It's really what sets this whole train in motion.
Way back before the bottom dropped out from Perimenopausal hell, my blood pressure started to run high when I went to a few doctor appointments.
I didn't think much of it. I was around 46 years old.
Then...I saw my general doctor and BP was really high.
That started a slow-moving train wreck that has taken 2 years to get out from underneath.
The full story is here but that doctor, rather than look at my age and hormone levels, put me on a slew of blood pressure meds.
Followed by other meds to offset those. And more meds since those made me feel horribly.
Heart scans. 30 days of a portable heart monitor. Daily monitoring.
It just got worse and worse.
My heart would race day and night and I would wake up with jolts (one of the last things to finally go away) in the middle of the night.
Wild swings of blood pressure and pulse.
My heart just felt off!!
This rolled right into panic attacks and the ensuing benzos and SSRI's.
I was a complete mess and it all started with a blood pressure reading.
To this day, I can't put the cuff on as I have a total panic response from it.
In the end, it was all hormones or the lack (flux) thereof as the root cause.
Women (and most doctors) don't realize how powerful estradiol (our main estrogen) and progesterone are for our entire cardiovascular system.
Don't worry...we'll get into that below.
That doctor eventually ran a simple hormone panel and told me, "your levels are just fine for menopause".
I still had a period!
After reading our full review on estradiol here, I challenge anyone to make that same statement.
We're going to dig deep into this and then we'll talk about whether research is showing CBD and other tools can help with blood pressure, heart palpitations, and the like.
These are the topics we'll cover:
- Perimenopause and heart-related issues like BP and palpitations
- How estradiol manages blood pressure
- Estradiol and heart palpitations
- Progesterone and health issues
- Can CBD help with blood pressure from perimenopause
- Can CBD help with heart palpitations from perimenopause
- How much CBD to take for perimenopause BP issues and heart palpitations
- What's the best CBD for BP and heart palpitations
Let's get started before a doctor writes another script.
Perimenopause and heart-related issues like BP and palpitations
First, what is the relationship between perimenopause and cardiovascular health?
A quick intro to the wonderful world of perimenopause.
You can get a full understanding of it at our perimenopause versus menopause article here.
Essentially, it's a period of intense (for some women) flux or change in hormones.
The two main players are:
- Estradiol - our primary estrogen called E2
Progesterone has been dropping since around age 20 but it takes a further dive when an egg is no longer released.
Estradiol, on the other hand, can be a mess.
There can be a roller coaster ride of peaks and valleys during the few years of perimenopause leading up to and including 12 months without a period.
Most women and doctors for that matter, assume that estradiol just gradually slides into menopause where it flatlines.
For about 25% of women, this "hayride" down can be debilitating. More on why some women are hit so hard.
Count me as one of those 25%.
There's a nasty cat-and-mouse change going on between FSH and estradiol to get out one….more….egg.
THAT's the culprit here.
A host of symptoms occur including various cardiovascular issues:
- Heart palpitations or racing heart
- Arrhythmia or missing/irregular beats
- Increased blood pressure
- Increased pulse
These all point to one main cause.
The drop or CHANGE in estradiol levels.
Contrary to the entirety of our medical tradition, estradiol is not JUST for making babies.
Let's look more closely at its powerful effects across our cardiovascular health (and well-being).
How estradiol manages blood pressure
It's well documented that menopause accompanies a dramatic rise in blood pressure.
Estrogen has its hands in the full gamut of pathways that affect blood pressure:
Both animal experimental and human clinical investigations suggest that estrogen engages several mechanisms that protect against hypertension, such as activation of the vasodilator pathway mediated by nitric oxide and prostacyclin and inhibition of the vasoconstrictor pathway mediated by the sympathetic nervous system and angiotensin.
It's a who's who of high blood pressure.
We can always look at oophorectomies where they remove the ovaries (our primary source of estrogen until the body quickly compensates with more fat tissue - see CBD and perimenopause weight gain).
Oophorectomy increased the mean values of 24 h (P < 0.001), daytime (P < 0.05), and nighttime (P < 0.01) diastolic blood pressure and nighttime systolic blood pressure.
Just as an example, let's tease out some of the big players in our blood pressure maintenance.
Angiotensin 2 is a big player as it constricts vessels to increase blood pressure.
Any relationship between it and estrogen?
Estrogen Regulates Angiotensin II Receptor Expression Patterns and Protects the Heart from Ischemic Injury in Female Rats.
