The Natural Woman's Guide to HRT:
Protecting Your Heart
by Sara M. Rosenthal Ph.D.
Heart disease is currently the number one cause of death in postmenopausal women; more women die of heart disease than of lung cancer or breast cancer. Although more men die of heart attacks before age 50, more women die of heart attacks after age 50, as a direct result of estrogen loss. Women who have their ovaries removed prior to natural menopause increase their risk of a heart attack by eight times. Until July, 2002, the medical community believed that conventional hormone replacement therapy (estrogen and a synthetic progesterone, called progestin) offered protection against heart disease. But the Women's Health Initiative Study demonstrated that long-term use of HRT actually increased the risk of heart disease in postmenopausal women.

Modifying your lifestyle and diet is the most critical first step in protecting your postmenopausal heart. Smokers, for example, are twice as likely to develop heart disease and die from a heart attack or stroke; therefore, postmenopausal women who smoke, dramatically increase their risk. Lesser-known long-term effects of smoking include a lowering of HDL, or "good" cholesterol and damage to the lining of blood vessel walls, which paves the way for arterial plaque formation. Hypnosis, meditation and acupuncture have helped some women smokers quit; there are a number of herbal and homeopathic smoking cessation aids now available in most health food/natural health stores.

Obesity in postmenopausal women is another modifiable risk factor for heart disease. Obesity can predispose women to type 2 diabetes, high blood pressure and high cholesterol, which are all precursors to heart disease. The most successful diets are those that incorporate a balance of roughly 40% carbohydrates, 30% protein and 30% fat. Diets that are too low in "good" fat can be harmful to your heart and health, and diets that are too low in carbohydrates, which include critical soluble fiber can also be bad for your heart and your colon! If you're confused about diets, you're not alone! Use "good" carbohydrates, such as foods high in fiber and whole grains, and minimize "bad carbohydrates" like refined sugars and starches. Calories from fat should maximize "good fats,” like omega-3 fatty acids or polyunsaturated fats and minimize "bad fats," like saturated fats. By simply modifying their diets, postmenopausal women can lower cholesterol, blood pressure and even reverse insulin resistance and/or Type 2 diabetes. In clinical circles, obese women, who have high blood pressure, high cholesterol and type 2 diabetes, are known as "a heart attack about to happen". For women who have high blood pressure or type 2 diabetes, following the DASH diet (visit the American Diabetes Association website at is critical. Dietary supplements such as vitamin E and vitamin C are recommended, and ideal dosages should be discussed with a healthcare provider. Foods high in antioxidants, such as deeply colored fruits and vegetables are also heart protective. While the jury is still out on Coenzyme Q10, anecdotal evidence suggests that may help reduce arterial plaque. For women who have no health problem that prevents them from drinking alcohol, a daily glass of red wine can raise your "good" cholesterol (HDL) as well as offer other heart-healthy benefits.

Herbal supplements can also be used to strengthen the heart. In fact, herbs that are good for the uterus are also good for the heart like hawthorn, rose, strawberry, raspberry and motherwort. If you're experiencing hot flashes or night sweats, this can trigger heart palpitations. Drinking lots of water, mineral-rich herbal infusions, fresh grape juice or eating grapes will help reduce palpitations. One or more tablespoons of wheatgerm oil, or flax seed oil can are heart protective (or grind flax seeds and sprinkle them on cereal). Other heart healthy herbs include garlic, lemon balm, ginseng and dandelion root. To calm heart palpitations, try rose flower essence, hawthorn, motherwort, valerian root, ginger root or real licorice. A daily spoonful of vinegar made from the leaves, buds, and/or flowers of alfalfa, birch and sweet clover can work as a "blood thinner," which can help to reduce the risk of stroke and blood clots.

Finally, exercise and movement are critical in reducing the risk of heart disease. Women who are physically active have a 60 to 75 percent lower risk of heart disease that inactive women. Yoga, qi gong, pilates, deep breathing exercises, dance, or any combination of movement, exercise or sport, will dramatically improve cardiovascular health. Stress is a contributing factor to heart disease, since it can dramatically increase blood pressure.Meditation, acupuncture, massage, and the many "nerve herbs" (ask your natural health pharmacist) can help your heart, too!

Dr. M. Sara Rosenthal is author of over 25 health books, including The Natural Woman's Guide To HRT (New Page Books, 2003, $13.99). She is Assistant Professor, Bioethics, University of Kentucky. For more information, visit her website at