As a natural phase of life, menopause offers a perfect opportunity to reflect with a patient on heart health and potential lifestyle changes — before she loses the “protective” effect of estrogen.

Heart disease is the No. 1 killer for both women and men, and the risk of heart disease for women rises significantly eight to 10 years postmenopause. Diet and lifestyle management can go a long way toward keeping the risks low.

If a patient is overweight or obese, I’ll encourage 30 to 40 minutes of exercise four to five times a week along with a healthy diet. If she has diabetes, we’ll talk about controlling her diabetes. We’ll go over managing cholesterol and consider cholesterol-lowering medication in the appropriate patient. With menopause, low-density lipoprotein (LDL) typically rises while high-density lipoprotein (HDL) decreases. Of course, if a patient is a smoker, that’s got to stop.

From my standpoint, unless there are significant menopause symptoms calling for hormone therapy, I don’t encourage it as a strategy to bring down cardiovascular risk. I defer to my gynecology colleagues to work through the benefits and risks of hormone therapy with patients.

Medicine is about risks and benefits. Risks are never zero. Postmenopausal patients need to bring down the risk of cardiovascular disease as much as possible, make sure they’ve dotted the i’s and crossed the t’s.

Mostafa O. El-Refai, M.D., is a cardiologist and interventional cardiologist with Norton Heart & Vascular Institute.