New research links perimenopause to early rise in heart disease risk factors

Heart health in women may begin declining years earlier than previously believed, with new research suggesting that the transition into perimenopause, not menopause itself, could mark a critical turning point for cardiovascular risk.

The findings, published in the American Heart Association journal Circulation, indicate that women in perimenopause were about twice as likely to have poorer cardiovascular health scores compared with premenopausal women.

Decline begins earlier than expected

The study analyzed data from roughly 9,000 women aged 18 to 80 from the U.S. National Health and Nutrition Examination Survey collected between 2007 and 2020.

Participants were grouped as premenopausal, perimenopausal, or postmenopausal based on self-reported menstrual history.

Researchers evaluated cardiovascular health using eight metrics recommended by the American Heart Association, including diet, physical activity, blood sugar, cholesterol, and body weight, producing an overall score on a 100-point scale.

While heart health declined gradually with age across all groups, the sharpest drop was seen during perimenopause.

After adjusting for age, perimenopausal women were twice as likely to score below 50 compared with premenopausal women. They were also significantly more likely to show poorer cholesterol and blood sugar levels.

Postmenopausal women, by contrast, did not show statistically significant differences in low cardiovascular health scores compared with premenopausal participants after adjustments.

Why the transition matters

Researchers say the findings point to perimenopause as a previously under-recognized “risk window” for cardiovascular changes.

Estrogen fluctuations during perimenopause are believed to play a key role. As levels decline, blood vessels may become less flexible, blood pressure can rise, and cholesterol and glucose regulation may worsen. These changes can quietly increase long-term risk for heart disease.

Experts involved in the research, including cardiologists at the Cardiovascular Medicine division of the University of Alabama at Birmingham, emphasized that these shifts often occur without obvious symptoms.

Silent changes, real risk

Doctors note that many women in perimenopause feel physically well, even as internal risk factors begin to shift.

Changes in sleep, energy levels, abdominal fat distribution, or subtle metabolic markers may be early signals, even if they are easy to dismiss as normal aging.

Clinicians not involved in the study, including specialists from Northwestern University, say the menopause transition should be treated as a broader cardiometabolic checkpoint not just a reproductive milestone.

They emphasize that routine monitoring of blood pressure, cholesterol, and blood sugar during midlife could help identify risk earlier and allow for preventive intervention.

A window for prevention

Researchers stress that the findings do not show causation, but they reinforce the importance of early awareness. Cardiovascular disease remains the leading cause of death among women globally, and risk develops gradually over decades.

The study authors suggest that perimenopause may be an opportunity to intervene earlier through lifestyle changes, medical monitoring, and risk management before long-term cardiovascular damage develops.