Should You Get a Calcium Score? Menopause Heart Guide

Why Heart Disease Risk Rises During Menopause

Estrogen has a protective role in heart health during a woman’s reproductive years. It helps regulate lipid metabolism, supports healthy blood vessel function, and influences arterial elasticity. When estrogen levels decline during perimenopause and menopause, LDL or “bad” cholesterol levels rise, HDL or “good” cholesterol levels decrease, blood pressure can increase, and arteries may become stiffer. Together, these changes contribute to accumulation of plaque on the walls of the arteries, or atherosclerosis.

Studies show that women who have gone through menopause have a higher risk of developing atherosclerotic cardiovascular disease compared with premenopausal women. Additionally, traditional risk factors for heart disease like diabetes, smoking, and high blood pressure have a greater impact on women postmenopause. Women who experience early or premature menopause face an even greater increase in cardiovascular risk.

Recognizing that menopause is a cardiovascular transition, not just a reproductive milestone, is essential for proper prevention and screening.

What Is a Coronary Artery Calcium Score?

A coronary artery calcium score is a measurement obtained through a specialized, low-dose CT scan that detects and quantifies calcium deposits in the coronary arteries. These calcium deposits represent calcified plaque, a marker of underlying atherosclerosis.

The CAC score reflects the total burden of calcified plaque in the coronary arteries. A score of zero suggests a very low short-term risk of heart events, while higher scores are associated with progressively greater risk of future cardiovascular events. The higher the score, the greater the likelihood of significant coronary artery disease.

The test itself is non-invasive, requires no contrast dye, and is typically completed within minutes. Because calcified plaque develops over time, calcium scoring is most useful for individuals with intermediate or uncertain cardiovascular risk, where results may clarify whether preventive medications or more intensive interventions are warranted.

Calcium scoring adds information in addition to traditional assessment, which is useful during midlife when cardiovascular risk profiles may shift.

How Menopause Can Affect Calcium Scoring

For many women, cardiovascular risk was not part of a practical medical conversation until menopause. Cholesterol levels may shift. Blood pressure may rise. Family history may start to feel more relevant. Routine labs that were once stable can begin to change.

As a result, you may hear about coronary artery calcium scoring for the first time during midlife. Alternatively, you may receive a different result than you would have earlier in life. Because calcified plaque accumulates gradually over time, calcium scoring can reflect the cumulative effects of aging, metabolic changes, and hormonal transitions.

Menopause does not automatically mean you will have a high calcium score. However, this transition often prompts a reassessment of cardiovascular risk and whether additional information could guide prevention decisions more precisely.

In this way, calcium scoring is not about reacting to menopause. It is about recognizing that midlife is a natural point to reevaluate long-term heart health. This is also particularly important since there are interventions that can make a significant impact in your heart health when started early.

Who Should Consider a Calcium Score During Menopause?

Coronary artery calcium scoring is not recommended for every menopausal woman. Its value lies in situations where there is uncertainty about how aggressively to approach prevention.

If cholesterol levels increase, blood pressure rises, or overall risk appears to be changing during midlife, additional information may help with treatment decisions. Calcium scoring can clarify whether preventive strategies, including medication, are appropriate or whether lifestyle measures alone should be used.

The test is not meant to replace standard cardiovascular assessment. It is one more tool that can help refine decision-making when the path forward is not obvious.

Benefits and Limitations of Calcium Scoring for Midlife Women

Calcium scoring offers several advantages in risk assessment. It can detect subclinical coronary artery disease and help guide treatment decisions. A score of zero may suggest a conservative approach, while an elevated score may justify earlier or more intensive preventive therapy.

At the same time, calcium scoring has limitations. The test involves low-dose radiation exposure. Costs and insurance coverage vary. It does not detect non-calcified plaque, which can still be clinically significant.

How Calcium Score Results Influence Prevention and Treatment

For women with elevated scores, clinicians may recommend more intensive cholesterol-lowering therapy with a statin and monitoring to ensure that cholesterol targets are achieved. Often stricter blood pressure targets and more frequent follow-up are needed as well.

Evidence suggests that hormone therapy may influence coronary calcification, but decisions regarding its use should be individualized and guided by a menopause-informed clinician.

Lifestyle adjustments remain one of the most effective methods to reduce cardiovascular risk at any point in a woman’s life, but especially in menopause. A diet that emphasizes whole foods, plant-forward nutrition, and adequate fiber helps to regulate LDL cholesterol and raise HDL cholesterol. Regular physical activity also improves lipid profiles, insulin sensitivity, and vascular function. Weight management and smoking cessation further reduce cardiovascular risk. These strategies are particularly important during menopause when metabolic changes can accelerate vascular disease.

Talking to Your Healthcare Provider About Calcium Scoring and Heart Health

Menopause is an important opportunity to reassess cardiovascular health.

When speaking with your provider, be prepared to discuss your personal medical history, family history of heart disease, cholesterol levels, blood pressure, and any menopausal symptoms you are experiencing. Ask whether your cardiovascular risk is considered low, intermediate, or high, and whether calcium scoring could provide useful clarification.

It may also be helpful to discuss how lifestyle changes, medications, and hormone therapy fit into your overall prevention strategy. Seeking care from a menopause-informed or certified provider can support more nuanced risk assessment and individualized treatment planning.

Cardiovascular prevention during midlife is not about reacting to disease. It is about using available tools to protect long-term heart health.

Frequently Asked Questions:

How does the transition to menopause specifically impact heart disease risk?

During reproductive years, estrogen protects the heart by regulating lipid metabolism and supporting healthy blood vessel function.When estrogen levels drop during perimenopause and menopause, LDL ("bad") cholesterol typically rises while HDL ("good") cholesterol decreases.Additionally, blood pressure may increase and arteries can become stiffer, which collectively leads to the accumulation of plaque, or atherosclerosis.

What is a coronary artery calcium score and what does it reveal?

A coronary artery calcium (CAC) score is a measurement taken via a specialized, low-dose CT scan.It detects and quantifies calcified plaque in the coronary arteries.A score of zero suggests a very low short-term risk of heart events, whereas higher scores indicate a greater burden of plaque and a higher likelihood of significant coronary artery disease.

Who should consider getting a calcium score during menopause?

The test is not recommended for every woman. It is most useful for those with intermediate or uncertain cardiovascular risk—situations where it isn't clear how aggressively to approach prevention.If cholesterol or blood pressure begins to rise during midlife, the score can help a clinician decide whether to stick with lifestyle measures or move toward more intensive interventions like medication.

What are the limitations of relying on a calcium score for heart health assessment?

While the test is non-invasive and provides valuable data, it does involve exposure to low-dose radiation, and insurance coverage or costs can vary.A key limitation is that it only detects calcified plaque; it does not identify non-calcified plaque, which can still be clinically significant and impact overall cardiovascular health.