Leading up to and during menopause, women experience significant hormonal changes that can impact their cardiovascular health, including in unexpected ways. Hormones like estrogen are important for maintaining a healthy heart—but their decline during perimenopause and menopause can increase the risk of cardiovascular disease.
It's common for women to experience symptoms like heart palpitations and changes in blood pressure during perimenopause, while many also experience long-term heart health risks if they're not careful about eating well, exercising, and maintaining a healthy weight.
In this article, we'll explore the connection between hormones, heart health, and menopause and what you can do to support your cardiovascular system during this transition.
In this article
How Hormones Affect Your Heart
Cardiovascular disease in menopause and afterward is a very common health problem; in fact, more than 30% of deaths worldwide1 are caused by heart disease (85% of these deaths are due to heart attacks and strokes). Heart disease is the leading cause of death2 for both women and men, including for people of most racial and ethnic groups.
Studies3 show that cardiovascular diseases in women are commonly underdiagnosed, and often, women tend to have a lower perception of their risk.
Hormones play a central role in regulating cardiovascular function, with estrogen being particularly important for heart health. There's a connection between estrogen and cardiovascular disease risk4 because estrogen helps:
- Protect blood vessels by promoting flexibility and reducing stiffness, which supports healthy blood flow
- Regulate cholesterol levels by increasing “good” HDL cholesterol and reducing “bad” LDL cholesterol
- Reduce inflammation in blood vessels, lowering the risk of plaque buildup
- Dilate blood vessels through its effects on nitric oxide, helping to maintain normal blood pressure.
As women transition through perimenopause and menopause, estrogen levels drop, which disrupts these protective mechanisms. Other hormones, like progesterone and cortisol, also fluctuate and can further impact heart rate, blood pressure, and overall cardiovascular health.
Impact of Perimenopause and Menopause on Heart Health
A large-scale study called the Framingham Heart Study found a 2.6-fold higher incidence5 of cardiovascular events in postmenopausal women compared to premenopausal counterparts of the same age.
Why does menopause increase the risk of heart disease? As mentioned above, the decline in estrogen during perimenopause and menopause is one of the major causes of an increased risk of cardiovascular disease, as well as other menopausal symptoms.
Lower estrogen levels6 during perimenopause and menopause can cause:
- Blood vessels to become less flexible, leading to higher blood pressure.
- Cholesterol levels often change, with LDL (“bad”) cholesterol rising and HDL (“good”) cholesterol falling.
- Inflammation in the body to increase, raising the risk of plaque buildup and arterial damage.
- Body fat distribution to shifts, often leading to more visceral fat (fat around the organs, also called menopause belly fat), which is closely linked to heart disease.
Additionally, menopause is associated with a significant increase in blood pressure, body mass index (BMI), obesity, and body fat distribution, all of which can increase heart disease risk7.
Menopause Cardiac Symptoms:
During perimenopause and menopause, women can experience various heart-related symptoms, including:
- Heart palpitations or heart flutters: These feel like a racing, skipping, or irregular heartbeat.
- Hot flashes and night sweats: These vasomotor symptoms can affect blood flow and increase cardiovascular strain.
- Shortness of breath or fatigue: This can be due to changes in cardiovascular efficiency or hormone-driven shifts in energy.
- Chest discomfort or tightness: While sometimes related to anxiety or hormonal fluctuations, it’s important to rule out heart disease.
Heart Palpitations in Perimenopause
Can menopause cause heart flutters? Yes, heart palpitations or flutters are common during perimenopause, the transition time into menopause. These sensations may feel like your heart is racing, skipping a beat, or pounding harder than usual.
Studies suggest that up to 42% of women in perimenopause8 and 54% of postmenopausal women experience palpitations at some point, often triggered by fluctuating estrogen and progesterone levels. You may experience heart palpitation in menopause or in the years leading up to it.
Why does this happen, and how can hormones affect heart rate? Here are some of the reasons that women entering or in menopause can experience irregular heartbeats and palpitations:
- Estrogen’s impact on the autonomic nervous system: Estrogen influences how your body regulates heart rate and blood pressure. As levels drop, your nervous system may overreact, causing an irregular heartbeat.
- Increased sensitivity to stress hormones like cortisol and adrenaline: This can make your heart feel like it’s beating faster or harder than normal.
- Hot flashes and vasodilation: These can temporarily increase heart rate.
While palpitations during perimenopause are usually harmless, they can sometimes be a sign of an underlying issue. If they are accompanied by chest pain, dizziness, or fainting, seek medical attention right away to rule out any serious conditions.
