Perimenopausal women are twice as likely to have low cardiovascular health scores compared to women with regular menstrual cycles, according to a new analysis published today in the Journal of the American Heart Association. The study, which analyzed data from the National Health and Nutrition Examination Survey (2007-2020), suggests that the transition into menopause may be a critical time for women to reassess their heart health and implement preventive measures.
Using the American Heart Association's Life's Essential 8 (LE8) metrics, researchers found that perimenopausal women had significantly lower scores, driven largely by higher cholesterol and blood sugar levels. The median LE8 score declined from 73.3 in premenopausal women to 69.1 in perimenopausal women, and further to 63.9 in postmenopausal women. After adjusting for age, perimenopausal women were 76% more likely to have a low cholesterol score and 83% more likely to have a low blood sugar score compared to premenopausal women.
“Mid-life women should think of the perimenopausal period as a ‘window of opportunity,’” said senior author Dr. Garima Arora, professor of medicine at the University of Alabama at Birmingham. “They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels.” The findings align with a 2020 scientific statement from the American Heart Association emphasizing that the menopause transition can increase cardiovascular disease risk.
Among the LE8 components, diet consistently received the lowest scores across all reproductive stages. The study also noted that sleep duration scores remained high despite perimenopausal women reporting difficulty sleeping, suggesting sleep quality may be more affected than duration. Fluctuating estrogen levels during perimenopause may contribute to declines in cardiovascular health by affecting cholesterol, insulin resistance, blood pressure, and weight management.
The analysis included 9,248 women aged 18-80, of whom 5,882 were premenopausal, 205 perimenopausal, and 3,161 postmenopausal. Participants were a broad cross-section of the U.S. population, including 65% non-Hispanic white, 11% non-Hispanic Black, 9% Mexican American, 7% other Hispanic, and 8% other races including Asian. Women who were pregnant, breastfeeding, or had a history of cardiovascular disease were excluded.
“Our analysis highlights that perimenopause is the critical time when the increase in cardiovascular risk seems magnified,” said lead author Dr. Amrita Nayak, research fellow at the University of Alabama at Birmingham. “When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
Dr. Stacey E. Rosen, volunteer president of the American Heart Association, noted the importance of recognizing female-specific risk factors. “This research highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan,” said Rosen, who was not involved in the study. “I encourage women to talk with their health care teams to learn about early detection and modification of traditional and ‘female-specific’ risk factors.”
The researchers emphasize that nutrition and lifestyle changes can be central to early intervention. “Focusing on heart-healthy habits early, especially getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt, can help improve cardiovascular health for perimenopausal women,” Arora said. The study's next steps include following women over several years to track hormone levels and heart health, which will help clarify the long-term impact of perimenopause and how lifestyle changes can reduce risk.
The findings underscore the need for clinicians to begin screening for high blood pressure, cholesterol, and Type 2 diabetes earlier in the perimenopausal transition. “We hope these findings encourage clinicians to begin screening earlier, leading to earlier diagnosis, prevention, and intervention at a critical time in women’s lives,” Arora added.
