Menopause and heart health: What women need to know

Most women are familiar with common menopause symptoms like hot flashes, sleep disruption, and brain fog. But one of the most important changes during the menopause transition is far less visible—a shift in cardiovascular risk. As estrogen levels decline, the protective effects hormones once provided for the heart begin to diminish.

“Menopause isn’t just about symptoms like hot flashes or mood changes,” says OBGYN Dr. Stephanie Da Silva Davis, a Menopause Society Certified Practitioner at Hoag. “Hormonal changes during this transition affect nearly every system in the body, including the cardiovascular system, which is why heart health becomes such an important part of the conversation.”

Before menopause, women generally have a lower risk of heart disease compared to men of the same age. However, that advantage begins to narrow as estrogen levels decline. Over time, this hormonal shift can contribute to changes in cholesterol levels, blood vessel function, and metabolism—all of which increase the risk of cardiovascular disease.

Dr. Davis recommends the following strategies to support heart health during the menopause transition:

Start Early. Hormonal changes associated with menopause often begin years before a woman’s final menstrual period. For women with a family history of heart disease or other risk factors, Dr. Davis encourages early conversations with their physician—and in some cases, a cardiologist—as early as their 30s or 40s.

“Menopause is a transition that unfolds over several years, not a single moment in time,” she explains. “That gives us an opportunity to identify risk factors early and help women build habits that protect their long-term health.”

Live Well. Lifestyle plays a powerful role in reducing cardiovascular risk during and after menopause.

“Regular physical activity and a balanced, nutrient-rich diet play a powerful role in supporting cardiovascular health,” Dr. Davis says. “These foundational habits improve circulation, support metabolic function, and help women feel stronger and more resilient through midlife.”

Get Your Rest. Sleep and stress are often overlooked but play a critical role in heart health.

“Hormonal fluctuations during menopause can disrupt sleep and increase stress levels, both of which are closely linked to cardiovascular health,” Dr. Davis notes. “Addressing these factors can support both physical and emotional well-being. If sleep becomes a challenge, it’s important to talk with your doctor.”

Discuss Your Options. For some women, hormone therapy may also be part of the conversation. While often used to manage symptoms such as hot flashes, its risks and benefits vary depending on age, timing and individual medical history.

“There is no one-size-fits-all approach to menopause care,” Dr. Davis says. “The goal is to look at the whole person—their symptoms, cardiovascular risk and long-term health—and develop a personalized plan that supports them through every stage of life.”

Learn more through the Hoag Menopause Program.