Menopause and Heart Health: What You Need to Know

By Naomi Braun, MPH, MSW • Published 2/12/2024

Medically Reviewed by MD, OB-GYN

Three white hearts on a pink background to represent menopause and heart health

Menopause is a time of big change, and it can bring about many changes to your body, including an increased risk for cardiovascular disease. As you go through this phase of life, it's important to understand the impact this change in hormones can have on your heart. In this article, we'll explore in-depth the connection between menopause and heart health. Be sure to talk to your doctor if you have any question or concerns or are looking for more information. 

What is heart disease?

Heart, or cardiovascular, disease is a group of conditions that affect your heart and blood vessels. It can be caused by a variety of factors, including lifestyle choices, genetics, and aging. The conditions under the umbrella of “heart disease” include coronary artery disease (CAD), stroke, heart failure, arrhythmia, congenital heart defects, and cardiomyopathy. Cardiovascular disease is the most common cause of death and disability for women in the United States. Let’s take a closer look at some of the types of heart disease. 

Coronary artery disease (CAD)

CAD is the most common type of heart disease. It happens when fatty deposits (called plaque) build up inside your arteries. Plaque is made up of cholesterol, fat, blood cells, and other substances in your blood. Over time, this can cause the arteries to narrow and can block blood flow to the heart. If untreated, it can cause chest pain (angina) and make it harder for the heart to pump blood around the body. In very serious cases, it can even lead to a heart attack. The typical signs of a heart attack can include:

  • shortness of breath
  • dizziness
  • palpitations
  • lightheadedness
  • fatigue
  • chest pain
  • discomfort in the arms or shoulders.


A stroke happens when the blood can’t get to parts of the brain. This can cause a brain injury, which can be fatal if not treated quickly enough. Strokes often happen because of clogged arteries, uncontrolled blood pressure, or an abnormal heartbeat, like atrial fibrillation (AFib) or other arrhythmias.

perimenopausal woman placing her hand on her chest over the where her heart is to show she is thinking about her heart health

Heart failure

Your heart is a pump that sends blood throughout your body. Heart failure happens when your heart is unable to pump enough blood around your body. Conditions like blocked arteries, high blood pressure, and certain heart valve problems can cause your heart to function incorrectly. When the heart can’t efficiently move blood around your system, fluid build-up can happen in areas where it shouldn’t be like the legs, ankles, lungs, etc. 

Is heart disease different for females?

Menopause can make it more likely to develop heart problems like high blood pressure and high cholesterol. This can increase their chance of developing heart disease. That’s why it’s important to understand how heart disease affects females differently than males.

Females are more likely than males to have different symptoms of a heart attack. Instead of the usual chest pain, they might feel:

  • Pain in their jaw
  • Feel sick to their stomach (nausea)
  • Have trouble breathing
  • Really tired.

Because of this, females might not realize they’re having a heart attack and might not get help right away.

Females are also more likely to have illnesses that come from stress. When we’re stressed, our bodies make a hormone called cortisol, which can raise our blood pressure and make it harder for our heart to work well.

Do hormone changes during menopause affect heart health?

The short answer is yes. Estrogen helps protect the heart. So, when estrogen levels decline during menopause, the risk of heart disease goes up.

Other hormones that decrease during menopause, like progesterone and testosterone, may also play a role in making heart disease more likely to occur. People who go through early menopause (menopause occurring between ages 40 and 45) are at an even higher risk.

Menopausal woman in office is considering her risk for heart health

During the menopausal transition, declining levels of estrogen impact heart health by influencing cardiovascular risk factors:

  • Lower estrogen levels can lead to changes in the blood vessels, making them more likely to be clogged with plaque. This can increase the risk of heart attack, stroke, or other heart problems.
  • LDL (bad) cholesterol goes up during the menopausal transition and HDL (good) cholesterol may go down. This can lead to clogged arteries and an increased risk of heart attack and stroke.
  • Triglycerides, fatty substances found in the blood, also go up. They can contribute to the buildup of plaque in the arteries.
  • Blood pressure may also increase.
  • Some weight gain and changes in body fat composition.
  • Resistance to insulin increases, which can lead to diabetes or pre-diabetes.

All of these changes raise the risk of heart disease. So, it's important to take steps to reduce your risk. In the next section, we’ll talk more about the steps you can take. Remember, taking care of your heart health during menopause is important for your overall well-being.

What can I do to keep my heart healthy?

Get moving!

