How to take care of your heart during menopause

Menopause is a natural life stage that typically occurs around age 51, although it can happen earlier, before age 45 or even 40, in cases of premature ovarian insufficiency.

“During this time there is a marked increase in cardiovascular risk. Before menopause, women benefit from a degree of protection compared to men of the same age. After menopause, however, this risk rises sharply, increasing the likelihood of events such as stroke or coronary artery disease. The earlier menopause begins, the greater the risk of early adverse cardiovascular events.” explains Dr. Castelvecchio.

The cause of menopause is the cessation of ovarian hormone production, specifically estrogen and progesterone, two hormones that play a key protective role in women’s health.

Hormones, especially estrogens and progesterone, are crucial in protecting women’s cardiovascular health during their reproductive years. Their decline during menopause exposes women to increased cardiac risk.

Endogenous estrogens have powerful protective effects on the cardiovascular system. They:

• Promote nitric oxide–mediated vasodilation
• Inhibit coronary vasospasm
• Exhibit antioxidant and anti-inflammatory properties
• Improve lipid profiles
• Increase insulin sensitivity
• Reduce abdominal fat

With menopause, the sharp decline in estrogen levels leads to:

• Increased vascular stiffness (sometimes with calcifications)
• Higher blood pressure
• Visceral fat accumulation
• Insulin resistance
• Elevated levels of “bad” LDL cholesterol and triglycerides, with a reduction in “good” HDL cholesterol

Some of these effects are direct, while others may be indirect, such as blood pressure rising due to both hormonal changes and natural aging processes.

Progesterone also plays an important role. It is key in the menstrual cycle and pregnancy but also has beneficial effects on the nervous system, reduces blood pressure and heart rate, improves blood flow, and has a diuretic effect. Its deficiency contributes to bloating and water retention.

The most frequent cardiovascular symptoms during menopause include:

• Tachycardia: resting heart rate above 100 bpm, often with palpitations, including at night
• Extrasystoles: irregular heart rhythms
• High blood pressure
• High cholesterol (detectable through routine bloodwork)
• Shortness of breath and fatigue
• Hot flashes and night sweats, which are vasomotor symptoms and may also indicate increased cardiovascular risk

The increased cardiovascular risk that comes with menopause and beyond should encourage healthcare providers to assess both cardiovascular and metabolic profiles, and to initiate preventive strategies to reduce long-term consequences.

Such a pathway should include:

• Monitoring weight, height, and ideally waist circumference, along with BMI calculation, and tracking any changes over time
• Assessing cardiovascular risk factors such as obesity, smoking, dyslipidemia, hypertension, insulin resistance, impaired glucose tolerance, and physical inactivity, using validated risk calculators (e.g., SCORE2, SCORE2-Diabetes)
• Regular blood pressure checks
• Carotid artery Doppler ultrasound: evaluates carotid intima-media thickness (CIMT), a marker useful for assessing cardiovascular risk
• Echocardiogram with Doppler imaging: assesses heart chambers and epicardial adipose tissue (EAT), whose accumulation is a known risk factor for atherosclerosis, coronary artery disease, heart failure, and atrial fibrillation

Diet and Lifestyle

Nutrition education and healthy lifestyle habits are fundamental to cardiovascular health. It’s important to follow the “Life’s Essential 8”, eight key rules for heart-healthy living:

1. Quit smoking
2. Engage in regular, sustained physical activity
3. Maintain a healthy weight
4. Ensure quality sleep (7–9 hours per night)
5. Keep blood pressure within the normal range (ideal is 120/80 mmHg; systolic 121–139 mmHg and diastolic 81–89 mmHg are considered elevated)
6. Maintain normal blood glucose levels
7. Keep LDL cholesterol low
8. Eat a balanced diet (rich in fruits, vegetables, whole grains, lean protein, and nuts; limited in sugar, saturated fats, and salt)

Cardiovascular health education is also vital to raise awareness among women about the cardiovascular and metabolic risks associated with menopause. In practice, the ideal diet should be cardioprotective, meaning it includes:

• Seasonal fruits and vegetables
• Whole grains
• Lean proteins (e.g., oily fish, legumes)
• Healthy fats (e.g., olive oil, nuts)
• Minimal salt
• No refined sugars
• Low intake of saturated fats

Physical Activity

Regular physical activity is essential to keeping the heart healthy. The general recommendation is:

• At least 150 minutes per week of moderate activity (e.g., brisk walking), or
• 75 minutes per week of vigorous activity (e.g., running, swimming, cycling)

Brisk walking is one of the best options, simple, accessible, and highly beneficial when done consistently. Exercise helps:

• Maintain healthy blood pressure
• Control body weight
• Lower LDL cholesterol
• Improve insulin sensitivity
• Enhance overall well-being, including psychological health

You don’t need extreme workouts, consistency is what truly matters.

Regular Check-ups

During menopause, regular cardiovascular monitoring is essential to prevent or detect heart conditions early. This applies both to women without prior heart issues and to those with known risk factors such as hypertension, high cholesterol, or family history of heart disease.

Routine check-ups help track how the body is responding to hormonal changes and allow for personalized interventions.

A full evaluation should include:

• Blood pressure
• Lipid profile (total cholesterol, HDL, LDL, triglycerides)
• Blood glucose
• Thyroid function
• Instrumental diagnostics (e.g., echocardiography, carotid Doppler)

Echocardiography can assess heart structure and detect epicardial fat, while carotid Doppler ultrasound evaluates artery condition and helps predict future cardiovascular risk. Check-up frequency depends on individual history, but an annual cardiovascular exam is generally recommended. It’s also important to seek care at gender-sensitive medical centers, where assessments are tailored to the specific needs of the female heart.

Ideally, women should consult a cardiologist before menopause begins, to be prepared for this physiological transition and to implement preventive strategies in advance. Early action can help shed excess weight and improve metabolic profiles, making the transition smoother and healthier.

In any case, never ignore potential warning signs, even if vague, such as shortness of breath, easy fatigue, palpitations, or irregular heartbeat, these may be early indicators of cardiovascular involvement and should be evaluated with targeted tests.

Menopause is inevitable, but it doesn’t have to mean sacrificing heart health. On the contrary, it’s a unique opportunity to tune into your body, adopt healthy habits, and manage risk factors proactively.

What matters is not to overlook the signals your body sends, like tachycardia, arrhythmias, or high blood pressure, and to stay on top of your health with regular check-ups.