Why does menopause affect heart health?

Heart and blood vessel diseases are among the leading causes of death worldwide in both women and men (The Menopause Society, Heart Health). Even so, heart disease is often thought of as a “man’s disease.” Women may underestimate their own risk.

Estrogen (the main female sex hormone) plays a protective role against heart disease in younger women (womenshealth.gov, Heart attack and women). As estrogen falls through the menopause transition, this protection also decreases. A 2020 scientific statement from the American Heart Association describes the menopause transition as a time when the risk of heart and blood vessel disease speeds up. According to the statement, unfavorable changes are seen in this phase in body composition, blood fats and measures of blood vessel health. The statement sees this phase as a critical window for preventive steps (El Khoudary et al., 2020).

These years are busy for most women. Between work, children and caring for aging parents, your own health can drop to the bottom of the list. Symptoms such as hot flashes, poor sleep and palpitations can also increase worry about your heart, or, the opposite, be brushed off as “it’s just menopause anyway.” Either way, the healthiest path is to talk based on measurements.

This information is not meant to scare you. On the contrary, most risk factors can be measured and monitored. Catching them early means being able to talk with your clinician in good time.

Does cholesterol go up in menopause?

Yes, it can. The SWAN study, which followed thousands of women in the US for years, looked at whether heart risk factors in midlife women change because of aging or because of menopause. Among the factors measured, only total cholesterol, LDL cholesterol and apolipoprotein B (a protein that carries “bad” cholesterol) showed a clear rise in the one-year period around the final period. The researchers concluded that women experience a rise in blood fats specific to the time of their final period (Matthews et al., 2009).

The Menopause Society also notes that cholesterol levels rise in the first years after menopause. High LDL cholesterol can lead to plaque building up in the artery walls and is one of the main risk factors for heart disease (The Menopause Society, Heart Health).

High cholesterol does not make itself known. It causes no pain and no other symptoms. The only way to know your level is to measure it with a blood test.

Does menopause raise blood pressure?

Blood pressure often rises in midlife. However, in the SWAN study the other risk factors, including blood pressure, followed a steady rise with age rather than a sudden jump around the final period (Matthews et al., 2009). So a rise in blood pressure is common during the menopause years, but how much of it comes from menopause and how much from age cannot always be separated.

Whatever the cause, high blood pressure matters. The Menopause Society defines below 120/80 mm Hg as normal and a regular 130/80 mm Hg or higher as high blood pressure (The Menopause Society, Heart Health). High blood pressure often causes no symptoms at all. So “I feel fine” does not mean your blood pressure is normal. The only way to know your blood pressure is to have it checked at regular intervals.

How does early menopause affect heart risk?

Early menopause is a known risk factor for heart and blood vessel disease (The Menopause Society, Heart Health). In a large analysis combining data from many observational studies, compared with women who reached menopause at 50–51, the risk of a heart or blood vessel event was about 1.55 times higher in those who reached it before 40, and about 1.3 times higher in those who reached it between 40 and 44. In these women, the risk of non-fatal heart and blood vessel events before age 60 was especially increased (Zhu et al., 2019).

For what early menopause means and which steps can be discussed, see our article on early menopause. Situations such as surgical removal of the ovaries can also bring menopause earlier. If this is part of your history, discuss your heart health with your clinician separately.

Which risk factors are monitored in menopause?

The table below summarizes the main factors discussed in relation to heart health.

Risk factor How it changes with menopause What is monitored
LDL and total cholesterol A clear rise around the final period (SWAN) Blood fats test
Blood pressure Rises with age; often has no symptoms Regular blood pressure checks
Blood sugar Becomes more important in midlife Fasting blood sugar or a test your clinician finds suitable
Waist size and weight Fat tends to settle around the belly Waist and weight measurements
Early menopause Increases heart and blood vessel risk (Zhu et al.) Telling your clinician your age at menopause

The Menopause Society notes that regular cholesterol tests, tests for diabetes, blood pressure, weight and blood sugar are the main factors to keep track of (The Menopause Society, Heart Health). How often these measurements are done depends on your age, family history and previous results; you decide this together with your clinician.

Lifestyle is also part of this picture. A balanced diet, regular movement, stopping smoking and good sleep are general steps that support heart health. For the diet side, our article on the menopause diet summarizes what the sources say.

Why do heart palpitations happen in menopause?

The NHS lists palpitations, described as the heart beating faster, slower or more noticeably, among menopause symptoms. Palpitations can also be felt during a hot flash. Palpitations are usually harmless, but the NHS recommends seeing a doctor about them. For details, see our article on heart palpitations.

Can heart attack symptoms be different in women?

Yes. The most common symptom of a heart attack in both women and men is pain or discomfort in the chest and upper body. However, other symptoms such as shortness of breath and nausea are more common in women than in men (womenshealth.gov, Heart attack and women). That is why women sometimes put their symptoms down to tiredness, anxiety or an upset stomach and delay asking for help.

The NHS lists these among the symptoms of a heart attack (NHS, Heart attack: symptoms):

  • Crushing or squeezing chest pain, which can spread to the arm, neck or jaw
  • Shortness of breath
  • Feeling or being sick
  • Symptoms like indigestion, such as burning or a bloated feeling in the chest
  • Sweating

If any of these symptoms starts suddenly, call your local emergency number (112 in Türkiye and the EU, 911 in the US). The NHS advises against driving yourself to the hospital in this situation. While you wait for help, it is recommended that you rest sitting down, with your knees bent and your back supported (NHS, Heart attack: symptoms).

What can you ask your clinician about your heart health?

  • How often should I have my blood pressure checked?
  • When should my cholesterol and blood sugar be tested?
  • How do my age at menopause and my family history affect my heart risk?
  • Could there be another cause for my palpitations?

This page does not cover treatment options. You should discuss options for blood pressure and cholesterol with your clinician.