The menopause-heart health connection

Women are unique — and so are their hearts. 

Cardiovascular disease is responsible for 1 in 3 deaths among women in the United States, yet women remain underrepresented in heart disease research. Only 38% of participants in cardiovascular disease trials are women, says Amy Ahnert, MD, an Atlantic Health cardiologist and the director of the Women’s Heart Program at Morristown Medical Center.  

That gap matters, especially during menopause — a life stage that can quietly increase heart disease risk. 

“It is estimated that 80% of heart disease is preventable,” Dr. Ahnert says. “Information is power.” 

How menopause affects heart health 

One of the most significant changes during menopause is a drop in estrogen. Estrogen plays a protective role in the cardiovascular system, helping blood vessels stay flexible and cholesterol levels balanced. 

As estrogen levels decline, LDL (or “bad”) cholesterol tends to rise, while HDL (or “good”) cholesterol decreases, Dr. Ahnert explains. Over time, this can raise blood pressure and increase the risk of heart attack or stroke. 

Hot flashes — one of the most common menopause symptoms — may also contribute to higher blood pressure, adding another layer of cardiovascular risk. 

Menopause and metabolic syndrome 

Women going through menopause are also more likely to develop metabolic syndrome, a group of conditions that significantly increases heart disease risk. 

Metabolic syndrome is diagnosed when someone has three or more of the following: 

• High blood pressure 
• High blood sugar 
• High triglycerides 
• Increased waist circumference 
• Low HDL cholesterol 

“Any of these conditions alone or in combination increases the risk of heart disease,” Dr. Ahnert says. 

Protecting your heart during menopause 

The good news: There are meaningful steps you can take to protect your heart. 

• Avoid smoking. According to the Centers for Disease Control and Prevention (CDC), smoking is responsible for 1 in 4 cardiovascular disease deaths. It damages blood vessels, lowers HDL cholesterol and increases clot risk. Secondhand smoke can also raise your risk. 
• Address sleep and mood changes. Menopause can contribute to sleep disturbances and depression, which may also affect heart health. Treating these concerns — through lifestyle changes, therapy or medication — may help reduce cardiovascular risk. 
• Eat a heart-healthy diet. Focus on fruits and vegetables, whole grains, lean proteins, healthy fats and low-fat dairy. These foods help manage cholesterol and blood pressure. 
• Move your body regularly. Aim for daily movement that includes both aerobic activity and strength training. The gym isn’t your only option — walking, dancing, swimming and pickleball all count, especially when you choose activities you enjoy. 

Finally, Dr. Ahnert notes that hormone replacement therapy (HRT) may be appropriate for some women, but it’s not for everyone.  

“The black box warning on menopausal hormone therapy was recently removed,” she says. “This is making consideration for the initiation of hormone therapy available to more women. But it’s imperative that women discuss the potential risks of hormones, including potential cardiovascular risk, with their doctor.” 

Specialists on the Women’s Heart Program team have experience and expertise in collaborating with women and their doctors to determine the cardiovascular safety of hormone therapy. 

“The risk must be individualized and requires cardiology specialists in women’s heart health who understand all the factors that must be considered,” Dr. Ahnert says, adding that the Women’s Health Program at Morristown Medical Center created a cardio-menopause clinic where specialists work with patients and their doctors to determine the safest strategy to treat menopause symptoms.