When women think about menopause, we tend to think about hot flashes, periods stopping and maybe some changes in weight.

Heart health usually isn't at the top of the list.

I think it should be part of the conversation.

Not because menopause suddenly causes heart disease, but because midlife is an important time to take stock of your cardiovascular risk and understand how your health is changing.

What happens to heart health after menopause?

Cardiovascular risk increases as we age in both women and men. But the menopause transition also brings changes that can influence that risk.

As estrogen levels change and eventually decline, we can see changes in:

  • Cholesterol and other blood lipids

  • Blood pressure

  • Insulin sensitivity

  • Body composition

  • Abdominal and visceral fat

For example, LDL cholesterol commonly increases across the menopause transition, and women tend to accumulate more fat around the abdomen and internal organs.

That doesn't mean estrogen loss is the only reason cardiovascular risk changes. Aging, genetics, smoking, physical activity, nutrition, sleep, blood pressure and metabolic health all matter.

This is exactly why I see menopause as an opportunity to look forward, not just manage symptoms.

Women's cardiovascular history starts long before menopause

One of the most interesting things about women's heart health is that some of our cardiovascular risk factors happen decades earlier.

Your reproductive history can give us clues about future cardiovascular risk.

A history of conditions such as:

  • Preeclampsia

  • Gestational hypertension

  • Gestational diabetes

  • Preterm delivery

  • Premature or early menopause

can be relevant when assessing cardiovascular health later in life.

I think this is incredibly important because many women don't realize that something that happened during a pregnancy 15 or 20 years ago may still be relevant to the conversation we're having about their health today.

What should we be checking?

Midlife is a great time to know your numbers.

That includes blood pressure, cholesterol and other appropriate lipid markers, blood glucose or A1C, and your broader metabolic health.

Family history matters too.

And rather than focusing only on body weight, I'm also interested in what's happening with muscle mass, physical activity, waist circumference and body composition.

These pieces tell us much more about long-term health than the scale alone.

What can you actually do about it?

Quite a lot.

This is where I want the conversation around menopause to feel empowering rather than frightening.

Regular physical activity matters, and resistance training becomes particularly important in midlife because we're thinking about muscle, bone and metabolic health at the same time.

Nutrition matters. Fibre matters. Protein matters. Not smoking matters.

Blood pressure matters.

Sleep matters.

Alcohol matters.

And knowing your cholesterol and glucose levels matters.

None of these things are particularly glamorous, but together they can have a significant impact on long-term health.

What about menopause hormone therapy and heart disease?

This is an area where the messaging has changed considerably over the years.

Menopause hormone therapy (MHT/HRT) should not be started solely for the purpose of preventing cardiovascular disease.

However, for many healthy women who are younger than 60 or within 10 years of menopause onset and are experiencing bothersome menopause symptoms, the overall benefit-risk profile of MHT can be favourable when there are no contraindications.

Timing, medical history, the type of hormone and how it is delivered all matter.

This is why I don't like blanket statements that hormones are either “good for your heart” or “bad for your heart.”

It's much more individualized than that.

Menopause is an opportunity to think about the next 30 years

This is one of the biggest shifts I would love to see in menopause care.

Yes, let's talk about hot flashes.

Let's treat the night sweats. Let's talk about sleep, mood, vaginal health and whether hormone therapy is appropriate.

But let's also zoom out.

What is your blood pressure?

What's happening with your cholesterol?

Are you maintaining muscle?

Are you strength training?

How are you sleeping?

What's your family and pregnancy history?

Because the goal of menopause care shouldn't simply be getting women through the transition.

I want women coming out the other side thinking about how they're going to protect their heart, brain, bones and muscle for the decades ahead.

That, to me, is the bigger conversation.

Looking for a more comprehensive approach to menopause?

I work with women throughout British Columbia to understand their symptoms, individual health risks and options during perimenopause and menopause — with a focus not only on feeling better now, but supporting long-term health.

Book a perimenopause or menopause consultation with Dr. Jenny Ma, ND, MSCP.

This article is for educational purposes and is not a substitute for individualized medical advice.