5 Signs of Heart Issues During Menopause
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5 Signs of Heart Issues During Menopause

5 Signs of Heart Issues During Menopause
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Updated on December 15, 2025
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Parveen Garg, MD MPH

5 Signs Your Heart Is Changing During Menopause

Heart disease is the No. 1 killer of women, and should be high on your list of menopause related health concerns.
5 Signs Your Heart Is Changing During Menopause

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Every year, more than one million people in the United States enter menopause — when someone stops menstruating and hasn’t had their period for 12 months in a row. When you think of menopause, hot flashes, insomnia, mood changes, and night sweats may come to mind.

But of all the major menopause-related health concerns, heart disease — the leading cause of death among people experiencing menopause, causing 1 in 5 deaths each year — should be at the top of the list.

Heart disease risk increases with age for everyone. “But there are heart disease risk factors especially associated with ovarian aging,” says Chrisandra Shufelt, MD, the associate director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida. Ovarian aging is the complex process marked by changes in hormone levels, ending with menopause.


Here’s a rundown of the risks associated with heart disease during menopause — and what you can do to lower your risk.

5 Signs of Heart Issues During Menopause

When your estrogen levels drop, your body can undergo several health changes, including in your heart.

1. High Cholesterol

Menopause can drive changes to your cholesterol and blood fat levels, which can lead to an artery-clogging condition called atherosclerosis.

Research has found that during menopause, total cholesterol and "bad" cholesterol (LDL-C) may go up, while "good" cholesterol (HDL) is likely to go down. This is not ideal, as HDL is required to move extra cholesterol that your body doesn’t need.

Too much cholesterol in your blood can cause the formation of plaque (a buildup of fat, cholesterol, calcium, and other substances) in your arteries, which ultimately can lead to a heart attack or stroke.

2. Gaining Belly Fat

People experiencing menopause are more likely to gain fat on their torsos after age 40. Shufelt says this specific fat distribution can put your heart at greater risk. Studies have found that excess fat around the midsection and vital organs — such as the liver — can increase your risk of heart disease, even if you are at a healthy weight for your body size.

The best way to know if you’re at risk is to get measured at your doctor’s office. Research has found that women who have a waist circumference of more than 35 inches, even if they have a “normal” body mass index (BMI), have a greater risk of heart disease death than those with minimal stomach fat.

3. Metabolic Syndrome

If you were diagnosed with metabolic syndrome — that is, a combination of conditions including excess belly fat, high cholesterol, and elevated blood sugar — during menopause or even perimenopause (right when your periods stop), you might be at an increased risk for heart disease, diabetes, and stroke.

But research has found that postmenopausal hormone therapy was associated with a lower risk of metabolic syndrome in women who underwent natural (not medically induced) menopause.

4. Depression

Depression and menopause are closely linked. Research has found that perimenopausal women are at a significantly higher risk for depressive symptoms than premenopausal women.

 Plus, women who have had a bout of major depressive disorder (MDD) before menopause may be more susceptible to feelings of depression during menopause.

Depressive symptoms can take a toll on your heart. A low mood and fatigue may cause you to stop certain lifestyle habits, such as eating balanced meals, getting daily exercise, and taking prescribed medications, and it may lead you to drink more alcohol or smoke to cope with symptoms. All this combined can hurt your heart.

“It’s important to discuss depression at the time of perimenopause and menopause,” Shufelt says. Talk to your doctor if you’re feeling persistently sad, anxious, hopeless, irritable, or fatigued.

“Don’t ignore depression symptoms,” she cautions. “Many effective treatment options are available,” including medications and psychotherapy.

5. Disrupted Sleep

Restless sleep is often one of the first symptoms of menopause and perimenopause. But chronic disrupted sleep can be a risk factor for heart disease.

When you’re sleeping, your blood pressure naturally falls. If you don’t get enough sleep, your blood pressure can stay higher for a longer period.

 Over time, high blood pressure — above 130/80 millimeters of mercury (mmHg) — can increase your risk of heart disease and stroke.

Disrupted sleep may be from menopause itself or sleep apnea, the risk of which also rises during menopause and is associated with heart disease risk.

While hypertension doesn't necessarily mean you have sleep apnea, it could be worth screening for. Talk to your doctor about being evaluated for sleep apnea, especially if your blood pressure is elevated.

