Blood pressure changes

Blood pressure is the force of your blood pushing against the walls of your blood vessels. When it stays too high, the NHS website says, it puts extra strain on the blood vessels, the heart and other organs, including the brain, kidneys and eyes.

Doctors call it hypertension. At home it is just BP.

The NHS page on high blood pressure does not list menopause as a cause. What changes in midlife is that the risk factors gather, which is why the menopause guidelines keep coming back to it.

Usually, nothing at all. Rarely, the NHS website says, it can cause headaches, blurred vision or chest pain. A headache in perimenopause could be many things, and a racing heart could be a hot flush or palpitations. Only the cuff knows.

The NHS website lists the things that raise your chances: getting older, close relatives with high blood pressure, a diet high in salt, being overweight, smoking, too much alcohol and stress that goes on for a long time. Your ethnicity is on the list too. The NHS names a South Asian background, with Black African and Black Caribbean backgrounds, as higher risk.

The menopause guidance says the same. The Pakistan Menopause Society notes that women in Pakistan reach menopause earlier on average than white women, and the European Menopause and Andropause Society (EMAS) says an earlier natural menopause may raise the risk of high blood pressure. The British Menopause Society says South Asian women show a higher incidence of heart and circulation risk factors during the transition, high blood pressure among them.

None of that means your blood pressure is high. It means a reading in your forties is worth more than you might think.

• The NHS website lists a healthy, balanced diet, regular exercise, losing weight if you are overweight, cutting down on salt, not smoking and not drinking too much alcohol. It also names too much caffeine, and lists tea among the drinks high in it. If the kettle goes on five times a day, see chai and caffeine.
• The Pakistan Menopause Society asks doctors to use the menopause visit for prevention: blood pressure, weight, sugar, cholesterol and tobacco use, with lifestyle advice (Table 1).

The NHS website says a GP will usually prescribe medicine if blood pressure is very high, if the risk of heart attack or stroke is higher, or if it stays high after lifestyle changes. Which medicine depends on how high the reading is, your age and your ethnicity, and that choice belongs to the doctor who measures it.

If you are thinking about HRT, blood pressure is part of that conversation. The Pakistan Menopause Society's recommendations ask doctors to investigate and refer high blood pressure, and to get any long-term condition under control before starting systemic treatment (Table 4). Whether HRT suits you, and in what form, is your doctor's call.

The NHS website suggests a check at a pharmacy or GP surgery if you think you might be at risk, or if you are 40 or over and have not had your blood pressure checked for more than 5 years. In England, many pharmacies offer free checks to the over-40s. Elsewhere, a pharmacy or clinic reading is something to take to your doctor.

The NHS website says to get urgent advice if you often get headaches or blurred vision, or chest pain that comes and goes.

Get emergency help straight away for sudden chest pain or pressure that does not go away, pain spreading to the arm, neck, jaw, stomach or back, or chest pain with sweating, sickness, light-headedness or breathlessness. The NHS website lists these as possible signs of a heart attack.

In many homes the blood pressure machine belongs to an elder, and the readings are about her, never you. Borrowing the cuff for yourself can feel odd. It is a small thing that tells you a lot.

In Ramadan, women ask how fasting and medicine timing fit together. Questions about the fast itself belong with a qualified scholar; questions about when to take a blood pressure tablet belong with whoever prescribes it, and that is not a change to make alone.