And estrogen just checked out with perimenopause!
Did you catch the net result of that?
Protection from stroke (ischemia).
Goodness...brand new, state-of-the-art research is showing that loss of estrogen basically ages you significantly:
A recent report (Levine et al., 2016) suggested that bilateral oophorectomy accelerates aging (particularly of the circulatory system), as measured by increased methylation.
Heck, even the ability to recover from a stroke is affected by lower estrogen levels:
Low estrogen levels were thus shown to be associated with exacerbated long-term neurovascular damage from ischemic stroke.
Sorry...back to blood pressure (but it's interesting, right...considering that estrogen is just for making babies).
What about estrogen replacement (only bio-identical for us...synthetics have issues).
Here's where we get angry.
If you type in estrogen replacement and blood pressure, the full first page of google points to old information showing a risk!
- First, most of that was from synthetic estrogens or horse-derived hormones.
- Secondly, much of the original 2002 study that scared women silly has been discredited.
Read the full estradiol review here to get to the bottom of it.
Get ready to get angry.
All those studies show a date in the early 2000s when millions of women were misled.
Look at more recent (and much more sophisticated studies) from recent years.
Let's go back to the components.
We already look at angiotensin which is the target for many blood pressure medications (ACE inhibitors).
Next up, Nitrous oxide which has an immediate vasodilation (reduces blood pressure) effect.
What does estrogen do there?
E2 significantly increased NO2 levels irrespective of its concentration in both cell lines by 35 % and 42 %.
That's the good guy.
What about the bad guy (relatively speaking) which constricts blood vessels and is tied to cardiac health issues….endothelin.
Estradiol inhibits endothelin-1 synthesis, an effect that may contribute to the cardiovascular protective effects of estradiol.
Estrogen's effects on the lining of the blood vessels are even more pronounced.
Estrogen boosts elastin and collagen (yes, the same thing that keeps your skin and hair looking healthy).
It also does this in the endothelium (walls of our blood vessels) that keeps them flexible.
This is key to blood pressure as a system that can't flex, pressurizes!
Estrogen's effect is pronounced there:
Estrogen replacement therapy (ERT) seems to improve endothelial function both in coronary arteries of postmenopausal women with coronary atherosclerosis and in brachial arteries of postmenopausal women with mild hypercholesterolemia.
We could keep going through the different pathways for blood pressure and show estrogen's powerful effects.
Let's zoom out a bit.
Results indicate that women with elevated resting BP and positive family history of CHD have exaggerated BP reactivity to stress and that HRT inhibits this effect.
Let's zoom out even further.
The leading cause of death for women is cardiac-related...heart attacks, heart disease, etc.
After accounting for age, coronary calcium score and cardiovascular risk factors including diabetes, high blood pressure, and high cholesterol, women using hormone replacement therapy were overall 30 percent less likely to die than those not on hormone therapy.
30% reduction in….death!
Without estrogen, women quickly catch up with men in terms of heart issues:
Studies show that premenopausal women, who produce high levels of estrogen, typically have the cardiovascular health of men 10 to 20 years younger than them, but rates of heart disease increase dramatically after menopause when estrogen levels plummet.
One note...we dug into a report that showed that chronic estrogen replacement increased blood pressure by boosting superoxide.
This study was done in young rats who presumably already have high levels of estrogen.
Secondly, it was reversed by resveratrol which points to supplementing for anti-oxidants...which we all need during perimenopause anyway.
What happens when estradiol is given to rats with ovaries removed (low/no estradiol):
Treatment with 17-β-estradiol reduces superoxide production in the aorta of ovariectomized rats.
In fact, estrogen was shown to increase the very substance that breaks down superoxides in our body and protect us from damage:
We conclude that EPT increases blood MnSOD and CuZnSOD activity in postmenopausal women, leading to an increased plasma total antioxidant capacity.
That's in postmenopausal (low estrogen) women. Not young rats! Not to malign young rats mind you.
We now know some of the players downstream from estradiol for blood pressure.
There's a great review here:
Next up...heart palpitations and arrhythmias.
Estradiol and heart palpitations
Heart palpitations, arrhythmias, skipped beats, fluttering hearts...whatever you want to call it.
Yes, you need to make sure it's not something else but palpitations are generally harmless.
That doesn't make them enjoyable!
There's a potential for an increase with perimenopause.
Heart palpitations are a direct result of lower levels of the female hormone estrogen, which leads to an overstimulation of the heart.
