Cardiovascular Health and Menopause: how the DUTCH hormonal test may support better cardiovascular health

January 03, 2025 / susan Foulger

Menopause marks a significant transition in a woman's life, bringing physiological changes that can adversely affect cardiovascular health. Oestrogen, a hormone crucial for maintaining heart health, declines significantly during menopause, leading to an increased risk of cardiovascular diseases.

The DUTCH test (comprehensive hormone testing) can be a valuable tool to understand and support the mechanism that relate to cardiovascular health; firstly let’s look at the mechanisms involved pertaining to hormones

The Role of Oestrogen in Cardiovascular Health

Oestrogen has been found in studies to provide multiple protective benefits for the cardiovascular system:

1. Cholesterol Regulation

Oestrogen has been found to increase high-density lipoprotein (HDL, "favourable" cholesterol) and reduces low-density lipoprotein (LDL, "less-favourable" cholesterol). This balance may help prevent atherosclerosis, the build-up of plaque in arteries.
Post-menopause studies have found that HDL levels drop, and LDL levels rise, elevating cardiovascular risks (1).

2. Vasodilation and Blood Pressure Regulation

Oestrogen has been found to stimulate nitric oxide production, which may assist in relaxing blood vessels and reducing blood pressure.
Without sufficient oestrogen, in studies vascular resistance has been found to increase, contributing to hypertension (2).

3. Anti-inflammatory Effects

Oestrogen has been found to suppress inflammatory pathways linked to arterial damage and plaque formation. Its decline may promotes a pro-inflammatory state, accelerating cardiovascular disease progression (3).

4. Antioxidant Effects

Oestrogen has been found to assist in reducing oxidative stress by neutralising free radicals. With reduced levels, oxidative damage accelerates vascular ageing (4).

Case Study: Managing High Blood Pressure and Raised Cholesterol

A client presenting with high blood pressure, elevated cholesterol, fatigue, low motivation, and heightened irritability highlights how these issues can be managed effectively during menopause.

The Role of DUTCH Testing

The DUTCH (Dried Urine Test for Comprehensive Hormones) test provides a detailed view of cortisol and sex hormone levels, enabling targeted interventions:

1. Cortisol Regulation

Elevated cortisol levels may drive inflammation and in turn oxidative stress. DUTCH testing helps pinpoint cortisol imbalances, allowing tailored strategies to reduce stress and inflammation (5).

2. Hormonal Imbalances

Testosterone: Reduced testosterone may lead to compromise blood vessel linings. Enhancing nitric oxide levels through dietary sources such as leafy greens and beets may assist in protecting vascular health.
Oestradiol: Declining oestradiol (a oestrogen) during menopause has been found to be linked to vascular damage. Hormone replacement therapy (HRT) or dietary phytoestrogens may mitigate these effects by addressing the mechanisms (6, 7).

Practical Interventions that may support Cardiovascular Health

1. Dietary Adjustments

Incorporate foods rich in nitric oxide precursors, such as spinach, rocket, and beetroot.
Focus on omega-3 fatty acids from fish and flaxseed to improve lipid (cholesterol) profiles (8).

2. Stress Management

Practice mindfulness, yoga, or meditation to regulate cortisol levels.
Ensure adequate sleep to support hormonal balance (9).

3. HRT or Natural Alternatives

For suitable candidates, HRT can restore hormonal balance and protect cardiovascular health.
Discuss HRT and alternatives, such as soy-based phytoestrogens, with a healthcare provider (10).

By leveraging diagnostic tools like the DUTCH test and implementing evidence-based interventions, women may effectively lower cardiovascular risks during menopause and maintain optimal health.

References:

1. Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999;340(23):1801-1811. DOI: 10.1056/NEJM199906103402306.

2. Arnal J, Fontaine A, et al. Estrogen Receptors and Endothelium. Arteriosclerosis, Thrombosis, and Vasular Biology. 2012.

3. Pamela Ouyang, Erin D. Michos, Richard H. Karas, Hormone Replacement Therapy and the Cardiovascular System: Lessons Learned and Unanswered Questions, Journal of the American College of Cardiology, Volume 47, Issue 9, 2006, Pages 1741-1753, ISSN 0735-1097,

4. Barton M, Meyer MR. Postmenopausal hypertension: mechanisms and therapy. Hypertension. 2009 Jul;54(1):11-8. doi: 10.1161/HYPERTENSIONAHA.108.120022. Epub 2009 May 26. PMID: 19470884.

5. Ortiz R, Kluwe B, Lazarus S, Teruel MN, Joseph JJ. Cortisol and cardiometabolic disease: a target for advancing health equity. Trends Endocrinol Metab. 2022 Nov;33(11):786-797. doi: 10.1016/j.tem.2022.08.002. Epub 2022 Oct 18. PMID: 36266164; PMCID: PMC9676046.

6. Barrett-Connor E. Hormones and heart disease in women: the timing hypothesis. Am J Epidemiol. 2007 Sep 1;166(5):506-10. doi: 10.1093/aje/kwm214. PMID: 17849510.

7. Richard E White, Estrogen and vascular function, Vascular Pharmacology, Volume 38, Issue 2, 2002, Pages 73-80, ISSN 1537-1891, https://doi.org/10.1016/S0306-3623(02)00129-5.

8. Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr. 1991 Sep;54(3):438-63. doi: 10.1093/ajcn/54.3.438. PMID: 1908631.

9, Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009 Jul;5(7):374-81. doi: 10.1038/nrendo.2009.106. Epub 2009 Jun 2. PMID: 19488073.

10. Kim, JE., Chang, JH., Jeong, MJ. et al. A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases. Sci Rep 10, 20631 (2020). https://doi.org/10.1038/s41598-020-77534-9