Key takeaways:
Heart disease is the leading cause of death in women, and this risk increases after menopause.
The drop in estrogen during menopause can cause changes in the body that impact your blood pressure, cholesterol, and body fat. These factors can increase your risk for heart disease.
There are steps you can take to reduce your heart disease risk, like having a balanced diet, regular exercise, and managing any chronic health conditions. In some cases, menopausal hormone treatment (MHT) can help reduce your risk.
Heart disease is the leading cause of death in women, and your risk increases after menopause. Menopause causes many changes in a woman’s body, which can affect your risk of heart disease and lead to heart issues in the future.
Fortunately, there are steps you can take to reduce your heart disease risk, no matter if you’re approaching menopause or already in your postmenopausal years. Let’s take a closer look at the link between menopause and heart disease, as well as what you can do to keep your heart healthy as you age.
What is menopause?
Menopause is when your periods slow down and stop. It usually happens between ages 45 and 55, but it may happen earlier in some women. When you’ve gone a full year without a period, you’ve officially reached menopause.
As you approach menopause, your ovaries begin producing less estrogen. You may notice symptoms including:
Hot flashes
Night sweats
Vaginal dryness and pain
Breast tenderness
Sleep disturbance
Mood changes
How is menopause linked to heart disease?
Menopause increases your risk for heart disease. The decline of estrogen in menopause is linked to many physical changes that can also affect your heart health, including:
Stiffer blood vessels
Higher blood pressure
Higher levels of low-density lipoprotein (LDL), the “bad” cholesterol
Lower levels of high-density lipoprotein (HDL), the “good” cholesterol
Increased triglycerides
Increased blood sugar levels
Increased body weight
Increased fat deposits around your heart
In addition, many women have poor sleep and mood changes during menopause, which can increase the risk of high blood pressure and worsen heart health.
All of these factors during menopause can affect your heart health and put you at risk for heart disease.
Is there a connection between estrogen and heart disease?
There’s a relationship between estrogen and heart disease, although it's not fully understood. Experts tend to agree that estrogen is important for heart health. Also, as estrogen levels decrease due to menopause, the risk for heart disease rises. This is likely due to many factors, but there are key ways that estrogen supports the heart:
It helps keep blood vessels flexible. Estrogen supports the lining of blood vessels, helping them stay relaxed and open. This allows blood to flow more easily and helps keep blood pressure under control, reducing strain on the heart.
It helps regulate cholesterol and blood sugar. Estrogen helps maintain healthier cholesterol levels by supporting higher HDL (“good”) cholesterol and lower LDL (“bad”) cholesterol. It also plays a role in how the body processes blood sugar, which can affect your diabetes risk.
As estrogen levels drop during menopause, these protective effects decrease. Blood vessels may become stiffer. Cholesterol levels may shift in an unfavorable direction. And blood sugar may rise. These are many of the same changes that increase heart disease risk.
Is heart disease higher in women who go through early menopause?
Yes. Early menopause is when you go through menopause before turning 45. Studies have shown that women who go through early menopause have a higher risk of heart disease. Early menopause has also been linked to an early onset of plaque buildup in the heart.
What can I do to prevent heart problems during and after menopause?
Menopause is a natural transition, but it’s also a turning point for heart health. The encouraging part is that much of this is within your control. There are many things you can do to protect your heart and improve overall health. As hormonal protection shifts, daily habits become even more important in shaping long-term risk.
Lifestyle changes
Heart health is built through consistent, everyday choices. The way you eat, move, and care for your body can help protect your heart over time. Here are some heart-healthy lifestyle changes to try during and after menopause:
Don’t smoke. Smoking damages blood vessels, raises blood pressure, and accelerates plaque buildup. You should avoid both tobacco and cannabis.
Maintain a comfortable weight. Extra weight — especially around the belly — places added strain on the heart and increases the risk of diabetes and high blood pressure.
Follow a heart-healthy diet. Prioritize fruits, vegetables, whole grains, lean proteins, and healthy fats to protect the heart. It’s also a good idea to limit processed foods, added sugars, and excess salt.
Move your body regularly. Regular movement — whether walking, dancing, strength training, or yoga — improves blood flow and helps lower blood pressure.
Limit alcohol use. Alcohol can quietly impact heart health. Excess alcohol intake raises blood pressure and strains the heart. Keeping intake low — about 1 to 2 standard drinks per week (or less) — can help reduce alcohol-related risks.
