Women’s heart health
Women have historically been underrepresented in cardiovascular clinical trials, leading to a gap in understanding how heart disease uniquely affects them. This underrepresentation has contributed to underdiagnosis and less effective treatments for women. As a female cardiologist, Dr Wamil emphasises the importance of personalised care tailored to women's heart health needs. Her approach includes comprehensive evaluations and treatments that consider sex-specific risk factors, aiming to improve outcomes and provide the attentive care women deserve.
The Heart of the Transition: Why Perimenopause is Your Most Important "Health Reset"
By Dr Gosia Wamil
When we talk about perimenopause, the conversation usually revolves around hot flashes, night sweats, and the unpredictable rollercoaster of moods. But while these symptoms grab the headlines, a much quieter—and more significant—transformation is happening beneath the surface. For women in their 40s and early 50s, the transition to menopause isn't just a reproductive milestone; it is a critical "window of opportunity" for heart health.
According to the latest scientific statements from the American Heart Association (AHA) and recent studies published in The Lancet and Nature (2025), the years leading up to your final period are when cardiovascular risk accelerates the most. Here is why this "golden age" of prevention matters and how you can take charge of your heart’s future.
The Estrogen "Shield" and the Great Shift
For decades, estrogen has been the unsung hero of a woman’s cardiovascular system. It helps keep blood vessels flexible, manages "bad" cholesterol (LDL), and encourages "good" cholesterol (HDL). As you enter perimenopause, estrogen levels begin to fluctuate and eventually decline.
This isn't just a slow fade; it’s a biological shift that can trigger a "perfect storm" for your heart. Research shows that during this transition, women often experience:
•A Lipid Leap: LDL cholesterol levels can spike significantly, even if you haven’t changed your diet.
•The "Menopause Belly": Fat often shifts from the hips to the abdomen. This "visceral fat" is metabolically active and produces inflammatory markers that stress the heart.
•Arterial Stiffening: Without the protective effect of estrogen, blood vessels can become less elastic, leading to a steady rise in blood pressure.
Why "Later" is Too Late
The old medical wisdom was to wait until after menopause to start worrying about heart disease. We now know that’s a mistake. A 2025 consensus in the Journal of the American College of Cardiology (JACC) highlights that the most dramatic changes in a woman’s heart health profile happen during the transition, not after.
"Perimenopause is the golden age to prevent cardiovascular disease," notes recent medical literature. Think of it as a "stress test" for your future health. If you can stabilise your blood pressure and cholesterol now, you set a trajectory for a much healthier next 30 years.
The Perimenopause Screening Checklist: What to Ask Your Doctor
Most standard checkups focus on the basics, but during perimenopause, you need a more nuanced approach. When you sit down with your physician, ensure these four areas are on the table:
Screening Tool
Why It Matters Now
Advanced Lipid Profile
Don't just look at "Total Cholesterol." Ask for a breakdown of LDL and ApoB, which are better indicators of plaque buildup during hormonal shifts.
Ambulatory Blood Pressure
Blood pressure can "spike" during perimenopause. Monitoring it over 24 hours can catch "masked hypertension" that a single office visit might miss.
CAC (Calcium Score)
If your risk is borderline, a Coronary Artery Calcium (CAC) scan—a quick, non-invasive CT—can see if there is actual plaque in your arteries.
HbA1c & Fasting Insulin
Insulin resistance often creeps up during perimenopause, increasing the risk of Type 2 diabetes and heart stress.
Red Flags: The Atypical Heart
Heart disease in women doesn't always look like a "Hollywood heart attack" (crushing chest pain). In perimenopausal women, symptoms can be subtle and easily dismissed as "just stress" or "hormones."
Watch out for:
•Unusual fatigue that doesn't go away with rest.
•Shortness of breath during activities that used to be easy.
•Persistent indigestion or nausea.
•Heart palpitations or a "fluttering" feeling in the chest.
A New Era for Hormone Therapy
For years, many women feared Menopausal Hormone Therapy (MHT) because of old studies suggesting it might harm the heart. However, 2025 has brought a major shift in perspective. The FDA recently updated labels for several MHT products, removing some of the most alarming "boxed warnings" regarding heart disease for younger women starting therapy near the onset of menopause.
The current medical consensus is that for most healthy women under 60 or within 10 years of menopause onset, MHT can be a safe and effective way to manage symptoms and may even have a neutral or slightly positive effect on heart health when started early.
The Bottom Line
Your heart doesn't suddenly age the day you hit menopause; it transitions alongside you. By treating perimenopause as a proactive "Health Reset" rather than just a phase to endure, you can protect your most vital organ for the decades to come.
Don't wait for the "change" to happen to you—be the change for your heart.
This article is based on the 2020 AHA Scientific Statement on Menopause Transition and CVD Risk, and updated clinical findings from 2024-2025 medical literature.
