Menopause and Heart Health: Risk, Prevention, and Hormone Therapy Facts

Author: Dr. Aaron R. Block, MD, MPH, CPH, DABFM, MSCP

Menopause doesn’t “cause” heart disease overnight—but the menopause transition is a real inflection point for cardiovascular risk. Hormonal changes, aging, sleep disruption, and shifting metabolism can nudge cholesterol, blood pressure, and abdominal fat in the wrong direction. The good news: this is also one of the best windows in life to take action and meaningfully lower your long-term risk.

EDUCATIONAL DISCLAIMER

This article is for education only and is not personal medical advice. If you have chest pain/pressure, shortness of breath, fainting, or sudden weakness/numbness, seek emergency care.

TABLE OF CONTENTS

1) Why menopause is a heart-health turning point

2) What tends to change during the menopause transition

3) Menopause symptoms: uncomfortable—and sometimes informative

4) The heart-health checklist for midlife

5) Medications and risk calculators: where they fit

6) Hormone therapy and the heart: the facts (including 2025 FDA labeling changes)

7) When to get urgent help

8) How The Cove supports prevention in real life

1) Why menopause is a heart-health turning point

Heart disease remains the leading cause of death for women in the U.S. The challenge is that cardiovascular risk often builds quietly for decades—then becomes more visible in midlife.

The menopause transition (perimenopause → menopause → postmenopause) is a period when several risk factors commonly drift upward at the same time. For many women, it’s the first time they’re told:

• “Your blood pressure is creeping up.”

• “Your LDL cholesterol is higher than it used to be.”

• “Your waistline changed even though you didn’t change much else.”

• “Your sleep is worse, and stress tolerance is different.”

Those changes may not be pleasant, but they are not inevitable— because these challenges are actionable. Explore how The Cove supports your actions in taking control of your health.

2) What tends to change during the menopause transition

Menopause is defined as 12 months and 1 day without a period (not due to another cause). The years leading up to it—perimenopause—are often where symptoms and metabolic shifts accelerate.

Common cardiovascular-related changes seen in midlife include:

Cholesterol and lipids:

LDL (“bad cholesterol”) often rises around the menopause transition. HDL (“good cholesterol”) patterns can change, and triglycerides may increase depending on genetics, weight changes, insulin resistance, and diet.

Blood pressure:

Blood pressure frequently rises with age, and midlife is a common time for hypertension to show up—especially when sleep, stress, and weight distribution shift.

Body composition (where weight sits):

Many women notice more abdominal/visceral fat (fat around organs) and less lean muscle mass. Visceral fat is metabolically active and can worsen inflammation and insulin resistance.

Blood sugar and insulin resistance:

Sleep disruption, stress, reduced muscle mass, and visceral fat can all contribute to higher fasting glucose and A1c over time.

Vascular health and inflammation:

Research suggests vascular function can change during the menopause transition, reinforcing why early prevention matters.

Key point: None of these changes automatically mean heart disease is coming. They mean it’s time to measure, interpret, and respond—early.

3) Menopause symptoms: uncomfortable—and sometimes informative

Hot flashes, night sweats, mood changes, and sleep disruption are not “just annoying.” Severe symptoms can meaningfully affect daily life—and they may also correlate with a less favorable cardiometabolic profile in some studies.

Important nuance:

• Correlation is not destiny.

• Symptoms are not a diagnosis.

• But symptoms are a reason to check the basics: blood pressure, lipids, glucose, sleep quality, and stress load. Schedule a consult.

4) The heart-health checklist for midlife (practical, not perfectionist)

If you do nothing else, do this: measure the key drivers regularly and build a plan you can sustain.

A simple framework comes from the American Heart Association’s “Life’s Essential 8”:

1) Nutrition: Favor a Mediterranean-style pattern (plants, fiber, olive oil, nuts, fish; fewer ultra-processed foods).

2) Physical activity: Aim for consistent movement + strength training. (Muscle matters in midlife.)

3) Nicotine: Don’t smoke/vape; avoid secondhand exposure.

