Deep Dive: Heart Health in Perimenopause
- Kristyn Zalota
- Apr 11
- 3 min read
Updated: Apr 15
Is Heart Disease the leading killer of women?
Yes, heart disease is the number one cause of death of women worldwide, killing more women than all types of cancer combined.[i]
The incidence of cardiovascular events increases after menopause, particularly in those experiencing severe vasomotor symptoms, namely hot flashes and night sweats.[ii]
For the first time at the end of 2020, a scientific statement from the American Heart Association, included the menopausal transition as a sex-specific event that profoundly affects future cardiometabolic health. [iii]
What role does perimenopause play in increasing heart disease?
Decline in estrogen causes:
arteries to become stiffer, which causes risk of hypertension to increase
rise in LDL (bad) cholesterol and a decline in HDL (good) cholesterol
fat metabolism to change: fat is stored around the waist, which boosts risks for heart disease
inflammation to increase, which leads to structural changes in the heart that increase chance of arrhythmias and heart failure
Perimenopause symptoms are associated with heart risks:
Severe hot flashes and night sweats are linked to higher vascular risk.
Fatigue, depression can lead to heart-damaging lifestyle changes: poor diet, lack of exercise, high stress [iv]
What can I do to promote heart health in perimenopause?
Research on over 100,000 adults found that those who performed 150–300 minutes of moderate activity weekly had a 22-25% lower risk of CVD mortality compared to those who were inactive.[iv]
Resistance training can also improve traditional CVD risk factors: blood pressure, glycemia, lipids, and body composition
Diet high in fiber, whole grains, fruits, and vegetables, low salt/saturated fats leads to lower LDL cholesterol, lower blood pressure, weight management, and reduced inflammation
Quit smoking or vaping, which significantly increases cardiovascular risk.
Prioritize 7-9 hours of sleep.
Manage stress through relaxation techniques, things that bring you joy.
Does HRT promote heart health in perimenopause?
According to the research, yes.
From the Lancet: “Menopausal hormone therapy (initiated in women younger than 60 years or within 10 years of menopause to alleviate menopausal symptoms and to prevent or treat osteoporosis) is currently the sole intervention that decreases the risk of cardiovascular disease and diabetes in healthy women at midlife.”[vi]
2002 WHI study data of younger women (50–59 years): After 13 years of follow-up HRT had “a beneficial effect on the cardiovascular system, reducing coronary diseases and all-cause mortality.”[vii]
DOPS study= after 10 years “women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.”[viii]
Talk to your doctor about your heart disease risk factors and how HRT can help.
And check out my post on Bone Health.
[ii] Cagnacci A, Venier M. The Controversial History of Hormone Replacement Therapy. Medicina (Kaunas). 2019; 55(9):602.
[iii] El Khoudary, SR ∙ Aggarwal, B ∙ Beckie, TM ∙ et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association Circulation. 2020; 142:e506-e532
[vi] Nappi R, Simoncini T, Menopause transition: a golden age to prevent cardiovascular disease. The Lancet Diabetes & Endocrinology, 2021; 9, 135-137
[vii] Cagnacci A, Venier M.
[viii] Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, Køber L, Jensen JE. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409. PMID: 23048011.
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