Menopause and Heart Disease: Understanding the Cardiovascular Risk and Early Warning Signs

Why Does Heart Disease Risk Increase During Menopause?

According to the American College of Cardiology, estrogen plays an important part in heart health by protecting blood vessels, reducing inflammation, and managing cholesterol. As hormones decline, cardiovascular risks rise sharply, to about the same level as men’s risks at the same age.

Dr. Ella Ishaaya, one of the lead authors of a 2024 study on the topic, says that “Women are underscreened and undertreated, especially post-menopausal women, who have a barrage of new risk factors that many are not aware of.”

In the study, post-menopausal women underwent heart scans to assess the plaque buildup (fat, calcium and other substances) in their arteries. The findings suggest that many women experience a steep rise in plaque, which contributes to the risk of heart problems.

“After menopause, women have much less estrogen and shift to a more testosterone-heavy profile,” Ishaaya said. “This affects the way your body stores fat, where it stores fat and the way it processes fat; it even affects the way your blood clots. And all of those increase your risk for developing heart disease.”

The Root Causes of Increased Heart Disease Risk in Women

• Estrogen Loss: Estrogen helps blood flow through vessels and without it, arteries can stiffen and cause high blood pressure.

• Cholesterol Changes: With lower estrogen the level of LDL (bad) cholesterol increases (HDL is more variable) and overall lipid profiles become more atherogenic, increasing plaque buildup.     I pulled the source of information from open evidence.

• Weight Gain: In menopause, fat accumulates in the abdominal area (called visceral fat), and is much more difficult to lose even if you are exercising more and eating healthily.

• Hot Flashes and Inflammation: Two of the main symptoms of menopause are hot flashes and night sweats. Hot flashes and night sweats have been associated with increased cardiovascular risk, due to the effects on blood vessel function, sleep disruption, and what happens to the body during stress.

In a 2020 American Heart Association scientific statement on how the menopause transition affects cardiovascular disease risk, Dr. Samar El Khoudary, a professor of epidemiology at the University of Pittsburgh's School of Public Health, noted that in menopause, ”arteries become more vulnerable to disease, getting thicker and stiffer.”

Another factor is mental health. Research suggests that women who experience depression during menopause have a higher cardiovascular disease risk.

Recognizing the Early Warning Signs of Heart Disease in Women

It’s important to know that the classic chest-grabbing heart attack you’ve seen in countless movies and TV shows is not usually how it works with women. In fact, the symptoms for women are much less sudden and dramatic.

• Extreme Fatigue: You might feel unexplained exhaustion that can’t be relived with extra sleep.

• Shortness of Breath: If you have difficulty breathing even while resting or sitting still.

• Heart Palpitations: If your heart is beating at a much faster rate than normal.

• Pain or discomfort in your chest: A “squeezing” sensation rather than sharp pain,

• Nausea: Digestive issues like nausea, vomiting, indigestion

• Unexpected Pain: Discomfort in the back, neck, shoulders, jaw, or stomach

• Dizziness: Feeling lightheaded, confused or faint seemingly out of nowhere

• Overwhelming Anxiety: Sudden feelings of distress or doom

• Sleep Problems: Trouble staying asleep or waking feeling panicked

In addition, women who experience natural menopause at a later age have a lower risk of cardiovascular disease and death. Factors that may influence an earlier start to menopause include worse cardiovascular health during reproductive years, cigarette smoking and possibly genetics.

How to Prevent Heart Disease and Manage Risk During Menopause

The best things you can do for your heart health are lifestyle changes. Being more physically active, eating better, quitting smoking, and managing stress are the most important. If you have depression or anxiety, you should consult with a mental health practitioner to address those issues.

The Role of Menopausal Hormone Therapy (MHT) in Cardiovascular Health

The fact we can all agree on is that Menopausal Hormone Therapy (MHT) is safest when started early.  It may have neutral or favorable cardiovascular effects in appropriately selected patients.It should not be framed as a primary prevention therapy for heart disease.

It’s important to note that there are many factors that contribute to heart disease (family history, high blood pressure, high cholesterol), and that is why we suggest you connect with an Alloy Doctor to discuss this and all of your health needs.

Frequently Asked Questions About Menopause and Heart Health

Why does heart disease risk increase during menopause?

The risk increases primarily due to the loss of estrogen, which helps maintain blood vessel elasticity and manage cholesterol. Without it, arteries stiffen and "bad" cholesterol levels often rise.

What are the "silent" symptoms of a heart attack in women?

Women often experience non-traditional symptoms such as extreme fatigue, nausea, dizziness, and discomfort in the jaw or neck rather than the sudden chest pain typically seen in men.

Does menopausal weight gain impact heart health?

Yes. Menopause often causes an increase in visceral fat (abdominal fat), which is linked to higher inflammation and cardiovascular risk, even for those who are physically active.

Can hormone therapy reduce the risk of heart disease?

Studies indicate that beginning hormone therapy within 10 years of menopause onset or before age 60 can lead to a significant reduction in heart disease and mortality.