Published October 15, 2026
As women go through menopause, they may be focused on alleviating bothersome symptoms like brain fog and hot flashes. It’s also an important time for addressing underlying risk factors that could impact heart health.
“Menopause is a continuum and process. So, it's not like all of a sudden a switch flips and cardiovascular profiles change for our patients. But over the course of the many years, sometimes 10 years, that menopause spans, cardiovascular risk does increase overall,” said Sangini Sheth, MD, MPH, an Ob/Gyn at Yale New Haven Health and associate professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine.
There are many factors that can contribute to changes in heart health. The first has to do with changing hormone levels. Estrogen has a protective effect on plaque buildup. As patients age, estrogen levels go down.
“That’s why women’s heart disease generally happens later than men. For men that happens around age 50 and for women it tends to happen around 60, because the protective effect of estrogen is no longer there,” said Yale New Haven Health Cardiologist Joyce Oen-Hsiao, MD, associate professor of Cardiovascular Medicine at Yale School of Medicine and director of the Women’s Heart and Vascular Program.
Patients tend to experience changes in their cholesterol levels as they age, as well as weight gain around the midsection. That weight gain can lead to increased insulin resistance.
Underlying risk factors can also put women at risk of cardiovascular disease. Those may include:
“We know in general that having preeclampsia, having severe preeclampsia, having preeclampsia in multiple pregnancies, each of these increases the risk of developing cardiovascular disease later in life,” said Dr. Sheth. “Part of the thought is that the pregnancy itself is almost like a stress test for the body, and so it may be revealing risks that maybe subside immediately following pregnancy, but then, as these other factors come into play such as age, menopause transition, weight gain, they become unmasked again later on.”
Potential warning signs patients should be aware of include:
“Persistent lower extremity edema is important because women who have high blood pressure in general tend to have what we call diastolic heart failure. And so, it's not that the heart is not squeezing well, it's that the heart doesn't relax well. One of the signs is shortness of breath as well as swelling in the legs,” said Dr. Oen-Hsiao.
While chest pain is the classic sign of a heart attack, women can also have more vague symptoms that are easy to ignore like fatigue, weakness or feelings of indigestion. Any time a symptom appears suddenly, it’s important to seek care right away.
Even if someone has underlying risk factors for cardiovascular disease, there are early interventions that can help. That’s why it’s so important to ‘know your numbers.’
That includes getting screenings for blood pressure, diabetes and cholesterol levels. The American College of Cardiology recommends at least one blood test for adults for Lp(a), a lipoprotein that is genetic.
For those with increased risk factors, a coronary calcium scan will check for the presence of coronary plaque, giving patients a better idea of their cardiovascular risk.
Those with increased risk factors may benefit from seeing a cardiologist, but often women can get the care they need through regular appointments with their gynecologist and primary care provider.
“Earlier interventions are always going to be easier when we're talking about preventative health,” said Dr. Sheth. “Sometimes what I'll do is I'll go ahead and I'll order those tests if I see that someone doesn't have a primary care doctor but then encourage them to establish a primary care provider who will then have all that data, those numbers available to them to make recommendations at that first visit.”
Support from a primary care clinician can be crucial for patients as they age, especially if they are trying to make important lifestyle changes. For example, quitting smoking, following a heart healthy diet and incorporating resistance training will all benefit patients as they go through menopause.
