Hot flashes, night sweats, or being drier-than-normal “down there” may not come as a surprise during menopause, but the transition can make itself known in your body in sneakier ways, too. Namely, by affecting your heart health.

One million hearts are affected by menopause each year. (Technically, it’s 1 million people, according to the National Institute on Aging, but you get what we’re saying.) You’re considered to have gone through menopause when you haven’t had a period for 12 months, and it’s a time that typically comes with intense hormonal changes.

Here’s what to know about the connection between menopause and heart health, and keep reading for expert-backed heart-healthy tips to keep your ticker stronger for longer.

Menopause and heart health

“We really do a disservice calling estrogen, progesterone, and testosterone ‘sex hormones’ because they truly affect the whole body,” says Heather Hirsch, MD, CEO and founder of the Health by Heather Hirsch MD Collaborative.

During perimenopause—the years leading up to menopause—estrogen and progesterone levels begin to fluctuate, says the NIA. Take estrogen, for instance: “Estrogen is anti-inflammatory, as well as a vasodilator,” Dr. Hirsch says. Meaning: Having estrogen on board helps keep blood vessels open to support easy blood flow. However, less estrogen in your body during menopause means you lose this protective benefit, and so you may be more at risk for developing plaque buildup in your arteries that can lead to a heart attack. This isn’t a little change, either: Heart disease is the leading killer of women in the U.S., responsible for 1 in 5 deaths in females, according to the Centers for Disease Control and Prevention (CDC).

What’s more, as estrogen goes on its downward slide, there’s also an increase in “bad” LDL cholesterol and triglycerides, as well as a decrease in “good” (and heart-protective) HDL cholesterol, adds cardiologist Karishma Patwa, MD, of Manhattan Cardiology in New York City. There’s also additional metabolic changes to contend with, such as gaining visceral (or belly) fat—which doubles or triples during this phase of life, per research—that can contribute to inflammation that also puts your heart at risk.

All of those reasons contribute to the 2020 consensus, published in the journal Circulation, from the American Heart Association, which named menopause an independent risk factor for heart disease.

“I don’t want people to never enjoy life. Sometimes it’s okay to have a glass of wine or a steak,” Heather Hirsch, MD, internist

How to care for your heart during menopause

It’s all pretty unsettling, we know. But you should also know this: There’s a lot you can do to combat this risk and keep your heart healthy during menopause. Here are six great places to start:

Get a heart checkup

What’s the status of your heart health? “When women enter menopause, they should be particularly diligent about checking their cardiovascular health,” says Dr. Patwa.

Along with menopause itself, additional risk factors—like higher blood pressure and cholesterol—put an additional strain on your heart. So here’s what to do: Get your blood pressure checked at an annual exam, and ask to get lab tests taken to examine your lipid levels. Dr. Patwa also recommends considering getting a coronary artery calcium score—this is a scan that detects calcium buildup in your arteries, and it’s an indication of how much your arteries are gummed up by plaque. This test can provide a preview of your risk for a heart attack or stroke in the future.

Share your *whole* health history with your doc

One of the unfortunate myths that exists in pregnancy is that common conditions, such as preeclampsia and gestational diabetes, “go away” once you deliver the baby. The truth is: “What happens in pregnancy doesn’t stay in pregnancy,” Dr. Hirsch says. (Preeclampsia is when you have abnormally high blood pressure levels, while gestational diabetes refers to having abnormally high blood sugar during pregnancy.) While your blood pressure or blood sugar may return to normal following delivery, your risk remains increased for high blood pressure or diabetes later in life. 

“Preeclampsia can have a deleterious impact on cardiovascular health,” adds Kecia Gaither, MD, MPH, who is double board-certified in OB/GYN and maternal fetal medicine. Indeed, having preeclampsia is associated with a three-fold higher risk of a stroke later in life, found a 2021 study in JAMA Network Open. Other research, published in 2022 in Diabetes Care, linked a history of gestational diabetes with a twofold higher risk of having a heart attack compared to those without the condition.

You can’t change your health history, obviously. But you can make sure both your primary care doctor and cardiologist are privy to this information, so they can help you make the best plan forward for protecting your heart.

Get serious about sleep

Peri- and postmenopausal women are more likely to say they struggle to snooze compared to those in premenopause, according to preliminary data from the American Heart Association Scientific Sessions in 2023. Unfortunately, that same study found that those who have poor sleep are also three times more likely to score poorly on a measurement of overall cardiovascular health, with lower scores specifically in diet and BMI parameters. (Meaning: Being short on sleep may be linked to how you eat and whether you carry excess weight.)

One of the problems is that menopause can disrupt sleep (such as if you wake up with soaked sheets from night sweats), so we acknowledge that simply getting more or better sleep can be a tall order. However, some of the go-to healthy sleep habits can help you log better zzzs, such as going to bed and waking up at the same time every day, getting exercise during the day, and adding in regular relaxation activities before bed to cue yourself up for sleep, per The North American Menopause Society.

And if you’ve tried all that and are still struggling, it might be worth it to work with a sleep specialist, who can help you get to the bottom of your sleep issues and find targeted strategies to help.

Talk to your doctor about HRT

Hormone replacement therapy (HRT) is not FDA-approved for the primary prevention of cardiovascular disease, says Dr. Hirsch. (It’s used to treat menopausal symptoms like hot flashes.) However, if it’s started at the right time—in someone who’s under age 60 and at or near menopause—HRT has been found to reduce death from heart disease and death from any cause, too, according to The Cancer Journal in 2022. That timing is critical, as this is when HRT protects blood vessels and reduces atherosclerosis (the buildup of plaque in arteries). Starting it too late can speed these things up and increase the risk to your heart, though.

The decision on when or if you should take HRT will depend on you as an individual, so have a chat with your doctor.

Lift weights

Both aerobic and resistance exercise are cornerstones of a well-rounded exercise routine. But we’ve long thought of aerobic—or cardio—exercise as movement that boosts heart health, while resistance exercise is good for your muscles and bones.

Well, newsflash: Resistance workouts (like lifting weights) actually make a difference for your heart health by helping to reduce total and LDL cholesterol and triglycerides, concluded a 2023 review and meta-analysis in the European Journal of Obstetrics & Gynecology and Reproductive Biology. Strength training also helps you build muscle and reduce excess body fat, which is linked to heart health issues.

Oh, and another perk to hitting the weights: It may also help decrease blood pressure, other research suggests.

Ditch a traditional Western diet

First, let’s be clear: You can still live a little during menopause. “I don’t want people to never enjoy life. Sometimes it’s okay to have a glass of wine or a steak,” says Dr. Hirsch.

However, there’s data to suggest that moving away from a Westernized diet—heavy on the red and processed meats, fried foods, and sugary drinks—will help keep your blood vessels clearer as you age, per The Journal of Nutrition in 2020.

While there are a variety of diets—such as Mediterranean or DASH—that are specifically associated with heart health, Dr. Hirsch says she doesn’t necessarily recommend one single diet. “Take an inventory of what works for you, using your own health data to guide you toward the best choice,” she says. A registered dietitian can help guide you, too—there are many who specialize in nutrition during menopause—so you don’t have to go it alone.

If you’re looking to adjust your diet to step away from processed meats, high fat foods, and sweetened drinks, one starting point is to keep a food journal for a week or two. From there, you can start making small adjustments and swaps. (Note: If you have a history of disordered eating, food journaling may not be the best approach for you. Instead, consider working with a registered dietitian who can help you shift your diet in a healthy way.)

—reviewed by Jennifer Logan, MD, MPH