Why Perimenopause Could Be One of the Most Important Times to Protect Your Heart

Menopause Research: Large cross-sectional population study suggests perimenopause may be a critical window for protecting cardiovascular health. 

For many years, heart disease was mostly associated with older men. Nowadays, we know that cardiovascular disease is also the leading cause of death in women, and the years surrounding menopause appear to be an important time for understanding future heart health.

As hormone levels begin to change during perimenopause, many women notice familiar symptoms like hot flashes, sleep disturbances, weight changes or brain fog. However, inside the body, less obvious changes are happening, including changes in cholesterol, blood sugar, blood pressure, and metabolism.

This growing understanding has led researchers to ask an important question: could the menopause transition itself represent a critical opportunity to identify women who may benefit from earlier cardiovascular screening and prevention?

What the Researchers Examined

In a large cross-sectional population study spanning 13 years, researchers analyzed data from 9,248 women across the United States to investigate how cardiovascular health differed across the menopause transition. The study used data from the National Health and Nutrition Examination Survey (NHANES), one of the largest ongoing health surveys in the United States.

The women were grouped as premenopausal, perimenopausal and postmenopausal, enabling comparisons of cardiovascular health across different stages of the menopause transition.

Rather than focusing on a single risk factor, the researchers assessed overall cardiovascular health using the American Heart Association’s Life’s Essential 8 framework.

This evidence-based scoring system evaluates eight key measures of heart and metabolic health: diet, physical activity, sleep, nicotine exposure, body mass index (BMI), blood pressure, blood cholesterol, and blood sugar.

The researchers then compared both the overall cardiovascular health scores and each of the eight individual components across the three groups to identify whether heart health changed during the menopause transition.

What They Discovered

First, the researchers looked at the raw differences between the three groups. They observed a clear pattern: The average cardiovascular health scores were highest in premenopausal women, lower in perimenopausal women, and lowest in postmenopausal women.

Because age itself has a strong influence on cardiovascular health, they then adjusted the results for age. After the adjustment, the picture changed, and one finding stood out: Perimenopausal women had 92% higher odds of having a poor overall Life’s Essential 8 score than premenopausal women.

They also had 76% higher odds of a poor cholesterol score and 83% higher odds of a poor blood sugar score. Once age was taken into account, the researchers no longer found a significant difference in overall cardiovascular health between postmenopausal and premenopausal women.

📚 Research Note 1: Why don’t researchers compare women in “menopause”?

A quick note on the terminology: although we commonly talk about perimenopause, menopause and postmenopause, menopause itself marks a specific point in time—confirmed after 12 consecutive months without a menstrual period. For research comparisons, women are therefore usually classified as premenopausal, perimenopausal or postmenopausal.

📚 Research Note 2: What does “higher odds” mean?

Studies often report odds rather than risk because of the statistical methods they use. While the two are related, they are not the same thing. In simple terms, higher odds mean the outcome was more common in one group than another, but they do not tell us the absolute likelihood that it will happen.

Why It Matters

Heart disease is the leading cause of death in women, yet many people still associate cardiovascular disease with older age or men. This study adds to growing evidence that the years surrounding menopause may be an important opportunity to pay closer attention to heart health.

The findings suggest that differences in cardiovascular health are already apparent during perimenopause, highlighting this stage as an important opportunity for prevention.

This does not mean that menopause causes heart disease, but it does highlight the importance of recognizing and managing risk factors like high cholesterol, elevated blood sugar, high blood pressure, and reduced physical activity as early as possible.

For some women living with obesity or type 2 diabetes, managing these metabolic risk factors may also include prescription GLP-1 medications alongside healthy lifestyle changes.

For women and healthcare professionals, perimenopause may represent a valuable window for conversations about cardiovascular health. Routine health checks, healthy lifestyle habits and early management of risk factors could help reduce the likelihood of future heart disease.

Study Limitations

Like all research, this study has some limitations. Because it was a cross-sectional study, it compared different groups of women at a single point in time rather than following the same women through the menopause transition. 

This means it can identify associations between menopausal stage and cardiovascular health, but it cannot prove that menopause itself caused the differences.

The researchers also relied on existing survey data, so other factors that were not measured or could not be fully accounted for may have influenced the results. In addition, the findings are based on women living in the United States and may not apply equally to all populations.

Even so, the study’s large, nationally representative sample and use of the American Heart Association’s Life’s Essential 8 framework make it an important contribution to our understanding of cardiovascular health during the menopause transition.

Lillepin Takeaway

This study suggests that perimenopause may be an important time to pay closer attention to your heart health. While it cannot prove that menopause itself causes cardiovascular changes, it highlights that differences in cardiovascular health are already apparent during the menopause transition.

The findings reinforce the value of regular health checks, including monitoring cholesterol, blood pressure and blood sugar, alongside healthy lifestyle habits that support long-term cardiovascular health.

Rather than waiting until after menopause, this research suggests that perimenopause may offer an important opportunity to identify potential risk factors early and take steps to protect heart health for the future.