Menopause is a natural biological process that marks the end of a woman’s reproductive years, typically between 45 and 55. As women approach or experience menopause, common “change of life” concerns include hot flushes, sweats and mood swings, brain fog and fatigue.

But many women may not be aware of the long-term effects of menopause on the heart and blood vessels that make up the cardiovascular system. Heart disease accounts for 35% of deaths in women each year – more than all cancers combined.

What should women – and their doctors – know about these risks?

Hormones protect hearts – until they don’t

As early as 1976, the Framingham Heart Study reported more than twice the rates of cardiovascular events in postmenopausal than pre-menopausal women of the same age. Early menopause (younger than age 40) also increases heart risk.

Before menopause, women tend to be protected by their circulating hormones: oestrogen, to a lesser extent progesterone and low levels of testosterone.

These sex hormones help to relax and dilate blood vessels, reduce inflammation and improve lipid (cholesterol) levels. From the mid-40s, a decline in these hormone levels can contribute to unfavourable changes in cholesterol levels, blood pressure and weight gain – all risk factors for heart disease.

4 ways hormone changes impact heart risk

1. Dyslipidaemia– Menopause often involves atherogenic changes – an unhealthy imbalance of lipids in the blood, with higher levels of total cholesterol, triglycerides, and low-density lipoprotein (LDL-C), dubbed the “bad” cholesterol. There are also reduced levels of high-density lipoprotein (HDL-C) – the “good” cholesterol that helps remove LDL-C from blood. These changes are a major risk factor for heart attack or stroke.

2. Hypertension – Declines in oestrogen and progesterone levels during menopause contribute to narrowing of the large blood vessels on the heart’s surface, arterial stiffness and raise blood pressure.

3. Weight gain – Females are born with one to two million eggs, which develop in follicles. By the time they stop ovulating in midlife, fewer than 1,000 remain. This depletion progressively changes fat distribution and storage, from the hips to the waist and abdomen. Increased waist circumference (greater than 80–88 cm) has been reported to contribute to heart risk – though it is not the only factor to consider.

4. Comorbidities – Changes in body composition, sex hormone decline, increased food consumption, weight gain and sedentary lifestyles impair the body’s ability to effectively use insulin. This increases the risk of developing metabolic syndromes such as type 2 diabetes.

While risk factors apply to both genders, hypertension, smoking, obesity and type 2 diabetes confer a greater relative risk for heart disease in women.

So, what can women do?

Every woman has a different level of baseline cardiovascular and metabolic risk pre-menopause. This is based on their genetics and family history, diet, and lifestyle. But all women can reduce their post-menopause heart risk with:

• regular moderate intensity exercise such as brisk walking, pushing a lawn mower, riding a bike or water aerobics for 30 minutes, four or five times every week
• a healthy heart diet with smaller portion sizes (try using a smaller plate or bowl) and more low-calorie, nutrient-rich foods such as vegetables, fruit and whole grains
• plant sterols (unrefined vegetable oil spreads, nuts, seeds and grains) each day. A review of 14 clinical trials found plant sterols, at doses of at least 2 grams a day, produced an average reduction in serum LDL-C (bad cholesterol) of about 9–14%. This could reduce the risk of heart disease by 25% in two years
• less unhealthy (saturated or trans) fats and more low-fat protein sources (lean meat, poultry, fish – especially oily fish high in omega-3 fatty acids), legumes and low-fat dairy
• less high-calorie, high-sodium foods such as processed or fast foods
• a reduction or cessation of smoking (nicotine or cannabis) and alcohol
• weight-gain management or prevention.

What about hormone therapy medications?

Hormone therapy remains the most effective means of managing hot flushes and night sweats and is beneficial for slowing the loss of bone mineral density.

The decision to recommend oestrogen alone or a combination of oestrogen plus progesterone hormone therapy depends on whether a woman has had a hysterectomy or not. The choice also depends on whether the hormone therapy benefit outweighs the woman’s disease risks. Where symptoms are bothersome, hormone therapy has favourable or neutral effects on coronary heart disease risk and medication risks are low for healthy women younger than 60 or within ten years of menopause.

