Updated on February 21, 2025.
For many people, menopause comes with telltale signs. Hormone shifts can cause common and noticeable symptoms, such as hot flashes, mood swings, and weight gain. But there are other things happening in the body that aren’t as obvious. Under the surface, estrogen loss is changing cells. And they’re changing in a way that could harm your heart.
“Women going through menopause are at greater risk of developing heart disease,” explains Sangeeta Sinha, MD, an OBGYN at StoneSprings OB/GYN in Dulles, Virginia. Common types of heart disease include heart attack, stroke, and heart failure. It’s the leading cause of death for women, responsible for one in three deaths each year, according to the American Heart Association.
But menopause doesn’t cause heart disease, and not everyone who goes through menopause will develop heart issues, notes Dr. Sinha. With that in mind, here’s what to know about how it affects your risk.
Menopause and heart disease risk
Menopause occurs when menstruation stops for a full year. The average age of menopause is 51 or 52, although any time in your 40s or 50s is considered typical. During this time, levels of reproductive hormones like estrogen and progesterone fall off. This decline could mean trouble for your heart.
Why? Among other heart benefits, estrogen helps to keep blood vessels flexible for good blood flow. It also promotes higher levels of high-density lipoprotein (HDL or “good”) cholesterol, and lower levels of low-density lipoprotein (LDL or “bad”) cholesterol. When estrogen drops, a person may lose some of these protections.
More evidence estrogen may be protective: Early menopause is linked to heart problems. People who reach it before age 45 tend to have more plaque in their arteries. This can lead to coronary artery disease, which occurs when the heart doesn’t get enough blood.
Aside from less estrogen, there are other links between menopause and heart disease. These include weight gain. During the menopausal transition, people gain an average of 1 pound per year. Some may gain 10 pounds or more over time. Carrying excess weight can contribute to higher levels of LDL and triglycerides (a type of fat found in the blood) and lower levels of HDL.
“Women also become more susceptible to weight gain around their abdomens after menopause, which has also been linked to an increased risk of heart disease,” notes Dr. Sinha.
Some studies link menopause to sleep problems and higher rates of depression, as well. Both play a role in heart disease.
How to reduce your risk
Taking some preventive steps can help lower your risk for heart disease and improve your overall health.
Stay up to date on screenings
After you’ve gone through menopause, experts advise seeing your healthcare provider (HCP) once per year for a well visit, says Dr. Sinha. The American Heart Association also recommends following these guidelines:
- Blood pressure should be checked once per year.
- Cholesterol should be checked at least every four to six years.
- Blood glucose levels should be checked at least every three years.
- BMI (a measure of body fat based on height and weight) should be checked during every health care visit.
If you have existing heart risk factors, speak to your HCP about getting screened even more frequently. These risk factors include being overweight or having high blood pressure, cholesterol, prediabetes, or type 2 diabetes.
Manage your weight
Managing your weight in a healthy way can reduce your risk of heart disease, and it may even improve menopausal symptoms. In fact, some experts recommend losing extra pounds to help reduce hot flashes in people who are overweight or obese.
Move more each day
Being sedentary (inactive) raises the risk of heart disease, as well as many symptoms of menopause, including sleeping problems, depression, anxiety, and memory issues.
Experts recommend getting at least 150 minutes of moderate physical activity or 75 minutes of vigorous activity each week. Ideally, activity should be spread across several days.
- Moderate activities raise your heart rate and cause you to breathe hard and break a sweat. They include swimming, riding a bike, and brisk walking. Sharecare (available for iOS and Android) can help you log your steps and you stay on track.
- Vigorous activities raise heart rate even more. They cause you to breath harder and faster than you would during moderate activities. They include things like running, swimming laps, and playing tennis.
Strength training at least two days each week can also help you build strength and reduce menopause-related muscle loss. Be sure to check with your HCP before starting a new exercise program.
Eat a heart-healthy diet
The Mediterranean diet—with its emphasis on plant-based foods such as fruits, veggies, whole grains, legumes, nuts, and healthy fats such as olive oil—has been shown to reduce the risk for heart disease, says Dr. Sinha.
Studies suggest following it can help reduce weight, blood pressure, triglycerides, total cholesterol, and LDL cholesterol levels. What’s more, it could help ease menopause symptoms, particularly in people who are obese.
Take steps to quit smoking
Smoking has a profound impact on the body. Among its many drawbacks, it lowers levels of healthy cholesterol, hardens arteries, and increases the risk of blood clots. It may also contribute to an earlier onset of menopause.
If you smoke, it’s never too late to stop. Speak with an HCP for advice and recommendations to get started.
Get advice about hormone replacement therapy
You may want to consider a conversation with your HCP about hormone replacement therapy (HRT). It uses prescription medication to replace female hormones that are depleted during menopause, like estrogen and progestogens.
The decision to start HRT is a personal one, and it’s guided by your medical history and other health risks. If you have a history of other heart disease risk factors—such as being overweight or smoking—you may not be a candidate.
“If I do prescribe it for a patient who is really miserable from menopause symptoms, I usually do it right after menopause, and for no more than five years total,” says Dr. Sinha. “We really want to see women off of it by their mid to late 50s.”
