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Much of the conversation around perimenopause and menopause focuses on symptoms such as hot flashes, night sweats, and brain fog. However, another issue—often overlooked and potentially more serious—is the impact menopause has on heart health. Menopause is a known risk factor for heart disease, increasing a woman’s risk for heart attack and stroke.

 

Despite this risk, awareness remains low. According to a 2020 study published in Circulation, only 56% of women know that heart disease is the leading cause of death among women. Awareness is even lower among younger generations—only 12% of millennials report feeling “well-informed” about menopause, based on a survey from Wrapp Consulting.

 

To better understand the connection between menopause and heart health, we spoke with Dr. Danielle Tientcheu, a Houston Methodist cardiologist who specializes in heart disease in women.

 

How does menopause affect heart disease risk?

 

Women are considered to be in menopause after going a full year without a period. Most women enter perimenopause—the transitional phase leading up to menopause— in the early 40s to early 50s, with the average age of menopause in the U.S. being 52.

 

During perimenopause, the body gradually produces less estrogen and progesterone—hormones that play an important role in cardiovascular health. As these hormone levels decline over several years, changes in heart disease risk factors often follow.

 

“It doesn’t happen all at once,” says Dr. Tientcheu. “As hormone levels slowly decrease, we begin to see changes in cholesterol—triglycerides and LDL rise, while HDL, the ‘good’ cholesterol, goes down.”

 

These hormonal shifts also affect blood pressure, body composition, and metabolism. Estrogen and progesterone help relax blood vessels and naturally lower blood pressure. As those protective effects diminish, blood pressure may rise, arteries may stiffen, muscle mass may decline, and fat—especially around the midsection—can increase.

 

“This combination can easily lead to metabolic syndrome,” Dr. Tientcheu explains, “which significantly raises the risk for heart disease unless aggressive lifestyle measures are followed such as diet, exercise, sleep, chronic stress, etc.”

 

Metabolic syndrome also increases the likelihood of developing insulin resistance, prediabetes, or diabetes—each an additional risk factor for heart disease. Even women without previous heart-related concerns can experience these changes during menopause, creating what Dr. Tientcheu describes as a “perfect storm” of risk factors.

 

What can women do to protect their heart health during perimenopause?

 

Regardless of how long perimenopause lasts, healthy habits play a critical role in protecting heart health. Dr. Tientcheu recommends following a heart-healthy diet, such as the Mediterranean diet, which is well-supported by research.

 

She also advises getting at least 150 minutes of moderate to vigorous exercise each week. This should include aerobic activity and regular strength training, which helps combat muscle loss and maintain overall function as women age.

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When should a woman consider seeing a cardiologist?

 

Dr. Tientcheu recommends that women consider a cardiology evaluation if any heart symptoms, risk factors, pregnancy-related complication, autoimmune condition, premature menopause or strong family history of heart disease.

For more information or to schedule an appointment, visit houstonmethodist.org/heart-vascular.