Women's Health Info

Unraveling How the Menopause Is Related To Cardiovascular Risk & Heart Health in Women During and After Menopause

Research overview: cardiovascular disease & heart health in the menopause transition

  • The Study of Women’s Health Across the Nation (SWAN) highlights a clear connection between the age when women experience menopause, the severity of symptoms and their risk of cardiovascular disease.
  • As SWAN researchers keep learning, we get a better picture of how menopause affects women’s health and, more specifically, the risk for cardiovascular disease and heart problems.
  • These findings are creating a unique opportunity to pinpoint risk factors, identify vulnerable populations and tackle potential health problems before they become bigger heart issues.
  • Researchers are also uncovering links between traumatic life experiences, such as childhood abuse or intimate partner violence, and future heart health.
  • During the menopause transition, women see increases in LDL-C (the “bad” cholesterol), increases in metabolic syndrome risk, and adverse changes in the structure of blood vessels, likely due to the menopause transition’s effects rather than just age.
  • Changes in body composition during the transition include more belly fat and less muscle mass, which can also elevate heart disease risk.
  • Contrary to assumptions, higher levels of HDL-C (good cholesterol) may not consistently mean better heart health across all life stages for women.
  • Menopausal hot flashes, previously assumed to be benign midlife symptoms, may actually indicate underlying risk for future heart problems, such as heart attacks and strokes.

Understanding a woman’s heart health during menopause transition

Menopause, a natural transition in a woman’s life, brings about a range of changes, including cessation of menstruation, hormonal shifts, and the occurrence of symptoms such as hot flashes and sleep problems. It is during this phase that significant changes in cardiometabolic and vascular health transpire, elevating the future risk of cardiovascular disease (CVD) including heart attacks, heart failure and stroke.

Heart disease is the leading cause of death among women in America – accounting for about 1 in 5 female deaths. SWAN is conducting  pivotal work regarding how characteristics of menopause relate to cardiovascular health, by meticulously tracking cardiovascular changes among diverse women through midlife and into early old age. By examining factors like cholesterol levels, blood pressure, metabolic changes and other physical measures, SWAN aims to identify potential heart risk factors across various groups at a time when interventions may be of maximum benefit. Our work also provides insights into preventive strategies and tailored care.

Happy grey haired middle aged woman snuggling to smiling older husband, enjoying tender moment at park. Bonding loving old family couple embracing, looking sunset

SWAN is a long-term, multi-racial and ethnic, and multicenter research project that aims to understand the physical, biological, and psychosocial changes that occur in women during the menopause transition. Researchers are examining various aspects, including hormone levels, sleep patterns, cardiovascular health, bone density, and psychological well-being. By studying a diverse population of women over time, SWAN aims to provide comprehensive insights into the menopause transition and its impact on women's health.

SWAN study implications for cardiovascular disease & risk

SWAN’s investigation unveils significant adverse shifts in body fat, cholesterol, metabolic syndrome risk and vascular remodeling during midlife, which are closely tied to the menopause transition. These changes emphasize menopause’s effects on heart health.

These health changes also have several other key implications, outlined below.

Link between early menopause and heart disease risk

Emerging evidence underscores that an earlier onset of natural menopause serves as a marker for heightened risk for heart problems. Factors like short menstrual cycle length, low parity, smoking, and unfavorable cardiovascular health status during reproductive years contribute to this risk. Additionally, individuals of Black and Hispanic backgrounds face an increased likelihood of experiencing early menopauseuse, magnifying their vulnerability to CVD.

Perimenopause: a window of cardiovascular disease vulnerability

Perimenopause, characterized by intermenstrual cycle irregularities extending up to 12 months after the final menstrual period, signifies a critical period marked by substantial alterations in cardio-metabolic and vascular health parameters. These shifts strongly correlate with future risk for heart attacks, stroke, and other forms of cardiovascular disease, warranting focused attention on mitigating risks during this phase (see key takeaways for women below).

Vasomotor symptoms and cardiovascular health

Vasomotor symptoms such as hot flashes may not be incidental midlife symptoms but in fact may offer insights into women’s future cardiovascular disease risk. These symptoms are associated with adverse cardiovascular risk factor profiles, such as higher LDL (“bad”)-cholesterol, higher blood pressure, and higher blood sugar levels. More frequent or severe hot flashes may signal adverse changes in the underlying vasculature, such as a thickening of vessel walls or accumulation of plaque on the vessel walls, which place women at future risk for heart disease events. Finally, women with more frequent hot flashes, particularly if they persist over midlife, are at elevated risk for heart attacks, strokes, and other cardiovascular disease events as they age. The links between hot flashes and women’s heart health is not accounted for by levels of estrogen in the body.

