Your heart rarely comes up in conversations about menopause. But heart disease is the leading cause of death in women in the U.S., and menopause is linked to a higher risk. Taking time to understand the relationship between menopause and heart health is an important step for your well-being.

Read on to better understand the link between menopause and heart health, symptoms to look out for, and treatment options to help keep you healthy and well. 

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How does menopause raise cardiovascular risk?

The ovaries decline in function during menopause, meaning they produce less estrogen. There’s a link between declining ovarian hormones and increased cardiovascular risk, as traced in a 2020 statement from the American Heart Association (AHA), highlighting: 

• Cholesterol: LDL (“bad”) cholesterol may increase for postmenopausal women. HDL (“good”) cholesterol may become less protective, too. These can lead to buildup in your arteries, the blood vessels that carry blood from your heart to the body, leading to higher blood pressure as blood flows less easily through the arteries.
• Visceral fat: Declining ovarian function may lead to an increase in fat stored deep in the abdomen (visceral fat), which can affect cardiovascular health in multiple ways. For example, it can increase systemic inflammation, which is linked to an increased risk of heart attack. 
• Vascular remodeling: For postmenopausal women, the blood vessel walls may thicken and lose flexibility, which can restrict blood flow and increase CVD risk. 
• Metabolic health: This refers to how effectively your body processes and uses energy. Menopause increases the risk of metabolic dysfunction. This dysfunction is an established cardiovascular risk factor, as all the mechanisms causing it also play a role in the progression of heart failure. 

The AHA’s statement also points out indirect indicators of cardiovascular health. Take vasomotor symptoms (VMS), for example, which include hot flashes and night sweats. 

Estrogen interacts with parts of the brain involved in body temperature regulation. Declining estrogen can dysregulate these systems, causing VMS (like waking at 4 a.m. in a needless cold sweat). VMS can indirectly influence cardiometabolic health by increasing blood pressure and insulin resistance. The Study of Women’s Health Across the Nation (SWAN) connects VMS and cardiovascular health more closely. People who regularly experienced VMS had higher blood pressure, pulse pressure, and odds of getting hypertension. SWAN also found that women with VMS had a higher risk of experiencing a cardiovascular event than those without.

Menopause timing and cardiovascular health risk

On average, women enter menopause at age 50. If it arrives early, however, cardiovascular health risk may increase. The research on why is mixed, but a proposed reason is that ovarian hormones, like estrogen, help protect the heart. When menopause arrives early, people spend more time without their protective effects. Interestingly, the inverse is also true: Poor cardiovascular health markers, like high blood pressure, may also increase the risk of menopause arriving early.

In a 2019 Lancet Public Health article, researchers assessed a woman’s risk of developing cardiovascular disease based on the age she reaches menopause. Here are the key findings:

• Menopause arriving before 40 (premature menopause): A 55% higher risk of developing cardiovascular disease compared to women who reach menopause at ages 50 or 51
• 40 to 44 (early menopause): 30% higher
• 45 to 49: 12% higher
• 52 to 54: No significant difference
• 55 and older: 12% lower

Early removal of both ovaries (known as surgical menopause) also has a similar impact. It causes a rapid drop in ovarian hormones, limiting their protective effects on the heart.

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Menopause heart symptoms to watch for

Though your body changes significantly before and during menopause, you shouldn’t dismiss new cardiovascular symptoms. Some require a visit to the emergency department, while others need to be monitored by your doctor.

What needs urgent attention

Certain symptoms require emergency care, as they may indicate a serious cardiovascular event. These include:

• Shortness of breath
• Sudden chest pain
• Facial weakness
• Speech difficulties
• Sudden memory loss
• Sight issues
• Heart palpitations
• Fainting

Seek medical care immediately, particularly if symptoms are new, sudden, or severe. 

What needs a clinician’s review

Certain cardiovascular diseases may not present symptoms immediately, so don’t overlook your routine medical care. Attend routine cardiovascular screenings with your primary care providers (PCPs). PCPs monitor risk factors as you progress through menopause, including your:

• Blood pressure
• Cholesterol
• Blood glucose
• Body weight
• Family history
• Physical activity
• Smoker status

These screens can be anxiety-inducing, but they’re usually not cause for alarm. Think of it as an opportunity to improve your cardiovascular health, with support from your care team.

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Is HRT effective for supporting cardiovascular health?

