Perimenopause may be the heart warning women are missing

Most women know perimenopause, the transition leading up to menopause, when hormone levels fluctuate and periods often become irregular, can bring hot flashes, mood changes, sleep problems and unpredictable periods.

What they may not know is that this transition can also quietly open the door to heart disease.

That sounds discouraging. But new research from the American Heart Association points to something far more useful: Perimenopause may be a window of opportunity — a time when women and their doctors can spot early cardiovascular changes and act before heart disease takes hold.

And that window may open earlier than many women realize.

Heart disease risk may rise during perimenopause

Heart disease is still often thought of as a man’s disease, even though it’s the leading cause of death for women.

For years, much of the attention has focused on what happens after menopause. That makes sense. Estrogen changes after menopause can affect blood vessels, cholesterol, blood pressure, body weight and blood sugar.

But the new analysis suggests the risk shift may begin before that, during perimenopause.

Researchers analyzed data from 9,248 women ages 18 to 80 who participated in the National Health and Nutrition Examination Survey between 2007 and 2020. Women were grouped as premenopausal, perimenopausal or postmenopausal. Those who were pregnant, breastfeeding or had a history of cardiovascular disease were excluded.

Then researchers evaluated their cardiovascular health using the American Heart Association’s Life’s Essential 8, a 100-point score that includes diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight and blood sugar.

The pattern was clear.

Median scores dropped from 73.3 in premenopausal women to 69.1 in perimenopausal women and 63.9 in postmenopausal women. After adjusting for age, perimenopausal women were still twice as likely to have an overall low cardiovascular health score compared with premenopausal women.

But two numbers stood out even more.

Perimenopausal women were 76 percent more likely to have a low cholesterol score and 83 percent more likely to have a low blood sugar score.

That matters because cholesterol and blood sugar problems can build silently for years before a woman ever feels “heart symptoms.”

Why perimenopause is a heart-health window of opportunity

Here’s the problem: Many women enter perimenopause expecting discomfort, not cardiovascular risk.

They may talk to their doctor about hot flashes, sleep, weight gain or heavier periods. But unless someone connects the dots, they may not think to ask whether this is also the right time to check blood pressure, cholesterol and blood sugar.

According to Dr. Garima Arora, the study’s senior author, midlife women should view perimenopause as a “window of opportunity” and not wait until menopause to start checking those numbers.

That is the practical takeaway.

Perimenopause is not a diagnosis of future heart disease. It’s a chance to look under the hood while there’s still time to course-correct.

How perimenopause may affect cholesterol, blood sugar and blood pressure

During perimenopause, estrogen levels don’t simply fall in a straight line. They fluctuate. Those ups and downs may affect cholesterol, insulin resistance, blood pressure and weight management — all of which influence cardiovascular health.

The study also found that diet scores were consistently the lowest of the Life’s Essential 8 measures and continued to decline across reproductive stages. That gives women a clear place to start.

Dr. Arora specifically pointed to regular exercise and a heart-healthy eating pattern, such as the DASH diet, especially one focused on lowering salt intake, as useful early steps for perimenopausal women.

Sleep deserves attention, too. In the study, sleep duration scores remained high despite many perimenopausal women reporting sleep problems. That suggests sleep quality — not just hours in bed — may be part of the issue.

What to ask your doctor during perimenopause

If you’re entering perimenopause or already in it, don’t wait for menopause to “officially” arrive before knowing more about all the aspects that can determine your heart attack risk, including…

Your blood pressure

Your cholesterol, including LDL and triglycerides

Your fasting blood sugar or A1C

Your weight and waist changes

Your family history of heart disease

Your sleep quality

Your exercise and eating habits (now’s the time to get familiar with the veggie that gives back what menopause steals)

And just as important, tell your healthcare team where you are in your reproductive life. Irregular periods, hot flashes, night sweats, mood changes and sleep disruption are not just quality-of-life issues. They may also help your doctor understand your changing heart risk.

Don’t miss the perimenopause window

Perimenopause can feel like something to endure until it passes. But this research suggests it may be something else…

A critical window when women can catch early changes in heart health and do something about them.

That doesn’t mean panic. It means pay attention.

Because if blood sugar, cholesterol or blood pressure are starting to move in the wrong direction, finding out now gives you more options — and more time to protect your heart.

Sources:

Perimenopause may offer a “window of opportunity” for heart disease prevention in women — American Heart Association

Cardiovascular Health Characterization Using Life’s Essential 8 Score in Perimenopausal Women: An Analysis of the National Health and Nutritional Examination Survey — JAHA

Midlife Health Risks and What You Can Do — Permanente Medicine

Preventing Heart Disease for Women in Midlife — Permanente Medicine

FAQ: Perimenopause and Heart Disease