Linking risk factors to cognitive decline

Cardiovascular risk factors, such as blood pressure or elevated cholesterol, encountered during midlife hold implications that extend far into the future. Recent SWAN research has established a link between midlife cardiovascular risk factors and the rate of adverse changes in cognitive function during midlife.  Greater declines in cognitive function during midlife may increase risk of developing Alzheimer’s disease and related dementias later in life.

While the impact of vascular risk factors on cognitive decline is still emerging, the connection is undeniable. SWAN’s findings point to the critical role of cardiovascular health in shaping cognition, and highlight the importance of managing cardiovascular risk factors in midlife to promote healthy cognition as women age.

Reimagining heart health indicators for women

SWAN’s findings are providing a more nuanced understanding of the risk and indicators of heart disease in women. For example, research is showing that the protective effect of high-density lipoprotein cholesterol (HDL-C, the so-called “good” cholesterol) may diminish as women undergo menopause. Furthermore, studies have  suggested that post-menopausal women have significantly greater volumes of fat around their hearts – a risk factor for heart disease – than their pre-menopausal counterparts.

Impact of early life adversity on heart health

Childhood trauma, particularly experiences of childhood abuse, can cast a lasting impact on cardiovascular well-being later in life. SWAN’s research has revealed that a history mistreatment is associated with a heightened risk of CVD events, such as heart attacks and strokes, in women as they age. SWAN’s research has also found that women who have experienced intimate partner violence have increased risk for CVD events as they age, and that this connection may be due in part due to the increased blood pressure that women experiencing intimate partner violence often have. These findings delve into the complex biological pathways through which traumatic experiences may shape heart health. These findings also suggest potential preventive measures, such as blood pressure control, that may help protect the heart among women who have experienced intimate partner violence.

Key takeaways for women

SWAN’s findings can help equip us with more information on women’s bodies and help researchers better design effective prevention and intervention strategies. SWAN findings highlight the fact that midlife is a critical period when control of cardiovascular risk and promotion of heart healthy lifestyles can prevent  health problems in later life.

By recognizing this connection, we’re empowered to take a holistic approach to heart care, addressing past experiences alongside current habits. This insight underscores the importance of comprehensive care that encompasses both physical and emotional well-being, enabling us to make informed choices for a heart that remains resilient and vibrant throughout life.

For women in or approaching perimenopause, these findings underscore the importance of the following.

  • Proactive measures: Recognize that heart health is an integral facet of the menopause journey. Embrace proactive measures to understand and manage potential risks.
  • Regular check-ups: Prioritize regular medical check-ups to monitor blood pressure, cholesterol levels, blood sugar and weight. These indicators serve as guides in navigating cardiovascular well-being.
  • Healthy lifestyle choices: Embrace a heart-healthy lifestyle by engaging in regular physical activity and adopting a balanced diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats. It’s never too late to start.
  • Open dialogue: Foster open and candid communication with healthcare providers. Discuss the changes experienced during menopause and collaborate on tailored strategies for heart health.
  • Explore hormone therapy: Women considering hormone therapy should engage in informed discussions with healthcare professionals to weigh benefits and risks based on individual circumstances.
  • Stay informed: Keep up with the latest research and recommendations related to heart health and the menopause transition. Informed decisions are pillars of empowered health.

Latest heart health news

What we are still learning about cardiovascular disease & menopause transition

SWAN’s ongoing research gives us the knowledge to make informed choices for strong hearts. Our research also raises the curtain on the influence of unmeasured socioeconomic, cultural and nontraditional biological factors to health. 

By identifying risk factors before they manifest as significant cardiovascular issues, these ongoing findings pave the way for targeted interventions, preventive strategies and informed decisions. This includes continuing to explore the complex interplay between physical function, quality of life, cognitive health and more.




Reviewed by:

Carol Derby, PhD, Professor, Albert Einstein College of Medicine

Rebecca C. Thurston, PhD, University of Pittsburgh

Nanette Santoro, MD, Professor, University of Colorado Denver