A new study suggests perimenopause may become an important early warning period for hidden cardiovascular and metabolic risks in women.
- Perimenopausal women showed nearly double the odds of poor cardiovascular health
- Researchers found worsening cholesterol and blood sugar scores during menopause transition
- Experts say perimenopause may become an important window for earlier heart disease prevention
For many women, the years leading up to menopause are often associated with hot flashes, irregular periods, mood changes, sleep problems, and fatigue.
But researchers now say this transition period may also quietly become one of the most important warning windows for future heart disease.
A major new study published in the Journal of the American Heart Association found that women in perimenopause — the transitional stage before menopause — had nearly double the age-adjusted odds of poor cardiovascular health compared with premenopausal women (1✔ ✔Trusted Source
Cardiovascular Health Characterization Using Life’s Essential 8 Score in Perimenopausal Women: An Analysis of the National Health and Nutritional Examination Survey
Go to source).
The decline was driven mainly by worsening cholesterol and blood sugar health scores, suggesting that hormonal changes during this stage may significantly affect long-term heart and metabolic health.
Researchers say the findings are especially important because cardiovascular disease remains the leading cause of death among women worldwide, yet the menopause transition is still frequently overlooked in routine cardiovascular screening and prevention strategies.
Why Are Researchers Paying More Attention to Perimenopause?
Perimenopause is the natural transition period before menopause, when the ovaries gradually begin producing less estrogen.
During this stage, menstrual cycles become irregular and hormone levels fluctuate widely before eventually declining.
For years, many symptoms linked to perimenopause — including poor sleep, hot flashes, weight gain, fatigue, mood changes, and anxiety — were often viewed mainly as quality-of-life concerns. But researchers increasingly believe this transition may also trigger important metabolic and cardiovascular changes inside the body.
Scientists say estrogen plays a major role in regulating:
- Cholesterol metabolism
- Blood vessel function
- Blood pressure
- Blood sugar balance
- Body fat distribution
- Insulin sensitivity
As estrogen levels fluctuate and decline, many of these protective effects may weaken. Researchers believe this may partly explain why women’s cardiovascular risk rises sharply during midlife.
A review published in the journal Menopause explained that many cardiometabolic changes occurring during perimenopause are not simply caused by aging alone but are closely linked to ovarian aging and hormonal shifts (2✔ ✔Trusted Source
Cardiometabolic changes in the menopause transition
Go to source).
The review described the menopause transition as a “critical window” for identifying hidden cardiovascular risk early and introducing preventive strategies before more serious disease develops.
How Did Researchers Measure Heart Health During Menopause Transition?
To better understand how cardiovascular health changes during menopause transition, researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2007 and 2020.
The final study included 9,248 women between 18 and 80 years of age who:
- Were not pregnant or breastfeeding
- Had no prior cardiovascular disease
- Were classified as premenopausal, perimenopausal, or postmenopausal
Researchers evaluated cardiovascular health using the American Heart Association’s Life’s Essential 8 (LE8) score, a newer cardiovascular health assessment tool introduced in 2022.
The LE8 score combines eight major heart-health measures (3✔ ✔Trusted Source
Associations of life’s essential 8 and life’s crucial 9 scores with all-cause and cardiovascular mortality: A population-based cohort study of postmenopausal women
Go to source):
- Diet
- Physical activity
- Smoking
- Sleep
- Blood pressure
- Cholesterol levels
- Blood sugar levels
- Body mass index (BMI)
Each category receives a score, which, together, creates an overall cardiovascular health score categorized as poor, intermediate, or ideal.
Researchers found that overall cardiovascular health gradually worsened as women progressed from premenopause to postmenopause.
What Changed Most in Women’s Heart Health During Perimenopause?
The most striking finding was that perimenopausal women showed significantly worse cardiovascular health even after researchers adjusted for age.
Compared with premenopausal women:
- Perimenopausal women had nearly 2 times higher odds of poor overall cardiovascular health
- They had 76% higher odds of poor cholesterol scores
- They had 83% higher odds of poor blood sugar scores
Researchers also found that women in perimenopause were much less likely to maintain ideal cholesterol health compared with premenopausal women.
To understand why researchers consider this transition stage important, the table below summarizes the major cardiovascular and metabolic changes that appeared to worsen most noticeably during perimenopause.
Major Heart and Metabolic Changes Seen During Perimenopause
| Health Change Observed During Perimenopause | Why Researchers Believe It Matters |
|---|---|
| Cholesterol health worsened significantly | Higher cholesterol may increase future heart disease risk |
| Blood sugar control declined | Poor glucose regulation may raise diabetes and metabolic syndrome risk |
| Body fat increased while lean muscle declined | These changes may worsen insulin resistance and inflammation |
| Blood pressure risk gradually increased | Hypertension is a major cardiovascular disease risk factor |
| Sleep disturbances became more common | Poor sleep can worsen metabolic and heart health |
| Overall cardiovascular health scores declined | Suggests the menopause transition may accelerate hidden cardiometabolic risk |
Source: Journal of the American Heart Association study (1✔ ✔Trusted Source
Cardiovascular Health Characterization Using Life’s Essential 8 Score in Perimenopausal Women: An Analysis of the National Health and Nutritional Examination Survey
Go to source
)and Menopause review article (2✔ ✔Trusted Source
Cardiometabolic changes in the menopause transition
Go to source
).Interestingly, researchers found that diet scores remained poor across all menopausal stages, while sleep scores remained relatively high despite many women reporting sleep problems.
