Category: HEARTe

Menopause Treatments and Cardiovascular Disease

As mentioned earlier, the lower levels of oestrogen due to menopause can affect heart health by increasing the likelihood of developing cardiovascular disease.  

Managing menopause symptoms can in turn help promote cardiovascular health.  

The cardiovascular risk factors associated with menopause can help to be managed by:  

  • Maintaining a healthy weight  
  • Not smoking 
  • Eating a healthy, balanced diet 
  • Reducing alcohol intake  
  • Increasing activity levels 

Hormone replacement therapy (HRT) can help treat menopause symptoms, but there is also evidence that it can reduce the risk of developing cardiovascular disease (CVD). However, the effect of hormone replacement therapy can vary based on the following factors:  

  • The time the therapy was started based on age and/or time since menopause 
  • Underlying health  
  • How long the therapy was  

Research suggests that if hormone replacement therapy is started in individuals who are younger than 60 years old and/or near/at menopause, then it can significantly reduce cardiovascular disease risk.  

However, hormone replacement therapy does also have risks including blood clots, stroke, and breast cancer. It may not be suitable for those who have a history of cardiovascular disease.  

Therefore, the start and continuation of hormone replacement therapy for an individual should be based on their menopause history, underlying health conditions, established non-cardiovascular benefits and risks, possible cardiovascular benefits and risks, and preference. 

When assessing the suitability of hormone replacement therapy (HRT), there is the following approach: 

Disclaimer: Women taking HRT who have had a heart attack (myocardial infarction) do not necessarily have to discontinue it. Women who have had a heart attack and who then require HRT can be given it.  

Important things to take into consideration for HRT and people who have had a heart attack: 

  • The starting dose is very important, it needs to be appropriate for the age of the patient. 
  • The type of progestogen may be important (non-androgenic progestogens preferred). 
  • The route of administration of oestrogen may be important. 
    • Non-oral administration being preferred in those with any perceived risk of thrombo-embolism.  
    • Tablets are higher-risk compared to patches. 
  • The co-administration of a statin may bring further synergistic benefits. 
  • Supervision from a specialist menopause clinic is recommended. 

Consultation

Morag has an appointment with her healthcare provider to discuss her symptoms, identify if they are due to menopause, and learn what could be done to help manage these symptoms.   

Please click through the slides below to see the conversation between Morag and her healthcare provider.  

Before we move on to Morag’s assessment and treatment options, we will first review what treatment options are available for menopause.  

​

Scenario 2: Morag

Morag's avatar

Who is Morag:  

  • 55 year old woman 
  • Ethnic background is white, Scottish 
  • Works part-time as a cleaner for a primary school 
  • Looks after her grandchildren part-time  
  • Married to her husband, Jimmy, who works at the local power station 

Morag’s Medical History:  

  • Has high blood pressure (hypertension)  
  • Has high cholesterol  
  • Experiences anxiety  
    • Takes a prescription for an anti-depressant to manage this.  
    • The antidepressant, known as sertraline, is also known as a selective serotonin reuptake inhibitor (SSRI) and it works by increasing the levels of the mood-enhancing chemical in the brain called serotonin.  
  • Smokes about 20 cigarettes a day  

Next Steps: 

  • Morag schedules an appointment with her healthcare provider because she has been experiencing menopause symptoms.  She wants to discuss these symptoms, find out if they are because of menopause, and see if there is something she can do to manage them.

When you find a term that you don’t know, please use the HEARTe Glossary for more information and explanation.​

Module Authors

Module leads

Jessica Wilson, Project Manager, Chest Heart & Stroke Scotland 

Maggie Simpson, Cardiology Advanced Nurse Practitioner, NHS Greater Glasgow & Clyde 

 

Group members

Dr Amy Small, Clinical Advisor, Chest Heart & Stroke Scotland 

Dr Aynsley Cowie, PhD Consultant Physiotherapist, NHS Ayrshire and Arran 

Caroline McGhee, Stroke Educator, Chest Heart & Stroke Scotland 

Professor Lis Neubeck, Head of the Centre for Cardiovascular Health, Edinburgh Napier University 

Katrina McCormick, Deputy Head Professional Engagement, RGN, Chest Heart & Stroke Scotland 

Richard Forsyth, Health & Care Lead, British Heart Foundation Scotland 

Serena Battistoni, eLearning Interactive Content Developer, Chest Heart & Stroke Scotland 

 

Module reviewers

Alliance Heart Disease Patient Network  

Amanda Baird, Advice Line Clinical Lead Practitioner, Chest Heart & Stroke Scotland 

Amanda Johnson, Head of Professional Engagement, Chest Heart & Stroke Scotland 

Jay Wilkinson, Health Information Officer, Chest Heart & Stroke Scotland 

Joanne Graham, Director of Services, Chest Heart & Stroke Scotland  

Mairi Whiston, Health Information and eLearning Clinical Lead, Chest Heart & Stroke Scotland 

Sophie Bridger, Policy and Campaigns Manager, Chest Heart & Stroke Scotland 

Women’s Health Steering Group at Chest Heart & Stroke Scotland 

Women’s Peer Support Group at Chest Heart & Stroke Scotland 

15. Women’s Health

Welcome to the new HEARTe15: Women’s Heart Health eLearning resource.

Chest Heart and Stroke Scotland (CHSS) are pleased to launch a new HEARTe Women’s Health eLearning resource: HEARTe15: Women’s Heart Health. This new module has been created by a range of health care professionals with experience, expertise and overall interest in women’s heart health.

