Navigating Menopause: Hormone Therapy and Women’s Cardiovascular Health

Céline Fiset, B Pharm, PhD
Catherine Martel, PhD

By : (from l. to r.) Céline Fiset, B Pharm, PhD1,2 and Catherine Martel, PhD1,3

1. Research Center, Montreal Heart Institute, Montreal, Quebec, Canada  /  2. Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada  /  3. Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada

Atherosclerosis, the main cause of cardiovascular diseases, is characterized by elevated circulating lipid levels, an exaggerated inflammatory response, and the accumulation of cholesterol within the arterial wall. Numerous factors, whether extrinsic like lifestyle choices or intrinsic such as genetic predispositions, exert influence over the development of this chronic inflammatory condition and its acute clinical outcome across one’s lifespan. In menopausal women, the risk of cardiovascular diseases significantly escalates. Moreover, women aged 45-74 years old have a 30% higher risk of mortality from acute myocardial infarction compared to men. Menopause signals a profound juncture in a woman’s journey, marked by the natural cessation of menstruation and substantial hormonal shifts, including diminished levels of estrogen and progesterone. This hormonal decline holds significant implications for cardiovascular health. Estrogens, particularly, play a pivotal role in preserving vascular function by fostering artery dilation, regulating cholesterol levels, and imparting anti-inflammatory effects on the vascular endothelium. As a result, the decline in estrogen levels after menopause contributes to the increased cardiovascular risk in women.

As for hormone therapy, also known as hormone replacement therapy (HRT), its impact on cardiovascular risk remains under perpetual investigations. The timing of HRT initiation is crucial. Early evidence suggests that HRT might mitigate the risk of adverse cardiovascular events in women experiencing premature menopause (before 45 years old). However, recent findings from the Society of Obstetricians and Gynaecologists of Canada (SOGC) caution against commencing combined HRT a decade or more after menopause, which appears to elevate the risk of cardiovascular complications, including stroke, compared to initiating HRT early (within 10 years) and maintaining it. Nonetheless, while HRT finds indication in alleviating menopausal symptoms, it is not endorsed for cardiovascular disease prevention, notwithstanding its potential benefits on lipid profiles and vascular function.

Given these insights, it is crucial to regularly monitor the cardiovascular health of women during menopause and promptly address modifiable abnormalities, such as circulating lipid levels. Women should discuss the benefits and risks of hormone therapy with their doctor, taking into account their medical history and cardiovascular risk profile.

 

References

  1. J Obstet Gynaecol Can 2021;43(12):1444−1449
  2. Coeur et AVC Canada (https://www.coeuretavc.ca)
  3. Rapport du Système canadien de surveillance des maladies chroniques : Les maladies du cœur au Canada, 2018
  4. S. Preventive Services Task Force, Grossman DC, Curry SJ, et al. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement. JAMA 2017;318:2224–33.7.

Image de Freepik

Read more

Diabetes

By: Dr. Ojistoh Horn, Family Medicine, Akwesasne Medical Clinic.

Diabetes is a health issue in Indigenous peoples around the world.  There is a lot of information available to people describing symptoms, ways of diagnosing it, and treating it.  These paragraphs aim to describe it from an Indigenous ‘ways of knowing’ view.

Humanity is realizing the consequences of the poor management of the planet’s most available energy source – oil.   The ways in which the lands and her resources have been turned into commodities, how people have been removed from their lands and ability to take care of themselves becoming dependent on an economy that is difficult to thrive in, and how humanity has removed itself from its relationships with all living things have created a profound imbalance.  Colloquially called Climate Change, through colonization, capitalism, and globalization, we have disturbed the Great Balance, or the Homeostasis that exists on our Earth.  Relationships, reciprocity, taking no more than needed, and looking into the future are indigenous ‘ways of knowing’ that have aimed to maintain the Great Balance in the lands that we take care of.

