at natural menopause: a pooled analysis of over 170,000 women. European journal of epidemiology, 34(3), pp.235-246.
Websites
Researchgate.net, 2019. Available at: researchgate.net/directory/publications , 2019 [Accessed on: 02.04.2022]
Impart.team, 2020. Available at:
impart.team/ground-breaking-research-into-the-impact-of-menopause-on-the-heart/,2020 [Accessed on: 02.04.2022]
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