EMAS is a leading international medical society advancing menopause and post-reproductive health through research, education, and advocacy. With members and affiliated societies across the globe, EMAS champions evidence-based, inclusive, and collaborative care for healthier aging.
Discover the multilingual animated video series on menopause, created by the CoMICs team at Birmingham University and supported by EMAS and the European Society of Endocrinology. Available in 11 languages, these educational resources aim to break down language barriers in patient education. Visit the website to access the videos!
Intro: Cardiovascular disease is the leading cause of mortality worldwide in women, accounting for 35% of total deaths.
Understanding how menopause impacts various aspects of health is crucial for creating a supportive workplace.
This podcast episode brought to you by the European Menopause and Andropause Society (EMAS), features Prof Jeanine Roeters van Lennep discussing how heart disease and stroke risk increase in women post-menopause and the steps that can be taken for prevention. Let’s dive into today’s discussion.
Prof Jeanine Roeters van Lennep: My name is Jeanine Roeters van Lennep and I’m an Associate Professor in Internal Medicine at Erasmus MC University Medical Centre, Rotterdam, the Netherlands. And I specialise in cardiovascular prevention with a focus on women. Today I will talk about heart disease and stroke in women.
Cardiovascular disease, which includes heart disease and stroke, is the leading cause of death in women. The number of women with cardiovascular disease continues to increase because of the pandemic of obesity and associated cardiovascular risk factors such as diabetes, hypertension, and high cholesterol. Nowadays, we know that there are differences between women and men in epidemiology such as age of onset, risk factors, diagnosis and treatment of cardiovascular disease.
First of all, coronary heart disease occurs about 10 years later in women compared to men.
Women have their own kind of cardiovascular protection which is likely due to the female sex hormones such as estrogen, because after menopause, when estrogens are low, the risk of heart disease increases more rapidly in women compared to men.
When women experience a myocardial infarction, most have chest pain. You really have to remember that. However, women also often have other symptoms at the same time, such as back pain or pain radiating to their neck or arms, but also shortness of breath or palpitations. And this makes it more difficult for women themselves, but also for healthcare professionals to recognise a myocardial infarction in a woman. Myocardial infarctions more often have a delayed or misdiagnosed in women. Myocardial infarctions can be caused by the blockage of coronary artery but can also have a myocardial infarction caused by coronary spasms or microvascular disease. And then often the coronary arteries are open and women more often have these latter forms.
Cardiovascular mortality in women is more often actually due to stroke than to heart disease, and women experience a stroke at an older age compared to men. Women also often have more atypical symptoms of stroke, enhanced more often by misdiagnosis.
Universal risk factors for heart disease and stroke for women and men include hypertension, high cholesterol, diabetes, and smoking. However, diabetes and smoking have more impact on cardiovascular disease in women compared to men. So even though smoking is bad for both women and men, it’s worse for women.
In addition to the universal cardiovascular risk factors, there are also sex-specific risk factors. Risk factors which only occur, for example, in women such as pregnancy complications like gestational diabetes and having had a hypertensive disorder of pregnancy, including gestational hypertension and preeclampsia, but also polycystic ovarium syndrome and also having an early menopause, especially Primary Ovarian Insufficiency, also called POI, when women experience their menopause at a very early age, before the age of 40.
During the menopausal transition, women develop more cardiovascular risk factors. Women experience weight gain, especially at the wrong places, and become more apple-shaped with a waist circumference higher than the hip circumference. Also the blood pressure increases, especially the increase in systolic blood pressure. That’s the first number of a blood pressure reading. And also the resistance to insulin increases leading to an increased risk of diabetes. And finally, last but not least, also cholesterol levels increase.
Because of all these changes, it’s very important to have regular cheques for blood pressure, glucose and cholesterol levels as even when these were OK before the menopausal transition, they might have increased and most women do not have symptoms of high blood pressure, diabetes and hypercholesterolemia. But these risk factors will lead to the progression of atherosclerosis in the arteries and eventually lead to heart disease and stroke. Therefore, timely treatments, preferably with lifestyle, but by drugs if needed, can prevent or at least slow down the process of atherosclerosis and ultimately heart disease and stroke. So I advise all women who are in perimenopause and menopause to know your numbers. Go and check your blood pressure, glucose and cholesterol levels in order to stay healthy at work and at home. I wish you a happy and healthy World Menopause and Work Day.