4) Sleep: Treat sleep as medical—not optional. Screen for snoring/sleep apnea if relevant.

5) Weight/body composition: Focus on waistline + strength, not just the scale.

6) Blood pressure: Know your numbers and confirm with home readings if needed.

7) Lipids: Check cholesterol and interpret in context (family history, metabolic health, menopause timing).

8) Blood sugar: Track fasting glucose and A1c—especially with central weight gain or a history of gestational diabetes.

What we want for patients:

• Clarity over guessing

• Consistency over intensity

• Progress over perfection

5) Medications and risk calculators: where they fit

Lifestyle is foundational—but it’s not the only tool.

Risk calculators

Clinicians often estimate 10-year cardiovascular risk using validated tools (e.g., ASCVD estimators). These can help guide discussions about statins, blood pressure medication, and intensity of prevention.

Statins (cholesterol-lowering medication)

National recommendations support statins for primary prevention in certain adults ages 40–75 depending on risk factors and estimated 10-year risk. This is not “one-size-fits-all”—it’s a shared decision based on your numbers, your history, and your priorities. And while many people seem fearful about these medications, the data overwhelmingly shows these to be a low cost life enhancer for years to come.

Blood pressure medication

If blood pressure is consistently elevated, treating it is one of the most powerful ways to prevent stroke and heart attack—especially over years.

Bottom line:

Midlife is not too early for prevention meds when risk is meaningfully elevated—and it’s not too late to benefit.

6) Hormone therapy and the heart: the facts (including the 2025 FDA labeling change)

Hormone therapy (HT) is the most effective treatment for hot flashes/night sweats and is also used for genitourinary symptoms of menopause. But the heart-related messaging has been confusing for decades.

Here’s what’s evidence-based and widely endorsed:

What HT is NOT for

• HT should not be used solely to prevent heart disease.

When HT may be reasonable

For many healthy, symptomatic women who are younger than 60 or within ~10 years of menopause onset, the benefit–risk profile can be favorable—especially with individualized choice of formulation, dose, and route.

Route matters

Transdermal estrogen (patch/gel/spray) may have a lower risk of blood clots than oral estrogen in some contexts. Treatment decisions should always consider personal and family history.

Local (vaginal) estrogen is different

Low-dose vaginal estrogen for genitourinary symptoms has minimal systemic absorption and is generally considered a separate risk category from systemic HT.

What changed in late 2025 (FDA)

In November 2025, the FDA announced it would begin working with manufacturers to revise menopausal hormone therapy labeling—removing certain boxed-warning language that broadly referenced cardiovascular disease, breast cancer, and probable dementia risk, while retaining endometrial cancer boxed warnings for systemic estrogen-alone products in women with a uterus. This change aims to clarify benefit/risk considerations rather than imply the same risk for every product and every patient.

Translation:

• The conversation is becoming more precise.

• It still must be individualized.

• “No warning” does not mean “no risk.”

• The right question is: “What is the best option for me, given my symptoms, goals, and risk profile?”

7) When to get urgent help

Call emergency services right away for:

• Chest pain or pressure (or a heavy/squeezing sensation)

• Shortness of breath at rest or with minimal activity

• Fainting, sudden sweating with nausea, or new severe weakness

• Sudden one-sided numbness/weakness, facial droop, trouble speaking, or sudden severe headache

Women’s heart symptoms can be subtle. If something feels seriously wrong, trust that signal.

8) How The Cove supports prevention in real life

In a rushed healthcare system, prevention gets reduced to slogans. At The Cove Concierge Medicine, we approach menopause and heart health the way it should be done: with time, evidence, and follow-through. The decisions we make are made together

What that can look like:

• A full risk review (family history, pregnancy history, menopause timing, labs, BP trends)

• Symptom-centered menopause care (including non-hormonal and hormonal options when appropriate)

• A practical prevention plan you can actually live with

• Ongoing monitoring—not “see you in a year”

If you’re in perimenopause or post-menopause and want a clear, science-based plan for long-term heart health, we’d love to help.

Schedule an exploratory consult at www.thecovecm.com