Scientists explained that the LE8 sleep score mainly measures sleep duration rather than sleep quality, meaning it may not fully capture menopause-related insomnia or disrupted sleep patterns.
Why Do Cholesterol, Blood Sugar, and Body Fat Change So Much During Perimenopause?
Researchers say several biological mechanisms may help explain these changes.
A review in Menopause reported that unfavorable cholesterol changes often accelerate in the years immediately before and after the final menstrual period.
Levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides often rise rapidly during this stage.
At the same time, many women experience:
- Increasing insulin resistance
- More visceral fat accumulation around organs
- Declining lean muscle mass
- Changes in blood vessel function
- Rising blood pressure
Researchers say these changes may collectively increase the risk of:
- Metabolic syndrome
- Type 2 diabetes
- Hypertension
- Cardiovascular disease
The study also noted that fat gain often begins approximately two years before the final menstrual period, while lean muscle mass gradually declines.
Importantly, these body composition changes may occur even when body weight itself does not change dramatically. Researchers say this means many women may appear “stable” in weight while still developing an increasing metabolic risk internally.
The Menopause review further highlighted that sleep disturbances become increasingly common during this transition and may further worsen inflammation, blood pressure, insulin resistance, and overall cardiovascular risk.
Why Could These Findings Matter Greatly for Indian Women?
Researchers say the findings may have important implications for countries like India, where cardiovascular disease already contributes heavily to female mortality.
An Indian study published in the Journal of Clinical and Scientific Research found that 30% of postmenopausal women in the study population showed high 10-year cardiovascular disease risk based on the Framingham Risk Score.
It is a medical tool doctors use to estimate a person’s risk of developing cardiovascular disease — such as heart attack or stroke — over the next 10 years (4✔ ✔Trusted Source
Prevalence and major contributing factors predicting the 10-year risk for cardiovascular disease in post-menopausal women based on the Framingham Risk Score
Go to source).
The study identified:
- Increasing age
- High blood pressure
as major contributors to future cardiovascular risk among postmenopausal women.
Researchers also noted that cardiovascular disease often develops earlier in Asian populations compared with many Western populations, making earlier prevention especially important.
Experts say many women entering perimenopause may not realize that symptoms such as fatigue, insomnia, hot flashes, emotional distress, or gradual body composition changes may also reflect deeper cardiometabolic shifts occurring during this transition.
The new findings suggest that perimenopause itself may become an important opportunity for earlier cardiovascular screening and prevention.
Researchers say doctors may need to pay closer attention to:
- Cholesterol levels
- Blood sugar control
- Blood pressure
- Sleep quality
- Waist circumference and body composition
during menopause transition rather than waiting until women become fully postmenopausal.
Scientists believe earlier identification of these risks could help reduce future cardiovascular disease burden and improve long-term health outcomes for women later in life.
Frequently Asked Questions
Q: What is perimenopause?
A: Perimenopause is the transition period before menopause when hormone levels fluctuate and menstrual cycles become irregular.
Q: Why does heart disease risk increase during perimenopause?
A: Researchers say hormonal changes during perimenopause may worsen cholesterol, blood sugar, blood pressure, and body fat distribution.
Q: What is the Life’s Essential 8 score?
A: Life’s Essential 8 is an American Heart Association tool that measures cardiovascular health using factors like diet, sleep, blood pressure, blood sugar, cholesterol, and physical activity.
Q: Can menopause affect cholesterol and blood sugar levels?
A: Yes. Researchers found that cholesterol and blood sugar health often worsen during the menopause transition.
Q: Why is perimenopause considered an important warning period?
A: Experts say the menopause transition may help identify hidden cardiovascular and metabolic risks before more serious disease develops.
References:
- Cardiovascular Health Characterization Using Life’s Essential 8 Score in Perimenopausal Women: An Analysis of the National Health and Nutritional Examination Survey – (https://www.ahajournals.org/doi/10.1161/JAHA.125.046898)
- Cardiometabolic changes in the menopause transition – (https://pmc.ncbi.nlm.nih.gov/articles/PMC13105580/)
- Associations of life’s essential 8 and life’s crucial 9 scores with all-cause and cardiovascular mortality: A population-based cohort study of postmenopausal women – (https://www.sciencedirect.com/science/article/pii/S0378512225005614)
- Prevalence and major contributing factors predicting the 10-year risk for cardiovascular disease in post-menopausal women based on the Framingham Risk Score – (https://journals.lww.com/jcsr/fulltext/2023/12040/prevalence_and_major_contributing_factors.8.aspx)
Source-Medindia