If you’re waking up often because of menopause symptoms like hot flashes, you should also talk to your doctor about hormone replacement therapy. “We don’t use estrogen replacement to prevent heart disease, but we do use it to manage bothersome symptoms,” Shufelt says.

“If you can’t sleep through the night because you’re having night sweats all night, that’s also a disruptive symptom.” Estrogen patches — a low dose of estrogen is applied through the skin — may help ease menopausal symptoms, including disrupted sleep.

How to Keep Your Heart Healthy During Menopause

You could spend roughly 30 years of your life — or more — living with menopause. That’s why it’s important to take hold of your heart health, says Shufelt. Here’s what you can do.

See your doctor regularly. “After 50, every woman should have an annual checkup,” Shufelt says. Yearly appointments can help you keep track of health markers like your cholesterol, weight, blood pressure, and blood sugar, and help keep those numbers within a healthy range to reduce your heart disease risk.

If you’re at high risk for heart disease because of high cholesterol or weight gain, or if heart disease runs in your family, your doctor may recommend more screening tests. “People with a family history of heart disease are at a higher than average risk of heart disease,” Shufelt says. “For those people, we might use tools to assess their risk, such as a coronary calcium scan.”

For women with a family history of heart disease, the coronary artery calcium (CAC) test offers a precise assessment to help guide treatment and medication options. The CAC test — an X-ray that takes images of your heart — can help detect and measure calcium-containing plaque in your arteries.

 “The scan is a good tool to virtually look at your heart,” Shufelt says.

Consider hormone replacement therapy. “We don’t use estrogen replacement to prevent heart disease, but we do use it in low doses for bothersome menopausal symptoms, such as having night sweats that prevent you from sleeping,” Shufelt says.

Previously, the Menopause Society recommended the lowest dose of supplemental hormones for the shortest time for menopause relief. “The guidelines now state ‘the appropriate amount of time,’” Shufelt (a coauthor on the new guidelines) says, which varies per person.

“There’s a certain percentage of women who will have troublesome menopausal symptoms for years — every woman is different,” Shufelt says.

If you enter menopause before age 45 (because of chemotherapy, hysterectomy, or premature ovarian insufficiency, a type of early menopause in younger women), hormone replacement therapy is also recommended.

Premature menopause (before age 40) or early menopause (before age 45) without hormone replacement therapy can accelerate your risk of heart disease, Shufelt says.

 “When you enter menopause at an earlier age, it’s important to get a dose of estrogen in an amount your body would otherwise naturally produce at this time,” Shufelt says. “These are women who should have estrogen naturally in their bodies.”

If you’re in premature or early menopause and you’re eligible, Shufelt recommends using a dose of estrogen and progesterone through the time of natural menopause, at age 52, to replace what your body would naturally produce.

Get daily physical activity. Exercise can lower your risk of heart disease as you age. One study that followed participants for more than 20 years found that women who regularly exercise had a 36 percent reduced risk of a fatal heart attack or stroke, and were 24 percent less likely to experience death from any cause compared with those who didn’t exercise.

In general, experts recommend 150 minutes of moderate exercise per week that includes a combination of strength and cardiovascular training.

Additionally, lifestyle habits like not smoking, eating a balanced diet, losing weight if recommended by your doctor, and managing your blood pressure, cholesterol, and blood sugar can help maintain health during menopause.

“Menopause is an opportunity to know your numbers and look at your lifestyle because exercise and diet are the backbone and the cornerstone of cardiovascular disease prevention,” Shufelt says.

The Takeaway

  • Menopause, the hormonal transition that occurs once periods stop, can increase the risk of heart disease because of a drop in estrogen and an increase in follicle-stimulating hormone (FSH).
  • Changes like high cholesterol, weight gain, depression, and disrupted sleep can raise your chance of heart issues during and after menopause.
  • Assessing your family history of heart disease can determine your course of treatment and prevention.
  • Regular doctor visits, hormone replacement therapy, and physical activity can all reduce your risk of heart disease during and after menopause.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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Parveen Garg, MD MPH

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Sandra Gordon

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Sandra Gordon is a health and medical writer with decades of experience writing for consumers and physicians online and in print. She has written for Prevention, Parents, Self, Energy Times, WebMD, the Cleveland Clinic, NYU Langone Health, Your Teen, Spirit of Women, Arthritis Today, dLife, HealthProview, and Medical Economics, among others. She's also the author of 11 books including the upcoming Gifted: My Journey of Surviving a Double Liver Transplant. Gordon is ghostwriting the autobiography.

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