Hormone replacement therapy (HRT) isn’t used to treat or prevent heart disease. But in appropriately selected younger women, it doesn’t appear to raise, and may lower, cardiovascular risk. A 2022 review, published in Cancer Journal, assessed its cardiovascular benefits. Researchers highlighted the following links:

• Reduced coronary heart disease (CHD) and all-cause mortality risk: Cochrane Heart Group found that when women started HRT before age 60 or within 10 years of menopause, their CHD risk was 48% lower. In addition, participants lowered their all-cause mortality risk by 30%. 
• Slower artery plaque buildup (atherosclerosis): Two trials, the Estrogen in the Prevention of Atherosclerosis Trial (EPAT) and the Women’s Estrogen-Progestin Lipid-Lowering Hormone Atherosclerosis Regression Trial (WELL-HART), looked at artery plaque buildup. EPAT showed that HRT was more effective for slowing buildup when patients started treatment early. But WELL-HART findings suggest HRT doesn’t help as much with established vascular disease.

When it comes to HRT and your heart, timing matters. Many providers talk about a “window of opportunity,” which means starting HRT within 10 years of menopause or before age 60. Research has linked starting during this window to better outcomes for heart health. 

One potential reason is that estrogen may destabilize plaque in the arteries (atherosclerotic plaque), which can raise certain cardiovascular risks, such as blood clots. Women later in the menopause transition—outside the window of opportunity—are at increased risk of atherosclerotic plaque destabilization.

Women earlier in menopause are at decreased risk of this destabilization (since there’s less plaque to begin with). Your doctor will screen for all risk factors, like this one, before prescribing. 

Note: No HRT products are approved by the U.S. Food and Drug Administration (FDA) for supporting cardiovascular health, and outcomes are mixed. Your doctor may prescribe it off-label (outside its approved indications) for this purpose. 

HRT’s indirect benefits

Some of HRT’s potential benefits are indirect. Various HRT products, for example, are FDA-approved for VMS relief. This matters because VMS, like hot flashes, may contribute to cardiovascular dysfunction. 

One 2004 study, published in the Cochrane Database of Systematic Reviews, found HRT reduced:

• Hot flash severity: The odds of experiencing severe symptoms declined by 87% versus placebo. 
• Hot flash frequency: Weekly hot flash frequency declined by 75% versus placebo.

Sleep support is another potential indirect benefit. Poor sleep is associated with various markers of cardiovascular dysfunction, such as increased inflammation and raised blood pressure. HRT may support sleep, including through VMS relief (e.g. fewer night sweats). 

Understanding HRT’s rescinded boxed warnings

Boxed warnings are reserved for serious, life-threatening risks of an FDA-approved product. In November 2025, the FDA announced they’d be rescinding multiple boxed warnings for HRT, including the risk of cardiovascular disease. 

The initial warning stemmed from a 2002 Women’s Health Initiative (WHI) trial, which reported an association between HRT and cardiovascular disease. WHI researchers proposed several potential contributing factors. They hypothesized, for example, that progestins (synthetic progesterone-like compounds) may promote cardiovascular dysfunction. They didn’t draw final conclusions on the cause, though. 

This trial’s findings no longer align with our modern understanding of HRT’s risk profile. However, that doesn’t mean that HRT carries no cardiovascular risk—although the absolute risk is low when prescribed appropriately. To minimize risk, doctors assess your full health profile before prescribing, from your age to medical history. 

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How to limit the risk of heart problems in menopause 

There are steps you can take to meaningfully support your heart, both before and during menopause, including:

• Limiting smoking: Smoking is a serious risk factor for CVD. For example, women who smoke are around three times as prone to coronary heart disease. 
• Exercise routinely: Cardiovascular and strength training can move the needle on a range of cardiometabolic markers, from lowering LDL cholesterol to regulating blood sugar. Aim for at least 150 minutes weekly of moderate activity, like brisk walking. 
• Diet: Certain diets, such as the Mediterranean diet, are associated with positive cardiovascular outcomes. This diet emphasizes plant-based, whole foods. Consider having a registered dietitian create a diet plan around your needs. 

These are just three of many possible steps. Talk to your care team about the right approach for you.

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Holistic, evidence-based hormone care at Maven Clinic

At Maven Clinic, our women’s care specialists provide a personalized path to improved health. We don’t treat cardiovascular symptoms in isolation. Instead, we connect the dots between what you’re experiencing and what’s happening beneath the surface—addressing the root cause. 

Discover our approach to hormone care.