Intro: Menopause and menstrual health policy are becoming increasingly important areas of focus in the workplace and public health settings.
Ensuring that policies are inclusive of the needs of menopausal and menstruating women can help alleviate the stigma and challenges faced by individuals during these life stages, promoting better well-being and equality in various societal domains.
Understanding how menopause impacts various aspects of health is crucial for creating a supportive workplace.
This podcast episode brought to you by the European Menopause and Andropause Society features Professor Kathleen Riach discussing how menstrual health policies can address the challenges faced by menopausal and menstruating individuals in the workplace. Let’s dive into today’s discussion.
Kathleen Riach: Hello, my name is Kathleen Riach and I’m a professor at Adam Smith Business School at the University of Glasgow in the UK. I’m the convenor of the forthcoming ISO standard on menstruation, menstrual health and menopause in the workplace.
Now, evidence is now firmly established that there’s a two-way relationship between menopause and work. Symptoms associated with the menopause can have an impact on employee engagement and satisfaction. At the same time, features of workplace and job design, such as lack of control over the physical environment or low levels of job-based autonomy can exacerbate symptoms.
In particular, studies have shown that high levels of supervisory support can positively offset the frequency and bothersomeness of menopausal symptoms.
Within organisations, menopause support can be situated as part of a broader suite of practices to encourage gender equality across the life of course that sits alongside maternity or menstrual health initiatives, for example.
Alternatively, it can be part of a work package that supports mental health and well-being at work that pays attention to, for example, heart disease and other conditions more likely to impact all employees as they grow older. However, features of workplace menopause support usually include four elements.
The first element is the development of policy and resources. This can be in the form of a specific menopause policy to signal an organisational commitment to being menopause inclusive, but should also ensure menopause is embedded into the organisation through being cross-referenced into other policies within the workplace such as being mentioned in flexible working guidance or occupational health and safety protocol. Resource allocation should also be made to support initiatives such as support networks, and awareness raising campaigns, or to help create protocols or guidelines to support those who are managing menopausal employees.
The second element is training, especially for line managers and supervisors. This is because the first conversation an employee has with someone in a position of authority in their workplace can make a significant positive or negative difference to whether they feel they can work through menopause or not. Now we don’t need managers to be experts about menopause and they certainly shouldn’t be giving menopause or health-related advice, but they do need to be scaled up in how to have a positive and productive conversation about supporting menopause at work, should an employee approach them. As well as know where they can go to get further advice or guidance about how they can practically support that employee.
The third element of menopause support at work is education and awareness where everyone in the workplace is able to access evidence-based, reliable and accessible information about menopause transition and menopause-related health. These do not have to be created by the organisation themselves but can be signposted to high-quality existing resources such as those found on the EMAS Menopause Essentials webpage.
The final element of a menopause policy is creating a culture that encourages a collaborative approach to finding solutions that keep employees in work in a capacity they feel comfortable, recognising that this might change over time as their symptoms evolve. Often the best support mechanisms are low resource but high impact, such as being able to quickly access a cheap fan without excessive bureaucracy or utilising flexible working practises when required. And if there is concern over whether this is the right solution, workplaces should be open to considering a trial period to see if it works for both the employee and the organisation.
Employees going through menopausal transition are a vital and valuable part of the workforce, and organisations to support them will be rewarded not only in employee engagement and satisfaction and low staff turnover but also in creating an inclusive workplace environment for everybody in work.
For further details, you can read the EMAS Menopause Essentials on Menopause in the Workplace available for free through the Menopause EMAS website or go to the Menopause Information Pack Online at [email protected] or download the current British Standards Institute guidelines on menstruation, menopausal health and Menopause.
Or if you’re interested in reading more about the employee experience of menopause in the workplace, download a free copy of the Amino Study of over 3000 employees’ Experience of Menopause at Work from either the Scottish Government, NHS Scotland website or the University of Glasgow webpages.