Okay...let's dig deeper...what does estrogen do to regulate heartbeat?
Heart rate variability is what we're after.
How "regular" is the heartbeat.
Turns out that this is directly influenced by estrogen and its receptor.
Look at the effect of drops in estrogen with perimenopause:
This is associated with an increase in heart rate (sinus tachycardia) and an increased frequency in palpitations and non-threatening arrhythmias, such as premature ventricular contractions or PVCs.
And it continues into menopause as estrogen further drops:
This time period is associated with irregular heartbeats, palpitations, spasmodic chest pain and nightmares in women 40 -64 years old².
They then go on to reference that 2002 study which causes countless women to come off of HRT and entertain cardiovascular issues.
There's a function of our heartbeat called the QT interval.
Essentially, it's the measurement between the big spike and the following little spike.
Estrogen and progesterone directly (and oppositely) affect this:
The increase in progesterone and the decrease in estrogen levels during the normal menstrual cycle correspond to the increased frequency, symptomatic burden, and duration of supraventricular tachycardia (SVT).
Tachycardia - irregular heartbeats.
Again, a drop in estrogen leads to an increase in all aspects of heart fluttering and palpitations!
Although testosterone has a role in heartbeat and palpitations, estrogen and progesterone primarily account for the differences that women experience.
In female rats, 300 ng kg-1 + 30 ng kg−1 min−1 17β-estradiol significantly reduced the number of ventricular premature beats (VPBs) and the incidence of ventricular fibrillation (VF)
Let's zoom out a bit.
What about hormone replacement and the mechanics of heartbeat:
Our results indicate that a 6-month course of HRT may significantly improve cardiac autonomic function parameters, a finding that could at least partly explain the potential cardioprotective effect(s) of HRT.
They were looking at the components that make up heart rate variability... the key to our discussion here.
Autonomic just means the things that run in the background "automatically" like...heartbeats!
Let's turn to progesterone which is no slouch in our general health.
Progesterone and blood pressure and heart palpitations
Estrogen's effects are more direct and powerful but progesterone is generally a counter to E2's effects.
On one hand, progesterone causes more water retention via the angiotensin pathway but on the other hand, it helps to relax blood vessels which directly affects blood pressure:
Our results provide evidence that progesterone is a vasoactive hormone, inhibiting agonist-induced vasoconstriction.
It does this by managing the literal currency of cells, calcium!
The net effect of this nuanced effect is this:
Thus progesterone receptors have been localized in the myocardium4 and in peripheral vascular tissue,5 and administration of progesterone lowers BP in humans.
Another great study points out why bioidentical hormones are so important.
First, estrogen and progesterone:
Significant decreases in nighttime systolic, diastolic, and mean blood pressure were observed in the group treated with estradiol and estradiol/progesterone.
Next up...synthetic progesterone (called progestin) like those found in birth control:
The vasodilator effect of estradiol replacement therapy is diminished by the co-administration of synthetic progestins such as medroxyprogesterone and cyproterone acetate.
It literally canceled out the benefits of estrogen.
Ladies...even the NIH knows the difference between bio-identical progesterone and progestins:
Progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with estrogen, relative risk 0.67.
33% reduction in risk!
The key is "natural" or bioidentical progesterone:
Moreover, oral administration of natural progesterone significantly lowered blood pressure in six men and four postmenopausal women with mild to moderate hypertension who were not receiving antihypertensive drugs.
Most important for blood pressure:
Most studies conducted with synthetic progestins for contraception or hormone replacement therapy have shown a blood pressure elevating effect
Goodness...and women have been on these for decades (birth control)!!
Progesterone also has positive effects on the long term contributors to high blood pressure (essentially, hardening of the arteries):
Similar to estradiol, progesterone inhibits mitogen-induced growth and proliferation of cardiac fibroblasts , vascular smooth muscle cells  and glomerular mesangial cells.
Let's look at heart rate variability (skipping and fluttering beats).
Progesterone and heart palpitations
Remember the whole QT time before the big spike and the little follow-up with heart rates?
When it gets long, that can lead to heart irregularities for some people.
It turns out that progesterone works opposite to estrogen to shorten that length.
So first, the effect of having too long of a QT period of time:
A prolonged QT interval is a marker for an increased risk of ventricular tachyarrhythmias.
Here's the interesting piece with progesterone:
During a single menstrual cycle, progesterone levels, but not estrogen levels, have the dominant effect on ventricular repolarization in women.