But there is also a Great Balance to be maintained within our bodies.  Diabetes is a physiological condition of profound imbalance and inability of the body to manage its main fuel, or energy source – glucose.  Specifically, the movement of glucose in the blood through the vessels to the body’s muscles and organs is disrupted because there is not an efficient or effective amount of insulin – the molecule that moves glucose between tissues.  The chronically high glucose in blood vessels causes inflammation, which then cause blockages making it even more difficult for oxygen and other important substances to be delivered to the tissues.  Not enough oxygen and glucose to the neurons is called neuropathy, to the kidneys is caused nephropathy, and to the eyes is called retinopathy.  The damage to the vessels increased blood pressure, strokes and heart disease, and non-healing wounds or ulcers in the skin.  All systems of the body are related.

By being unable to practice our cultures, unable to sustain our diets and physical labors in the ways that our ancestors did, not fulfilling the ceremonies that reaffirm our relationships with each other, to other living beings, and to the lands, waters, ice, and air, we have found it difficult to maintain the Great Balance, or the Great Homeostasis outside and within our bodies.  Illnesses today are our body’s progressive inability to maintain the inner homeostasis and balance.  Climate change is Mother Earth’s progressive inability to maintain her great homeostasis and balance.  Diabetes is the illness of our people that mirrors the health of our mother, the Earth.  We are all related.

Information: https://www.diabetes.ca/  

Read more

I, too, had bariatric surgery…

By: Dr. Isabelle Labonté, Internist, IUCPQ – Quebec Heart and Lung Institute.

By: Dr. Isabelle Labonté, Internist, IUCPQ – Quebec Heart and Lung Institute Why not me? That’s what I thought to myself about a year ago. I’m an internist at the IUCPQ – Quebec Heart and Lung Institute at Université Laval. I work extensively in bariatric medicine, helping patients with obesity and sharing my knowledge on its management. Over the past few years I realized that I am part of that group of patients who at risk of developing many diseases that can shorten one’s lifespan and healthy lifespan. It was a wakeup call. It’s scary to think about all those metabolic comorbidities, cardiovascular risks and the 14 cancers linked with an excess risk! Not only that. I was also feeling less and less credible in my own professional practice. But despite all my knowledge on the subject, the many medications I tried and the endless lifestyle changes I made, I couldn’t lose the excess weight. So who would believe and follow my advice? I’ve played sports my whole life. I swam competitively 24 hours a week, played soccer, cycled and did 10-k runs, all despite my obesity. I went on my first diet when I was 14, and I’ve been hungry ever since. Those darn hormones that make you hungry and increase your appetite while you deprive yourself and stay active! Obelix’s famous quote: “When you’re eating well, you’re well” doesn’t apply to everyone. My basal metabolic rate dropped so low that it almost collided with the earth’s core. Being from an obese family, my genes certainly didn’t help. I cried so many times. My childhood, teenage years and even adult life were marked with disappointments: I was bullied, judged and rejected by boys. After being around successful gastric surgery patients (including my sister) and reading more about obesity, I realized that I needed to pull on the bannister to make it up a flight of stairs. I had also started wearing a CPAP for sleep apnea. I had had enough. I decided to go for it and choose myself – to take action at 53 rather than waiting until I was 60 or 65! On November 27, 2020, with a BMI of 45, I took the plunge. I had a Roux-en-Y- bypass to regain my health. Then I had to completely relearn how to eat. This included a lot of bland and even downright unpleasant textures (I now know why babies don’t like pureed meat). I also had to adjust my quantities because one bite too many can cause reflux and regurgitation. Post-operative pain, fatigue, hair loss and excess skin were all part of my journey to a healthy weight. But, miracle of miracles, I was finally seeing results on the scale without having to starve myself. After 7 months of eating carefully and walking over 300 km, I have lost 80 pounds and my BMI is now 31. I’m still losing weight, albeit more slowly. All I need to do now is overcome my fears of gaining the weight back – something I see every week in my work. Despite it all, I wouldn’t hesitate for a moment to choose myself again!
Dr. Isabelle Labonté

Why not me? That’s what I thought to myself about a year ago. I’m an internist at the IUCPQ – Quebec Heart and Lung Institute at Université Laval. I work extensively in bariatric medicine, helping patients with obesity and sharing my knowledge on its management.

