Menopause may increase the risk of heart disease due to declining estrogen levels and other hormone-related factors. But you can lower your risk by managing blood pressure and cholesterol levels, eating a healthy diet, and exercising regularly.

Menopause doesn’t cause heart disease. But there are certain heart disease risk factors associated with this natural stage of life. These risks start to increase in the years leading to menopause and continue after menopause.

Women usually develop heart disease several years later than men do, which is why it may fly under your radar. But it’s still the leading cause of death in women.

This article explores the connection between menopause and heart disease, other risk factors, and what you can do to keep your heart as healthy as possible.

Language matters

In this article, we talk about menopause and the risk of heart disease in people who are assigned female at birth. It’s important to note that not everyone assigned female at birth identifies with the label “woman.” However, at times we use “man” or “woman” to reflect the language in a study or statistic.

Although we typically avoid language like this, specificity is key when reporting on research participants and findings. Unfortunately, the studies and surveys referenced in this article did not include data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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Menopause involves major hormonal changes that can affect every system in your body. These changes start as you enter perimenopause. For most women, this happens in their mid to late 40s and lasts an average of 4 years.

During this time, your estrogen levels start declining.

Estrogen protects your heart in several ways. It helps keep your blood vessels relaxed and open, which promotes good blood flow and keeps your cholesterol from building up. And it helps regulate your blood pressure.

Estrogen also affects your immune system. Women may be at increased risk of developing an autoimmune disorder during the menopause transition. And autoimmune disorders are associated with an increased risk of heart disease.

Other menopause-related factors that can increase your risk

According to American Heart Association research, there are other factors related to menopause that can increase your risk of heart disease. These include:

So, a combination of factors related to menopausal status can affect heart health.

The answer to whether hormone replacement therapy (HRT) lowers your risk of heart disease isn’t the same for everyone.

HRT for menopause can involve estrogen only or estrogen in combination with progestin. Research indicates that combined HRT may help lower the risk of heart disease when initiated in women younger than 60 years old or within 10 years of menopause.

HRT involves many potential benefits and risks. Whether HRT is right for you depends on your overall health. For some women, HRT can increase the risk of:

Who should not take HRT?

According to the American College of Obstetricians and Gynecologists, HRT isn’t usually recommended if you’ve ever had:

A healthcare professional can make an individual risk assessment based on your complete medical history and lifestyle.

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The leading cause of heart disease is high blood pressure (hypertension).

Heart disease can happen at any stage of life, but the risks do increase with age. Other risk factors include:

Some other risk factors for heart disease are related to reproductive health, including:

Some of the more common symptoms of heart disease are:

Symptoms more common in women than men:

  • chest discomfort during emotional stress
  • chest discomfort that wakes you from sleep
  • sharp, burning chest pain (angina)
  • pain in your neck, jaw, throat, stomach, or back
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It’s more likely that you’d have just a few symptoms than all of them.

Screening for heart disease

An annual wellness exam typically includes a check of your weight/body mass index (BMI) and blood pressure. It’s also a good time to go over your diet, exercise, and smoking history.

Further screening for heart disease is based on individual risk factors, including your age. A doctor or healthcare professional may recommend additional tests such as:

If you’re at especially high risk or already have symptoms of heart disease, a primary care doctor may refer you to a cardiologist. A cardiologist is a doctor who specializes in disorders of the heart.

Some risk factors, such as your age and medical history, aren’t within your control. But it’s important to work with a healthcare team to manage your blood pressure, cholesterol, and glucose levels.

Here are some other ways to keep your heart as healthy as possible:

  • If you smoke, try to quit: If you need help, ask a healthcare professional about smoking cessation programs. You can also visit the Centers for Disease Control and Prevention (CDC)’s How to Quit Smoking page or call the Quit Line at 800-784-8669.
  • Exercise regularly: Work on getting at least 150 minutes a week of moderate-intensity exercise or 75 minutes a week of vigorous exercise.
  • Eat a heart-healthy diet: Aim for a Dietary Approaches to Stop Hypertension (DASH) eating plan. Your diet should be high in heart-healthy foods such as fruits, vegetables, whole grains, and lean meats. Try to avoid foods high in saturated fats, trans fats, cholesterol, and salt.
  • Drink alcohol in moderation: The CDC recommends a one-drink-a-day maximum for women. If you have certain medical conditions a doctor may advise that you not drink at all. If you suspect you have alcohol use disorder, it may be worth a discussion with a doctor. Or you can call the Substance Abuse and Mental Health Services Administration (SAMSA) hotline at 800-662-4357.

Menopause doesn’t cause heart disease, but it’s associated with some increase in risk. Heart disease is the number one cause of death for women, though it usually develops at a later age than it does in men.

Heart disease risk rises with age, but there are risk factors besides age and menopausal status. Some that you can control are diet, physical activity, and not smoking. It’s also vital to work with a doctor to manage your blood pressure, cholesterol, and glucose levels.

Seeing a doctor for an annual checkup may help catch heart issues early.

Symptoms of developing heart disease include unexplained shortness of breath, chest pressure or discomfort, and swelling in your feet, legs, or abdomen. If you have any symptoms of heart disease or believe you may be at high risk, consider seeing a doctor right away.