Ventricular repolarization is the technical term for this QT value and its regularity.
So, progesterone has a bigger impact on this process and why is it important?:
Prolonged QTc reflects cardiac repolarization prolongation and/or increased repolarization inhomogeneity known to be associated with an increased risk of arrhythmias.
So..progesterone keeps our heart beat...regular.
No wonder perimenopause and even menopause see such an uptick in heart-related issues.
Check out the review of Siberian Rhubarb (alternative to estradiol) which shows the main symptoms of menopause and you'll see cardiovascular right there.
The two hormones literally shape our heart rate!
Not to mention our entire vascular system.
Just for making babies indeed.
Let's finally get to the question at hand. Thanks for being patient but it's important to really drill down and understand what's going on...based on research.
Can CBD help with blood pressure from perimenopause
We'll jump right into CBD's general effect on blood pressure and then we'll find the actual pathways affected.
Not to show our cards but...a drop in blood pressure is one of the 4 common side effects of CBD!
CBD reduced resting systolic BP (–6 mmHg; P < 0.05) and stroke volume (–8 ml; P < 0.05), with increased heart rate (HR) and maintained cardiac output.
CBD's effect on blood pressure is especially acute in response to stress or anxiety, the latter being one of the main complaints of perimenopause:
Resstel and colleagues have shown in Wistar rats that a single dose of CBD (10 or 20 mg kg−1 i.p.) reduced the heart rate and blood pressure response to conditioned fear  or to acute restraint stress.
Just check out CBD and perimenopause anxiety for more info on this.
What's really interesting is that they were able to stop this blood pressure effect by blocking the serotonin pathway!
Remember how estradiol is in direct control of serotonin levels.
What does CBD do there?
Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain.
The keyword there is "modulates". You'll see this throughout the research.
Not boost or decrease...modulate. Normalize.
This is critical with serotonin as too much or too little can be debilitating.
Check out my story on using CBD to wean off SSRI's as an example.
Too much serotonin (called Serotonin Syndrome) and I was awake for 3 days and had a psychotic break!
Learn all about CBD versus SSRI's for serotonin here.
By the way, that's one of the first things a doctor will throw women with perimenopause on.
Lexapro is their go-to.
Without ever looking at hormones!
CBD's effect on vascular flexibility (key to blood pressure) is one of it's biggest effects on this system both short term and more importantly, long term!
CBD caused acute, non-recoverable vasorelaxation of human mesenteric arteries with an Rmax of ∼40%.
That article then spilled out a litany of cardio-related values that were positively affected by CBD.
Now, let's get technical!
TRPV4. Yes, it's thrown around these days too much but let's go there. Just kidding.
This is a very important channel that research is showing as the key to sex differences in blood pressure.
Remember how women have better blood pressure situations prior to perimenopause?
We then catch up (in the wrong direction) with men.
This is primarily a result of estrogen and progesterone as we've seen above.
A study found that a key component of sex differences in blood pressure is because of a specific pathway called TRPV4.
These findings suggest that altered TRPV4 expression might be involved in the sex differences in blood pressure regulation. blood pressure regulation; gender differences; nucleus tractus solitarius; transcriptome.
TRPV is interesting due to where it operates:
TRPV4 is involved in the regulation of systemic osmotic pressure in the brain and plays a role in vascular function, skin barrier function, and nociception
It's also directly tied to maintaining body temperature (umm..hot flashes!!!).
Smoking gun please:
The progesterone receptor regulates the expression of TRPV4 channel
And what does CBD do there?
Collectively, these data unambiguously confirm that CBD activates TRPV4 and that this ion channel selectively mediates its lipostatic action.
We geek out so hard on this stuff!!
It's very exciting to take control of our own health and OWN how we feel.
Anyway, that's just one targeted pathway but the sex difference in blood pressure, as a result, is fascinating.
Next up...CBD and heart rate.
Can CBD help with heart palpitations from perimenopause
So, there's an interesting effect here which shows how different CBD is from THC (opposing, really).
When they gave THC/CBD combos, there was no effect on the heart rate variability (via long TQ issues)
However, look at what happens when the gave only CBD:
CBD reduced both the total number of ischemia-induced arrhythmias and infarct size when administered prior to ischemia, an effect that was dose-dependent. Infarct size was also reduced when CBD was given prior to reperfusion.
