For most, the mention of menopause calls to mind words like “hot flashes”, “night sweats” and insomnia, while heart disease and diabetes would be far in the background.

Yet despite the current view that women have a greater risk of cardiac problems and diabetes after they reach menopausal age, a new ten-year study indicates the worry is higher at the pre-menopausal stage.  
However, the drop in estrogen that leads up to menopause actually raises a woman’s risk of various heart conditions, including atrial fibrillation and high blood pressure. This may leave older women more vulnerable to unsuspected heart problems unless they are made aware that they should have their heart health screened even before reaching menopause. 
“This may mean that the higher cardiovascular risk seen among post-menopausal women could be related to changes in that time before menopause and less so to the changes after menopause has occurred,” said lead study author Dr. Mark DeBoer, a researcher at University of Virginia School of Medicine.

Risk factors even in early 40s

While the reasons for this are unclear, the findings suggest that women may need to pay especially close attention to cardiovascular risk factors in the years leading up to menopause and consider lifestyle changes like improved diet and exercise habits that can make problems like diabetes and heart disease less likely, DeBoer added.
As for diabetes, the hormonal changes will also affect how cells respond to insulin, which controls blood sugar levels. Thus, these levels may become less predictable and should be monitored more often.
Additionally, the lower levels of estrogen that result from menopause can lead to more urinary tract and vaginal infections in women with diabetes.  
Many women also experience weight gain and sleep problems during menopause, so those with diabetes may need to change their insulin doses or oral diabetes medications to adapt to these changes which can make managing blood sugar levels more difficult.
Menopause, which typically begins around the ages of 45 to 55, often sees a waning in sexual interest in many women due to the hormonal shifts. However, diabetes can also damage nerve cells in the vagina which often leads to more difficulty in sexual arousal, as well as vaginal dryness.

Caution urged for hormonal treatments

Thus, many women opt to use synthetic hormone treatments to overcome menopausal symptoms, but these have been linked to increased risk of stroke and heart attacks. Instead, they may want to consider US FDA recommendations that focus more on lifestyle changes and low-risk medications. 
Not all types of hormone-replacement therapy carry the same risks, and the study also didn’t account for the way hormones were administered, Eckel, who wasn’t involved in the study, said by email.
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