Surprising Ways Menopause Can Impact Heart Health
February 19, 2025
Menopause has a reputation for unpleasant symptoms like hot flashes. But the change of life marking the end of a woman’s reproductive years can be more than uncomfortable. It can put her heart at risk. Sheila Sahni, M.D., and Marian Vandyck-Acquah, M.D., Hackensack Meridian Health cardiologists, explain how menopause affects women’s heart health and what women can do to protect themselves.
When Does Menopause Start?
Your hormones begin fluctuating a few years before menopause. During this transition phase called perimenopause, your ovaries make less and less estrogen. One tell-tale symptom of perimenopause is irregular periods, which can vary from one week to two months outside your normal cycle.
“Perimenopause is a hormonal roller-coaster in the years leading up to menopause,” says Dr. Sahni.
A woman reaches menopause when she goes one year without menstrual periods. For most women, this happens between ages 45 and 55. Women who have their ovaries removed may go through menopause sooner if they are younger than 45 at the time of surgery.
What Does Menopause Have to Do With the Heart?
“Estrogen protects the heart,” says Dr. Vandyck-Acquah. “When you lose that protective feature, your risk of heart disease suddenly increases.”
Decreasing estrogen levels can have a variety of negative effects:
Changes in cholesterol levels
A woman’s HDL, or “good” cholesterol levels, may drop, and LDL, or “bad” cholesterol, may rise, says Dr. Sahni. High LDL can lead to blockages in your arteries that put you at risk for heart attack and stroke.
Narrowed blood vessels
Dr. Vandyck-Acquah says that decreases in estrogen may cause blood vessels to constrict, which can raise blood pressure—even in women without a family history of blood pressure problems.
Narrow blood vessels can also cause hot flashes and night sweats. When your body gets too warm, your blood vessels widen to allow more blood to flow near your skin, where it can release heat. Narrowed vessels have the opposite effect, making your body hold on to heat.
Weight gain
Women may gain excess weight, especially in the midsection. “Fat around the belly is a risk factor for future heart events, like heart attack and stroke,” Dr. Vandyck-Acquah says. “Lack of estrogen and more androgens — another type of sex hormones — promotes what we call central obesity.”
4 Ways to Improve Your Health During and After Menopause
While going through perimenopause and menopause is a part of life, heart disease doesn’t have to be. Positive changes may decrease your risk of estrogen-related heart issues.
“It’s time for a wake-up call,” Dr. Vandyck-Acquah says. “The cardiac changes brought on by menopause are all things that we can combat.”
Here’s what you can do:
1: Talk to your doctor
Schedule a visit to discuss perimenopause or menopause and possible health changes. If your doctor doesn’t suggest it, ask for bloodwork to check your cholesterol levels and other indicators of heart disease.
“The American Heart Association recommends annual visits and calculating a heart disease risk score,” Dr. Vandyck-Acquah says. “Know your numbers, and change your lifestyle to reverse any abnormal numbers.”
2: Take medication if needed
If your doctor prescribes medication, take it regularly. Medication can manage high blood pressure, high cholesterol or diabetes.
“Work closely with your physician,” Dr. Vandyck-Acquah says. “You may need treatment, especially for younger women with premature or early menopause.”
3: Work on healthy habits
Meaningful changes that you adopt may keep you healthier when estrogen levels drop. Dr. Sahni recommends:
- A balanced diet
- Regular exercise
- Getting enough sleep
- Stress management
- Not smoking or quitting
- Limiting alcohol
4: Discuss hormone therapy
If you have hot flashes and other unpleasant symptoms, tell your doctor. Some women may benefit from short-term hormone-replacement therapy. Dr. Sahni says starting this type of therapy as early as possible at the onset of menopause and for the least amount of time required is best.
Next Steps & Resources:
- Meet our sources: Marian Vandyck-Acquah, M.D., and Sheila Sahni, M.D.
- Make an appointment with a cardiologist near you or call 800-822-8905.
- Learn more about cardiology at Hackensack Meridian Health.
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