Keep other health conditions under control. Manage conditions such as high blood pressure, diabetes, and high cholesterol with regular checkups, medications (if needed), and healthy habits. This helps to decrease your heart disease risk.
Consistent, intentional choices remain one of the most powerful ways to protect your heart over time.
Regular checkups
Routine visits with a healthcare professional can help monitor your heart health and catch changes early. Regular checkups allow you to track important numbers like blood pressure, cholesterol, and blood sugar. These are all key factors that can affect your risk of heart disease.
In some cases, medications — such as those for blood pressure, aspirin, or statins — may be recommended to help lower your risk. These treatments are most effective when combined with healthy lifestyle habits.
A healthcare professional can talk to you about your personal risk and whether any screenings or treatments are right for you.
Early intervention
Many changes that affect the heart can happen quietly. Noticing and acting on small changes early can prevent bigger problems later. This includes addressing early signs such as rising blood pressure, increasing cholesterol, or changes in blood sugar.
In some cases, early action may include:
Making targeted lifestyle changes
More frequent screenings
Starting treatment sooner, if needed
Addressing these changes early can help slow progression and reduce strain on the heart.
How does menopausal hormone therapy impact my risk of heart disease?
Menopausal hormone therapy (MHT) is a group of medications used to treat menopause symptoms. MHT typically includes two types of hormones: estrogen and progesterone. These hormones help relieve menopause symptoms. And they may also provide other health benefits, including support for heart health in some women.
Heart-specific health benefits of MHT
Studies suggest that women who begin MHT within 10 years of menopause, or before the age of 60, may have a lower risk of heart disease.
MHT may benefit your heart in other ways, including:
Relaxing your blood vessels
Improving your cholesterol levels
Lowering your risk of developing Type 2 diabetes
Improving blood sugar in people who already have diabetes
Decreasing plaque buildup in the arteries
Other health benefits of MHT
MHT can have other health benefits too. These include:
Reducing menopause symptoms, such as hot flashes, mood changes, and sleep problems
Reducing vaginal dryness and pain during sex
Decreasing urinary tract infections (UTIs) and bladder symptoms
Helping maintain bone strength
Risks of MHT
For many women, especially those who start MHT within 10 years of menopause, the benefits may outweigh the risks. Current guidance supports the use of MHT for symptom relief in appropriate candidates.
Risks of MHT can vary based on your health history, the type of therapy, and how long it’s used. Taking estrogen alone may increase the risk of endometrial cancer. However, adding progesterone can help lower this risk.
MHT was previously linked to other health risks, like:
Cardiovascular disease
Stroke
Breast cancer
Dementia
But these risks were ordered to be removed from MHT labels by the FDA in 2025, after research showed there was no definite link to these conditions.
Decisions to start MHT should be made with the guidance of a healthcare professional based on individual risk factors and preferences.
When should I talk to my doctor about heart health?
It’s not too early to have a conversation with a healthcare professional about reducing heart disease risk. Even if you’re far from menopause, there may be steps you can take to reduce your risk of heart disease later.
If you’re approaching menopause, or have recently gone through it, you may be a candidate for MHT. As we just discussed, MHT might not only reduce your heart disease risk. It can come with many other benefits too — both for your heart health and your quality of life.
Even if you’re unsure whether MHT is right for you, it’s still worth having a conversation with your primary care provider or OB-GYN. In some cases, the benefits may outweigh the risks.
Frequently asked questions
Yes, it’s possible to have chest pain as a symptom of menopause. But if you experience sudden pressure, chain, or discomfort in your chest, it could be a sign that you’re experiencing a heart attack. Women can have different heart attack symptoms from men, like lightheadedness or pain or discomfort in other areas of the body.
The main point: If you’re concerned about a heart attack, you should call 911 or go to the emergency room right away.
Yes, it’s possible to have chest pain as a symptom of menopause. But if you experience sudden pressure, chain, or discomfort in your chest, it could be a sign that you’re experiencing a heart attack. Women can have different heart attack symptoms from men, like lightheadedness or pain or discomfort in other areas of the body.
The main point: If you’re concerned about a heart attack, you should call 911 or go to the emergency room right away.
The bottom line
Menopause can bring many changes that affect your heart health. You can take care of your heart by making heart-healthy choices during menopause and beyond — like eating well, exercising, and limiting alcohol and tobacco. And for many women, hormone therapy can not only ease menopause symptoms but also help protect your heart. Talk to a healthcare professional to learn more about what you can do to keep your heart healthy both now and in the future.
Why trust our experts?
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