Depending on the level of stroke or heart risk and the response to lifestyle strategies, some women may also require medication management to control high blood pressure or elevated cholesterol levels. Up until the early 2000s, women were underrepresented in most outcome trials with lipid-lowering medicines.

The Cholesterol Treatment Trialists’ Collaboration analysed 27 clinical trials of statins (medications commonly prescribed to lower cholesterol) with a total of 174,000 participants, of whom 27% were women. Statins were about as effective in women and men who had similar risk of heart disease in preventing events such as stroke and heart attack.

Every woman approaching menopause should ask their GP for a 20-minute Heart Health Check to help better understand their risk of a heart attack or stroke and get tailored strategies to reduce it.

Treasure McGuire, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We know the importance of staying hydrated, especially in hot weather. But even for something as simple as a drink of water, conflicting advice and urban myths abound.

Is cold water really bad for your health? What about hot water from the tap? And what is “raw water”? Let’s dive in and find out.

Myth 1: Cold water is bad for you

Some recent TikToks have suggested cold water causes health problems by somehow “contracting blood vessels” and “restricting digestion”. There is little evidence for this.

While a 2001 study found 51 out of 669 women tested (7.6%) got a headache after drinking cold water, most of them already suffered from migraines and the work hasn’t been repeated since.

Cold drinks were shown to cause discomfort in people with achalasia (a rare swallowing disorder) in 2012 but the study only had 12 participants.

For most people, the temperature you drink your water is down to personal preference and circumstances. Cold water after exercise in summer or hot water to relax in winter won’t make any difference to your overall health.

Myth 2: You shouldn’t drink hot tap water

This belief has a grain of scientific truth behind it. Hot water is generally a better solvent than cold water, so may dissolve metals and minerals from pipes better. Hot water is also often stored in tanks and may be heated and cooled many times. Bacteria and other disease-causing microorganisms tend to grow better in warm water and can build up over time.

It’s better to fill your cup from the cold tap and get hot water for drinks from the kettle.

Myth 3: Bottled water is better

While bottled water might be safer in certain parts of the world due to pollution of source water, there is no real advantage to drinking bottled water in Australia and similar countries.

According to University of Queensland researchers, bottled water is not safer than tap water. It may even be tap water. Most people can’t tell the difference either. Bottled water usually costs (substantially) more than turning on the tap and is worse for the environment.

What about lead in tap water? This problem hit the headlines after a public health emergency in Flint, Michigan, in the United States. But Flint used lead pipes with a corrosion inhibitor (in this case orthophosphate) to keep lead from dissolving. Then the city switched water sources to one without a corrosion inhibitor. Lead levels rose and a public emergency was declared.

Fortunately, lead pipes haven’t been used in Australia since the 1930s. While lead might be present in some old plumbing products, it is unlikely to cause problems.

Myth 4: Raw water is naturally healthier

Some people bypass bottled and tap water, going straight to the source.

The “raw water” trend emerged a few years ago, encouraging people to drink from rivers, streams and lakes. There is even a website to help you find a local source.

Supporters say our ancestors drank spring water, so we should, too. However, our ancestors also often died from dysentery and cholera and their life expectancy was low.

While it is true even highly treated drinking water can contain low levels of things like microplastics, unless you live somewhere very remote, the risks of drinking untreated water are far higher as it is more likely to contain pollutants from the surrounding area.

Myth 5: It’s OK to drink directly from hoses

Tempting as it may be, it’s probably best not to drink from the hose when watering the plants. Water might have sat in there, in the warm sun for weeks or more potentially leading to bacterial buildup.

Similarly, while drinking water fountains are generally perfectly safe to use, they can contain a variety of bacteria. It’s useful (though not essential) to run them for a few seconds before you start to drink so as to get fresh water through the system rather than what might have been sat there for a while.

We are fortunate to be able to take safe drinking water for granted. Billions of people around the world are not so lucky.

So whether you like it hot or cold, or somewhere in between, feel free to enjoy a glass of water this summer.

Just don’t drink it from the hose.

Oliver A.H. Jones, Professor of chemistry, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.