The purpose of this free online module is to provide an educational resource with a specific focus on women’s heart health. This is a unique module as it is the first CHSS eLearning resource aimed at both health care professionals and those with lived experience audiences.

In developing this new HEARTe module consideration has been given to:

  • the style of writing that aims to be as accessible and inclusive as possible
  • providing an enjoyable way of learning, utilising a range of both text and interactives to improve users understanding of women’s heart health
  • ensuring content is evidence based and up to date
  • signposting to further information and support across Scotland

The CHSS Women’s HEARTe Module Development Group and the CHSS Women’s Health Steering Group hope you find this new HEARTe Module 15: Women’s Heart Health resource informative and enjoyable.

 

For your consideration

Please note that ‘Pulse Points‘ appear on certain pages of this module. Pulse Points are included for you to take some time to reflect on ‘themes’ raised or to highlight other ‘themes’ you may wish to consider.

This module contains a View Text Alternative (VTA) option. Where diagrams, pictures and interactives appear there is the option to read a VTA. This helps people with visual disabilities to understand pictures and other graphical content.

 

General Medical Disclaimer: The information, including but not limited to, text, graphics, images, recommendations, opinions and other material contained on or accessed through this website (or in any module or content accessible through this website) (together “Website”), is intended for general informational purposes only. The information should not be considered as professional medical advice, diagnosis, recommendations or treatment.  The information on this Website is provided without any assurance, representations or warranties, express or implied. We do not warrant that the information on this Website is applicable to all healthcare practices, geographical locations, health needs or circumstances. We do not warrant that the information on this module is complete, true, accurate, up-to-date, or non-misleading. You should always seek the guidance of a qualified healthcare professional before making any decisions related to your health or wellbeing. Never disregard or delay seeking medical advice due to something you have read on this Website. The use of or any reliance placed on any information provided on or accessed through this Website is solely at your own risk.  If you have any specific questions or concerns about your health, please consult a qualified healthcare provider or other qualified medical professional. Do not rely on the information on this Website as an alternative to medical advice from your doctor or other qualified professional healthcare professional or healthcare provider.

 

NB: When you find a term that you don’t know, please use the HEARTe Glossary for more information and explanation.

 

Questionnaire

Module test certificate icon

Questionnaire for the OHCA module

Are you
How Did You Hear About this Resource?

What Made you visit this Resource?
Are you aware of the Out of Hospital Cardiac Arrest Pilot Project?
Copy and paste the following link on your browser for more: https://www.chss.org.uk/services/ohca-advice-line-support-service/
Would you recommend this resource to others?
12345

Links and Resources

A-Z icon

Organisations

Strategies

Responding

AEDs

Cardiac Rehabilitation

General

Self Management

Exercise

Sexual Activity

Diet

Practical

Mental Health & Wellbeing

Support for Carers

Relaxation

Spiritual Care

Post Traumatic Stress Disorder

Peer Support

A number of regional cardiac peer support groups are available in Scotland. Information on these can be obtained from the Chest Heart & Stroke Advice Line Nurses:

Brain Injuries

Inherited Conditions

Death & Dying

Planning Care

Do Not Attempt Cardiopulmonary Resuscitation

Practical Issues

Bereavement

Other Resources

Six months later

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Jill is referred to a clinical psychologist and attends for an appointment. Jill and the psychologist agree that cognitive behavioural therapy (CBT) might help her adjust to the impact of her aunt’s death and to develop more effective coping strategies.

CBT is a form of psychotherapy that focuses on teaching people skills to assist them to see their situation in a more helpful way and to learn some skills of managing life in a more productive manner. CBT helps people refocus on the positive and develop strategies for the challenges they are facing. The skills allow people to relax more, see the future in a more helpful manner and, generally, feel more in control of their life.

The video below is a useful introduction to CBT:

Jill finds it difficult travelling to face-to-face CBT sessions, as she lives some distance from the clinical psychology department, so she accesses an online CBT course (Living Life to the Full) and is supported by a practitioner trained in SPIRIT (Structured Psychosocial Interventions in Teams course Five areas: SPIRIT Training Project (Glasgow). The SPIRIT practitioner phones Jill regularly to support her.

Jill is feeling the benefit of the CBT and is coping more effectively with the trauma of her aunt’s death. She now has her drinking under control and her sleep pattern has improved. Along with her mum, she has attended a CPR training session in her local community and feels confident that she would now know how to deal with an OHCA.

Supporting the Responders

MIND, a leading UK mental health charity, reported that 87% of emergency service workers had experienced stress, low mood and poor mental health at some point since taking up their post. It is important that professionals responding to a OHCA event are offered the opportunity for support, if required.

One strategy for allowing responders to reflect on their experience of an OHCA is “hot” debriefing. A hot debrief is an informal supportive session, exploring events immediately after they have occurred. It takes place while everybody involved in the incident is still present and while everything is fresh in people’s minds.

The video below shows an example of a hot debrief being carried out by firefighters following their attendance at a cardiac arrest.

The impact of responding to an event, such as Rose’s cardiac arrest, may not always be immediately evident. An example of good practice can be seen in a collaboration between Scottish Fire & Rescue and NHS Lothian’s Rivers Centre. Fire & Rescue staff who attend an OHCA are offered the opportunity to complete a 1 month critical incident support form (see below). This acknowledges that issues can emerge for an individual some time after an actual event.

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