Menopause and Your Heart

Hot flashes, night sweats, mood swings—these are the classic signals that menopause is underway. But beneath the noticeable symptoms lies another important shift: a woman’s heart health.

Heart disease is the leading cause of death among women in the U.S., with women generally developing the condition several years later than men.  While menopause doesn’t directly cause heart disease, it marks a turning point when women are at an increased risk of heart disease.

Much of this heightened risk is tied to the physiological changes that come with menopause—one major factor being the decline in estrogen levels. Estrogen is more than just a key hormone for reproduction; it also plays an important role in cardiovascular health. When estrogen levels drop, fat can accumulate in the arteries, causing them to narrow and increasing the likelihood of heart disease. Low estrogen can also raise blood pressure, increase LDL (bad) cholesterol and lead to higher blood sugar levels. A healthy cholesterol level for women is typically between 125 and 200 mg/dL. As women hit menopause, these levels typically rise by 10 to 15%, about 10 to 20 mg/dL, according to the National Library of Medicine. During the menopausal transition, women may also face other changes that affect cardiovascular health, such as sleep issues, stiffening or weakening of the blood vessels, and depression.

Given these changes, it’s important for women to prioritize their health in midlife to be in the best possible shape when navigating this transition.

Stages of Change

Perimenopause

This is the period leading up to menopause, marked by hormonal fluctuations that can cause menopause-like symptoms. Changes in estrogen begin here, so adopting heart-healthy habits during perimenopause can help prepare you for the years ahead.

Menopause

A woman is officially in menopause once she has gone 12 months without a period. It’s important to know when you have entered menopause, as your risk for cardiac events increases during this time. Research also indicates that early menopause (before 45) is linked to a higher risk of developing coronary heart disease.

Postmenopause

In the “after menopause” stage, decreased estrogen further increases the risk for heart disease—which can even exceed the risk faced by men.

Protecting Cardiac Wellness

Know Your Numbers
Consider monitoring cardiovascular numbers more frequently starting in midlife, including cholesterol levels, blood pressure, blood sugar and weight. Understanding your baseline allows you to monitor any shifts as you transition into menopause, so you can work with your doctor to address issues early on.

Embrace a Heart-Healthy Lifestyle
Diet and exercise are your best defense against heart disease. According to the American Heart Association (AHA), only 7.2% of women in menopause get the recommended amount of physical activity, and fewer than 20% maintain a consistently healthy diet.
To lower your risk, focus on a diet rich in fruits, vegetables, lean proteins and whole grains. The AHA also recommends at least 150 minutes of moderate physical activity each week. Reducing stress through mindfulness, yoga or meditation can also support heart health. 

Consider Hormone Therapy 
Hormone replacement therapy (HRT) can help manage menopausal symptoms, such as hot flashes and night sweats. But when it comes to heart health, more research is needed. Some studies suggest that HRT might have cardiovascular benefits when started early. According to the AHA, the benefits seem to outweigh the risks for most women in early menopause. The AHA advises against using hormone therapy for those well past menopause.