They basically induced a stroke and looked at the effects on the heart in terms of heart rate stability and heart attacks. CBD offset this result!
Let's bring back anandamide, our naturally occurring endocannabinoid.
It's shown to have a powerful antiarrhythmic effect...it blocks heart irregularities.
[Anandamide and R-(+)-methanandamide prevent the development of ischemic and reperfusion arrhythmia in rats by stimulation of CB2-receptors].
What does CBD do for anandamide?
A powerful study on schizophrenia points to the result:
Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia.
Notice the language…" enhances". THC is a direct imitator of anandamide but it boosts activity in CB1 receptors too strongly.
CBD "constrains" the low and high end of anandamide as needed.
That's the beauty of it and why it doesn't have psychoactive results like THC.
We look forward to more research on CBD by itself for heart palpitations.
Keep in mind that hormone balancing is really the driver of all things perimenopause and that has to be addressed.
Estradiol and progesterone are just too integral to our entire health!
Now, some practical questions.
How much CBD to take for perimenopause BP issues and heart palpitations
We don't have good, hard research on this front.
The good thing is that heart palpitations are relatively easy to gauge in terms of response.
A starter-level is usually 25-30 mg.
Sleep studies are pointing at 160 mg and studies on anxiety/depression with neurogenesis (brain repair) are pointing at 300 mg.
The study on acute blood pressure and palpitations due to public speaking (see CBD and public speaking anxiety) used 600 mgs.
That's on the high end of course.
The sweet spot for me was between 100-200 mg daily although I now take 150mg morning and night for hippocampus neurogenesis (see CBD and neurogenesis here).
I have 2 years of trauma (thank you doctors) to clear out. Some brain remodeling if you will.
Make sure to look at other key nutrients:
- Methylated B's
- Magnesium Glycinate
- Basic minerals
- Omega 3's (see the fats review...goodness)
You can buy these online here.
We also added metformin due to its powerful anti-aging results lately. See metformin review here for effects on cardiovascular health.
Next up...what type of CBD?
What's the best CBD for BP and heart palpitations
First, the bare minimum requirements still apply:
- Organically grown in the US at an FDA registered farm
- CO2 processed (cleanest option)
- 3rd party tested for:
- No THC
- No pesticides
- No heavy metals
- No bacteria
- No mold
In today's wild west world of CBD, we MUST have these verified.
We actually test ours twice (biomass and finished product) since our whole family uses it including our teens.
We don't mess around and hopefully, our level of research speaks to that.
We focus on CBD isolate for two reasons.
- All the research is on CBD by itself (See CBD isolate versus full spectrum)
- The histamine issue (histamine drives blood pressure, racing heart, etc)
- We want ZERO THC
Let's look at the latter two for blood pressure and heart palpitations.
Perimenopausal women are at the very high end for histamine issues (40-60%).
The last thing we need is a bunch of plant material to set off that inflammatory system.
I tried 3-4 of the biggest CBD brands originally and had an immediate histamine response.
Keep in mind that my allergies and histamine got worse during my 40's (progesterone is dropping) and fell off a cliff when true perimenopause kicked in.
All of a sudden, I couldn't eat certain things or use almost any common cosmetics anymore.
It was crazy how sensitive my body became.
Full-spectrum is probably not going to feel great to many women in perimenopause.
CBD isolate on the other hand has a powerful effect to calm our immune response (See CBD and histamines/allergies here).
Some of the full spectrum CBD on the market has up to .3% THC (the limit by law).
We really want zero THC.
Aside from 75% of people with histamines issues (hello perimenopause) being allergic to THC, It's effect on blood pressure and heart rate is mixed.
In fact, there's a known effect from THC for sick sinus syndrome.
Essentially, the node that controls heart rate starts to have issues.
You'll see more of this as the THC levels keep rising in cannabis (see why high THC sellers need to lawyer up here).
In terms of blood pressure, it actually has a tri-phasic effect...lower, raise, lower depending on amount and duration.
Hopefully, this all sheds some light on one aspect of perimenopause we can do without.
The long term protective effects of CBD, estradiol, and progesterone are separate benefits.
Be well. Be informed. Be empowered!
This glimpse into perimenopause is just the beginning. 'Dre's Story' offers our complete, research-rich journey into hormones, tools to feel better, and safety. The full Perimenopause Toolkit with new additions can be found Here. Please review so other can learn. Feeling better starts with understanding what is happening.
Get specific links for CBD and Perimenopause symptoms and questions here.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.