Perimenopause – the handful of years before a woman's menopause – is a critical time for preventing heart disease and osteoporosis, says a researcher. "Research in animals suggests that the five years before menopause are when bone is lost and when heart vessel disease begins to accelerate," said Jay Kaplan, from Wake Forest University Baptist Medical Center. "Waiting until menopause is not the time to start thinking about prevention," he added.

It was widely believed that women were immune from heart disease until after menopause, when their estrogen levels drop most dramatically. But Kaplan's research has shown that in monkeys, the process starts much earlier. He found that stress in the younger years can reduce estrogen levels and lead to the buildup of fatty deposits in the blood vessels (atherosclerosis) that can lead to heart attacks and strokes.

"But, this isn't just a problem in younger women," he said. "At perimenopause, all women are affected by variably changing and ultimately declining estrogen levels. Perimenopause is a time of increased vulnerability to chronic disease. Cardiovascular health after menopause is influenced by hormone levels many years earlier," he explained. "Our monkey studies showed that a deficiency of estrogen before menopause places these females on a high-risk trajectory, even if they got estrogen treatment after menopause." He added that the findings were consistent with the hypothesis that estrogen inhibits the development of vessel disease, but may be ineffective if the disease already exists.

"Applied to women, this lifetime study suggests that having an estrogen deficiency in the pre-menopausal years predicts a higher rate of heart disease after menopause, even when treated with hormone replacement therapy after menopause," said Kaplan. For women in perimenopause who intend to take hormone therapy, Kaplan said that perimenopause may be the best time to start. "The results emphasize that primary prevention of heart disease should start pre-menopausally."

Source: Wake Forest University Baptist Medical Center

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