Getting regular physical activity can help lower your risk of heart disease and other problems that are tied to the hormonal changes during menopause. Try to do at least 150 minutes (about 2 and a half hours) of moderate-intensity physical activity each week. This can be anything from walking, biking, playing sports, yard work, or taking an exercise class. Again, talk to your doctor before starting or changing an exercise program.

couple exercising to help improve their heart health during midlife

Here are some of the benefits of exercise during menopause:

  • Helps your body work better by improving your metabolism.
  • Makes your bones stronger.
  • Helps you build muscle strength and muscle mass.
  • Helps regulate your hormones, which can lower stress levels while boosting mood and energy levels.
  • Helps with sleep quality issues due to menopausal hormonal changes.
  • Helps you think more clearly and focus better.

Eat a healthy, balanced diet and limit alcohol

Stick to a balanced diet by eating nutrient-rich foods such as fruits, vegetables, whole grains, and healthy fats. You should also limit your intake of saturated fat, trans fat, cholesterol, sodium, and added sugar to help protect your heart health.

Paying attention to nutrition can help keep your heart healthy during menopause. A healthy diet can help lower blood pressure, improve cholesterol levels, reduce inflammation, and help you maintain a healthy weight.

Drinking too much alcohol can increase your risk of heart disease. If you do drink alcohol, try to stick to the recommended guidelines. For females, that’s no more than one drink per day according to the Centers for Disease Control and Prevention (CDC).

Variety of heart-healthy foods that you can eating to help improve heart health during menopause

Manage stress

When we’re stressed for a long time (chronic stress), it can lead to an increased risk of heart disease and atherosclerosis (thickening or hardening of the arteries). It can also lead to unhealthy eating habits, potential weight gain, poor sleep, and high blood pressure. All these things can increase the risk of having a heart attack or stroke. 

But don’t worry, there are ways to manage stress and keep our hearts healthy. Yoga, meditation, and deep breathing exercises can help us relax our minds and bodies, while reducing the levels of cortisol (the stress hormone) in the bloodstream. Yoga, in particular, has been found to be great for reducing anxiety, improving mood, and promoting better sleep quality — all factors that help our heart health. 

Remember that the menopausal transition can come with many changes that can take some time to get used to. But there are healthy ways to cope so we can protect our heart health during this time of change. 

Quit smoking

Smoking is one of the most dangerous habits for your heart health. It damages your blood vessels and increases the risk of heart attack, stroke, and other heart problems. If you currently smoke or use tobacco in any way (including vaping), quitting all tobacco use is the best thing you can do to protect your heart.

Manage existing conditions

If you have high blood pressure or diabetes, it’s important to manage these conditions. Be sure to keep up with all necessary medications and checkups recommended by your doctor. Medication may be recommended.

Schedule regular checkups with your healthcare provider

Menopause brings several changes in the body that can cause an increased risk for cardiovascular disease, so it’s important to stay on top of your heart health by getting regular checkups with your healthcare provider.

At these checkups, your healthcare provider can assess your heart health including checking your blood pressure and cholesterol levels. In addition, they can help you identify any factors that could increase your risk of developing heart issues.

menopausal woman talking to her nurse practitioner about menopause and her general health

Remember, you can ask your provider any questions or share any worries you have about menopause and heart health. They’re there to help. Don’t forget to also discuss your daily habits that can affect your heart health, like what you’re eating, exercise, stress levels, and if you drink any alcohol. They may suggest tweaks you can make to help improve your heart health.

Sometimes, your healthcare provider may recommend certain medications to help lower your risk of heart problems during menopause. It’s important to take care of your heart health during menopause, and your healthcare provider is your partner in this! 

What about menopausal hormone therapy (MHT) and cardiovascular disease?

Menopause hormone therapy (MHT) can help ease the not-so-fun symptoms of menopause, like hot flashes and night sweats. When considering MHT, it’s important to know all the good things it can do and the not-so-good things that can also happen too.

Let’s start by talking about the heart-helping benefits first. MHT may help lower cholesterol levels and improve blood vessel health. 

A person’s age and time since menopause might change whether MHT could be beneficial for your heart health. However, there are some potential risks to consider before starting any hormone therapy regimen. The risks may include:

  • An increased risk for stroke or blood clots because of the higher estrogen levels in the body.
  • A slightly increased risk for breast cancer for those taking progestin. It’s possible that breast cancer risk is lower with specific types of progestin, like micronized progesterone.
  • An increased risk for gallbladder disease because of higher progesterone levels in the body.

It's important to talk with a medical professional to understand how these risks and benefits apply to you before deciding if MHT is the right choice for you.

Last Updated 2/12/2024



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