Intro: The Mediterranean diet is a plant-dominant dietary pattern, low in saturated fats, prevailing in the olive-growing areas of the Mediterranean basin.
Understanding how menopause impacts various aspects of health is crucial for creating a supportive workplace.
This podcast episode brought to you by the European Menopause and Andropause Society (EMAS), features Prof Antonio Cano exploring the benefits of the Mediterranean diet for menopausal health.
Let’s dive into today’s discussion.
Antonio Cano: I am Professor Antonio Cano from Valencia, Spain, and in the coming minutes I will be delighted to share with you the main features of the Mediterranean diet in what refers to the dysfunctions associated with menopause and particularly the case of women who are passing their menopause while incorporated in the markets, work markets, and at the workplace.
What I will do is try to answer three very basic questions.
The first one is Why a Mediterranean diet?
The second will be Why at menopause?
And the third will be just to review the main benefits provided by the Mediterranean diet for women across the menopause.
So I will start by reviewing data that show that obesity is a pandemic which extends across the world and also is particularly important in some countries like the USA or Mexico, for example.
And the rates of obese people keep increasing. So that, by 2030, it has been calculated that 40% of the American population will be obese. So diet is important.
It’s also important not only because of obesity but also because inaccuracies in diet are associated with mortality. For example, it has been shown in recent data published in the Lancet that 11,000,000 deaths in the world in 2017 were the result of inaccuracies in diet. For example, a high consumption of salt or a low level of fruits.
And as I was saying, it is important at the moment of menopause because menopause is associated and disease data we know from the SWAN study is associated with an increase in fat and an increase in weight. And this fat accumulates at the waist so there is an increase in visceral obesity.
This is something which has important implications at the level of the cardiovascular risk and risk of other diseases that have been shown to be limited by the Mediterranean diet.
And why is it important? When Mediterranean diet is important?
This is not only because it is an intangible cultural heritage of humanity as defined by UNESCO, but also because it keeps being first in the rank of the different diets as recognised by scientific societies of different agencies.
The second question was what is actually the Mediterranean diet?
And the main message is that it is something flexible. It’s very easy to follow. It’s represented by the diet pyramid, in which foods are stratified according to the frequency that they may be used.
For example, there are fruits which may be used at every meal. For example, fruits, olive oil, pasta or vegetables.
Others should be used at least once per day, as is the case of olives, nuts or dairy, for example. Two servings per day.
And some others which should be served, used, or consumed on a weekly basis. This is the case of white and red meat or fish or eggs, for example, which may be consumed two or even six per week. Almost every day.
So it’s a diet which is very easily followed, which is, which includes components which are found at different, in different countries in the world. And this is important because it accommodates the principles of the Paris Agreement which increases its importance. It’s easy to commit to sustainability. So it is something easy to follow. Adherence, for example, is important, something that in a diet is crucial.
But what are the benefits of this diet?
And this is something which has been investigated for many years, because the Mediterranean diet already in the 50s of last century was investigated by different American endocrinologists, for example, who were developing studies like the Seven Countries Studies in the different countries in Europe, particularly in Greece and in Italy. And the data we have are particularly important in what concerns cardiovascular disease, but also for other diseases.
The case of cardiovascular disease is very clear because there is an improvement in the risk factors, for example, the metabolic syndrome which decreases and that’s something which implies benefits in terms of cardiovascular disease.
And there are important studies, randomised controlled trials, first level of evidence, like the PREDIMED study, that has shown that by increasing, increasing the consumption of nuts or olive oil, there is a reduction in the incidence of cardiovascular events. So it is important to stress that we are not speaking of cardiovascular risk factors, or intermediate risk factors, but final events which were reduced. This has been shown also in other smaller studies.
But we have evidence also concerning observational studies of huge populations, for example at the level of cognition or mental health or even osteoporosis. Important is also the impact on the level of mortality, which has been shown to be reduced by the consumption of a Mediterranean diet.
So in summary, we have a diet which is particularly appropriate for menopausal women also and specifically for those who are involved in the work markets, at the workplace, which is as I was commenting, easy to follow.
Adherence is important and is also associated with the control of weight and with the reduction of different cardiovascular diseases and other non-communicable diseases, something which has a very important impact at the level of health.
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