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Once you reach menopause, you may be at a higher risk of getting diseases that affect your heart, blood vessels and circulation. These are called cardiovascular diseases. They include:

• Atherosclerosis. This is when your arteries become hard and thick. It is caused by raised patches called plaques developing in the walls of the arteries. These raised patches are partly made of fat-like substances called low-density lipoproteins or LDL cholesterol. Atherosclerosis can block the flow of blood and cause a heart attack or a stroke
• High blood pressure. If your blood pressure is too high, it increases your chances of having a stroke or getting heart disease
• Angina. This is a pain in your chest that happens when your heart muscle doesn't get enough oxygen, usually because the blood supply is poor. This can happen if your arteries are narrowed by atherosclerosis
• Heart attack. This happens when part of your heart muscle dies because it has no blood supply and is starved of oxygen. In most cases, it is caused by atherosclerosis
• Stroke. This is when part of your brain is damaged because the blood supply is cut off, or because blood leaks through the walls of blood vessels in your brain. Things that can increase your chances of having a stroke include high blood pressure and atherosclerosis.

These diseases are the biggest causes of death among women (as well as men) in America, according to figures from the National Institutes of Health. Among women between 45 and 64, 1 in 10 have some form of heart disease, and by 65, about 1 in 4 do.

Before menopause, women have a lower risk of heart disease and strokes than men of the same age. In fact women tend to get heart disease and strokes about 10 years later, on average, than men do.¹ Researchers aren't sure why this is, but one theory is that the female sex hormone estrogen helps to protect women against heart disease during their childbearing years.² After menopause, a woman's risk of heart disease is about the same as a man's.

Researchers have found that women who have been through menopause have twice the chance of getting heart disease as women who haven't, even when their different ages are taken into account. Researchers have also found that women who have had their ovaries removed have a greater chance of getting heart disease.³

Other things that affect your chances of getting heart disease or having a stroke after menopause include:

• What you eat
• Whether you smoke
• How much you exercise
• Whether anyone in your family has had these diseases.

Women who don't smoke, who exercise regularly and who have a healthy diet (high in fiber and low in saturated fats) are at lower risk of heart disease and stroke.

If you want to protect yourself from these diseases:⁴

• Stop smoking
• Exercise regularly (aerobic exercise such as brisk walking, running and swimming is good for your heart)
• Watch your weight
• Cut down on saturated fats and trans fatty acids. Saturated fats are hard fats that come from dairy and animal products such as butter, milk, cheese, cream and meat. Common sources of trans fatty acids are fried foods, cookies and other baked goods
• If you have high cholesterol or high blood pressure, be sure to ask your doctor about treatments.

Taking hormone replacement therapy (HRT) will not protect you against heart disease. Researchers had thought that taking HRT containing estrogen might lower your risk of heart disease. But large studies that included more than 20,000 women show that it doesn't. Women who took combined HRT (estrogen and progestin) for five years were no less likely to have a heart attack than women who took a pretend treatment for comparison (a placebo).⁵

In fact, research shows that HRT slightly increases your chance of getting heart disease and having a stroke.⁶

See our page on HRT for more about these risks.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.