The menopause transition is a cardiovascular event, too.
Cholesterol and blood pressure patterns often worsen through the transition, and the premenopausal advantage women hold over men narrows. We assess risk formally — and act on it.
What changes at the transition
Before menopause, women have substantially lower rates of coronary disease than men of the same age. That advantage narrows through the transition and largely disappears in the years that follow. Cholesterol and blood pressure patterns often worsen in exactly these years, and cardiovascular disease remains the leading cause of death in women in the United States. Women who go through menopause early — especially with POI — face the highest risk.
What we do about it
We assess cardiovascular risk formally — lipids, blood pressure, glucose, weight, family history, and menopause-specific factors like age at menopause — and we treat what we find: lipid management, blood pressure coordination, and metabolic treatment as part of the same menopause plan, reviewed over years by the same physician.
Hormone therapy and the heart, stated precisely
We do not start hormone therapy to prevent cardiovascular disease — that is not its indication. But the old fear that it causes heart disease in typical candidates has been substantially walked back: women who begin within ten years of menopause or before 60 do not show increased coronary risk in age-stratified analyses, and may show a modest mortality benefit. Practical implications: risk factors are optimized before starting therapy, transdermal estrogen is preferred when risk is elevated, and a personal history of heart disease or stroke changes the calculus entirely.