Perimenopause, Menopause and Your Heart: What We Know Today That We Didn't Know Then
Women's health research has come a long way. Are we putting that knowledge to work?
There was a time when menopause was something women were simply expected to get through.
Hot flashes. Night sweats. Mood swings. Changes in weight. Trouble sleeping.
Some women talked about it. Others suffered through it quietly. And many were left wondering whether what they were experiencing was normal.
But here's something worth considering:
For much of modern medical history, researchers didn't fully understand what the transition into menopause meant for a woman's cardiovascular health.
That wasn't because the connection didn't exist.
It was because we hadn't studied it nearly enough.
And even today, as our understanding continues to grow, I wonder how many women are actually benefiting from what we've learned.
❤️ Women's health research has changed dramatically
For decades, much of what we understood about cardiovascular disease came from research that focused heavily on men.
Women were often underrepresented in cardiovascular studies, and important differences in how heart disease develops, presents and progresses in women received less attention.
That began to change.
In 1991, the National Institutes of Health launched the Women's Health Initiative, one of the largest studies of women's health ever undertaken.
More than 161,000 women participated.
Researchers examined major health concerns affecting women after menopause, including heart disease, cancer and osteoporosis.
The findings challenged longstanding assumptions, particularly the belief that hormone replacement therapy could prevent cardiovascular disease.
The research also helped establish that hormone therapy should not be prescribed specifically to prevent heart attacks or strokes, although it can remain an appropriate treatment for menopausal symptoms in selected women.
It was a significant turning point in how medicine approached women's health. NHLBI, NIH
But the research didn't stop there.
What we're learning about the menopause transition
In November 2020, the American Heart Association published a scientific statement examining the relationship between menopause and cardiovascular disease.
The researchers highlighted something particularly important:
The years leading up to menopause may represent a critical window for preventing heart disease.
During perimenopause, changes can occur in cholesterol levels, body composition, blood vessels and metabolic health.
Some of those changes are associated with hormonal shifts rather than simply getting older.
And they can begin before a woman reaches menopause.
The American Heart Association acknowledged that our understanding of these connections had evolved dramatically over the preceding two decades.
In fact, its earlier 2011 cardiovascular prevention guidelines for women did not include much of the information researchers subsequently developed about the menopause transition. American Heart Association
Think about that.
Information that wasn't part of cardiovascular prevention guidance just 15 years ago is now helping us better understand when women may need closer attention to their heart health.
That's progress.
But it also raises an important question.
How many women are still going through perimenopause without anyone discussing their cardiovascular risk?
❤️ It's not just about hormones.
Perimenopause is a natural biological transition.
But natural doesn't necessarily mean that everything happening during that transition is harmless.
Researchers have documented changes involving:
Cholesterol: LDL cholesterol can increase during the menopause transition.
Blood sugar: Changes in insulin sensitivity and metabolic health may increase cardiovascular risk.
Body composition: Fat distribution can shift toward the abdomen, even without substantial weight gain.
Blood vessels: Changes in vascular health can contribute to cardiovascular risk.
Sleep: Night sweats, insomnia and sleep disturbances can complicate an already important part of heart-health prevention.
Not every woman experiences these changes in the same way. Genetics, lifestyle, existing health conditions and individual circumstances all matter.
But the evidence is increasingly clear that midlife deserves more attention as an opportunity for cardiovascular prevention. professional.heart.org
And that's where our message at The Heart2Heart Foundation comes in.
One of the most important advances in cardiovascular medicine isn't simply that we know more about heart disease.
It's that we have better tools to identify risk before a heart attack or stroke occurs.
And women deserve to know those tools exist.
The updated 2026 American College of Cardiology/American Heart Association cholesterol guidelines reflect this evolving approach to prevention.
Rather than relying solely on traditional cholesterol measurements, the guidelines emphasize a more complete understanding of cardiovascular risk.
That includes testing and assessments that may not have been part of routine conversations years ago.
Know your numbers. But know what they mean, too.
Blood pressure: High blood pressure often develops without noticeable symptoms.
Cholesterol: A complete lipid profile helps identify abnormalities that can contribute to plaque buildup.
Blood sugar and A1C: These measurements help identify diabetes and prediabetes, both important cardiovascular risk factors.
Lipoprotein(a), or Lp(a): This largely inherited risk factor can be elevated even when other cholesterol measurements appear acceptable. The 2026 guidelines recommend measuring Lp(a) at least once in adulthood.
Apolipoprotein B, or ApoB: This test can provide additional information about the number of potentially harmful cholesterol-carrying particles, particularly in selected patients with metabolic or lipid abnormalities.
Coronary artery calcium (CAC) scan: This noninvasive CT scan can identify calcified plaque in the coronary arteries.
The 2026 guidelines recommend selective CAC scanning for women age 45 and older who have borderline or intermediate cardiovascular risk when the results could help guide preventive treatment decisions.
Not every woman needs every test. The goal is to use the right information for the right person. professional.heart.org
Here's what concerns me.
We have made tremendous progress in understanding women's cardiovascular health.
We know more about the menopause transition.
We recognize more risk factors.
We have better screening tools.
And we have more opportunities to intervene before cardiovascular disease becomes a life-threatening emergency.
But information only saves lives when it reaches the women who need it—and when that information leads to action.
How many women have been told their cholesterol is “a little high” without understanding their overall cardiovascular risk?
How many have experienced changes during perimenopause without discussing what those changes might mean for their hearts?
How many assume they're fine because they feel fine?
And how many simply don't know what questions to ask?
That's the gap we need to close.
❤️ A conversation worth having at your next appointment
If you're approaching perimenopause, experiencing it now or already through menopause, consider asking your healthcare provider:
“Has my cardiovascular risk changed, and are there tests or preventive steps we should consider?”
Discuss your family history, blood pressure, cholesterol, blood sugar, sleep and other health concerns.
Ask about Lp(a).
And if your cardiovascular risk assessment leaves unanswered questions, discuss whether additional testing, including a CAC scan, would be appropriate.
You don't have to become a medical expert.
But you do deserve to be an informed participant in decisions about your health.
The next generation deserves even better.
One of the most encouraging things about the evolution of women's health research is that knowledge doesn't have to stop with us.
What researchers are learning today can change how our daughters and granddaughters understand their health tomorrow.
Imagine a generation of women who enter midlife already knowing that cardiovascular health belongs in the menopause conversation.
Women who understand their family history.
Women who know their numbers.
Women who recognize that prevention begins long before symptoms appear.
Women who feel comfortable asking questions—and expect meaningful answers.
That's the future we're working toward at The Heart2Heart Foundation.
Because menopause isn't simply something women should be expected to endure.
It's another important stage of life when we have an opportunity to protect our health.
And with the knowledge available today, we have more reasons than ever to take that opportunity seriously.
❤️ Don't wait for symptoms to tell you something is wrong.
Know your risk. Know your numbers.
The Heart2Heart FoundationTouching hearts. Saving lives.
Research and resources
NIH — Women's Health Initiative — Landmark research that changed understanding of menopause, hormone therapy and cardiovascular health.
American Heart Association — Menopause Transition and Cardiovascular Risk — Scientific statement explaining cardiovascular changes during perimenopause.
NIH — Menopause and Midlife Health — Research developments and resources for women's health.
ACC/AHA — 2026 Cholesterol Guideline — Updated recommendations for Lp(a), ApoB, CAC scanning and cardiovascular prevention.
Comments