Hormone Replacement Therapy (HRT) and Heart Disease
Hormone replacement therapy (HRT) can reduce certain menopause-related symptoms like hot flashes in many cases and may offer some cardiovascular benefits if it's started early in menopause.
Studies show that HRT for cardiovascular disease9 can offer benefits to some women like:
- Improved blood vessel flexibility
- Reduced risk of plaque buildup when initiated during the early menopausal transition
- Help regulating cholesterol levels and lowering LDL cholesterol
- Reduced visceral obesity
- Improved blood sugar control (glucose hemostasis)
While HRT is a good option for some women to help manage heart conditions, systemic HRT is not appropriate for everyone. Women with an active clot or a history of recent blood clots should avoid HRT, as estrogen can increase the risk of clotting. Additionally, HRT is typically not recommended for women with certain types of cancer or other contraindications.
If you’re considering HRT, consult your doctor to weigh the potential risks and benefits based on your medical history and specific needs. Keep in mind that HRT is typically recommended to be used for the shortest time conceivable and in the lowest possible dosages to help reduce side effects.
Science-Backed Ways to Support Heart Health During Menopause
In addition to HRT, there are several other evidence-based strategies to support your heart health during menopause:
- Exercise regularly: Engage in both aerobic (like walking, cycling, or swimming) and resistance training exercises to improve cardiovascular function and maintain healthy blood pressure.
- Manage stress: Practice mindfulness, yoga, or deep breathing to keep cortisol levels balanced, which helps to support overall hormonal and heart health.
- Adopt a heart-healthy diet: Follow the Mediterranean diet, which is rich in fruits, vegetables, whole grains, lean proteins, nuts, seeds, and healthy fats like olive oil and omega-3s.
Check out our full article here on the best healthy diet for heart health.
- Quit smoking and only drink alcohol moderately: Smoking damages blood vessels and significantly increases heart disease risk. Excess alcohol consumption (having more than one drink per day or binge drinking) increases inflammation, can lead to weight gain and high blood sugar, and increases heart disease risk.
- Maintain a healthy weight: Losing weight during menopause, particularly around the midsection, can improve heart health markers like blood pressure and cholesterol.
- Take omega-3 fatty acids: Omega-3s, found in fatty fish like salmon and in supplements, support cardiovascular health by:
- Reducing inflammation.
- Lowering triglycerides.
- Supporting normal heart rhythm.
Aim to consume two servings of fatty fish per week or consider an omega-3 supplement like Omega Plus.
Find out more about supplements to support heart health here or about the Best Menopausal Supplements According to a Hormone Expert.
When to See a Doctor
While many cardiovascular symptoms during menopause are normal, some require medical attention. You should see a doctor if you experience:
- Persistent chest pain or tightness
- Severe shortness of breath
- Dizziness or fainting
- Heart palpitations that are frequent or worsening
What Are Women’s Heart Attack Symptoms?
Unlike men, women often experience subtler heart attack symptoms10 like those described below:
| Women’s Heart Attack Symptoms | How It Feels |
| Chest discomfort | Pressure, squeezing, fullness, or pain (may feel mild or unusual) |
| Shortness of breath | Feeling winded, even without exertion |
| Fatigue | Extreme tiredness that doesn’t improve with rest |
| Pain in the back, neck, jaw, or stomach | Can feel like indigestion, muscle pain, or radiating discomfort |
| Nausea or vomiting | Often mistaken for food poisoning or a stomach bug |
| Dizziness or lightheadedness | Sudden feeling of being faint or unsteady |
If you notice any of these symptoms, call 911 immediately, as early intervention is the best way to save lives.
Final Thoughts
Perimenopause and menopause can lead to many changes in cardiovascular function due to how hormones affect the heart, blood vessels, body weight, nervous system, and more. Becoming aware of heart disease risk factors and symptoms is the first step in prevention. By adopting a heart-smart lifestyle that includes regular exercise, a healthy diet, stress management, and possibly HRT, you can reduce your risk of cardiovascular disease during this life stage.
If you’re experiencing persistent symptoms like heart palpitations or chest discomfort, consult your doctor to rule out serious conditions. And remember—your heart health is just as important as any other aspect of your well-being during menopause!
References
- https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) ↩︎
- https://www.cdc.gov/heart-disease/data-research/facts-stats/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10074318/ ↩︎
- https://www.heart.org/en/health-topics/house-calls/menopause-and-heart-health ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10672665/ ↩︎
- https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000912?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10074318/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9289918/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10074318/ ↩︎
- https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack ↩︎
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