Over the past few years I realized that I am part of that group of patients who at risk of developing many diseases that can shorten one’s lifespan and healthy lifespan. It was a wakeup call. It’s scary to think about all those metabolic comorbidities, cardiovascular risks and the 14 cancers linked with an excess risk!

Not only that. I was also feeling less and less credible in my own professional practice. But despite all my knowledge on the subject, the many medications I tried and the endless lifestyle changes I made, I couldn’t lose the excess weight. So who would believe and follow my advice?

I’ve played sports my whole life. I swam competitively 24 hours a week, played soccer, cycled and did 10-k runs, all despite my obesity. I went on my first diet when I was 14, and I’ve been hungry ever since. Those darn hormones that make you hungry and increase your appetite while you deprive yourself and stay active! Obelix’s famous quote: “When you’re eating well, you’re well” doesn’t apply to everyone. My basal metabolic rate dropped so low that it almost collided with the earth’s core. Being from an obese family, my genes certainly didn’t help. I cried so many times. My childhood, teenage years and even adult life were marked with disappointments: I was bullied, judged and rejected by boys.

After being around successful gastric surgery patients (including my sister) and reading more about obesity, I realized that I needed to pull on the bannister to make it up a flight of stairs. I had also started wearing a CPAP for sleep apnea. I had had enough. I decided to go for it and choose myself – to take action at 53 rather than waiting until I was 60 or 65!

On November 27, 2020, with a BMI of 45, I took the plunge. I had a Roux-en-Y- bypass to regain my health. Then I had to completely relearn how to eat. This included a lot of bland and even downright unpleasant textures (I now know why babies don’t like pureed meat). I also had to adjust my quantities because one bite too many can cause reflux and regurgitation. Post-operative pain, fatigue, hair loss and excess skin were all part of my journey to a healthy weight. 

But, miracle of miracles, I was finally seeing results on the scale without having to starve myself. After 7 months of eating carefully and walking over 300 km, I have lost 80 pounds and my BMI is now 31. I’m still losing weight, albeit more slowly. All I need to do now is overcome my fears of gaining the weight back – something I see every week in my work.

Despite it all, I wouldn’t hesitate for a moment to choose myself again!

Read more

New category in diabetes self-monitoring!

Abbott Freestyle

 

An innovative new category in self-monitoring has been added to the 2018 Diabetes Canada Clinical Practice Guidelines for people with type 1 and type 2 diabetes. According to Diabetes Canada, self-management of diabetes remains the cornerstone of diabetes care, making the addition of the “flash glucose monitoring” class an important tool to help improve patient outcomes. This new class of monitoring technology automatically measures, captures and stores glucose level data continuously so that patients and their doctors can see patterns over time and make adjustments to lifestyle, diet or treatment, when needed. The guidelines are published every five years by the top diabetes researchers and clinicians in Canada and they provide healthcare providers with the most up-to-date information on caring for people with diabetes.

Flash glucose monitoring has the unique ability to measure glucose every minute in interstitial fluid through a small filament that is inserted just under the skin and held in place with a small adhesive pad. Glucose levels are displayed on demand when the sensor is waved over, or “flashed”, with a hand-held scanner. The FreeStyle Libre system, the first-ever flash glucose monitoring system, developed by Abbott, was authorized for sale by Health Canada in 2017 and is covered by most private health insurance companies.

“Flash glucose monitoring is the next chapter in the management of diabetes,” says Tina Kader, M.D., endocrinologist, at the Jewish General Hospital and LMC Glen in Montreal. “Not only does it empower patients in their daily self-management, it also provides healthcare professionals with meaningful insights into their glucose control, which can lead to changes in their insulin dosing. Many of my patients see this as life changing and we are all very excited as we enter into this new era of diabetes management.”

Do not hesitate to discuss with your healthcare professional.
Always read and follow the label.
More information: https://myfreestyle.ca/en/
News Release 2018
Abbott Media:
Jennifer Heth, Abbott
+1 (510) 749-6469
Read more