It's Heart Health Month. Did you know that heart disease is the number 1 cause of death in women in Canada?
In most cases, this is a preventable disease. Understanding your risk, early, is essential for reducing your future risk of heart attack or stroke. The menopause transition is a unique period where this risk is amplified. Let's dive in.
Cardiovascular risk rises during the menopausal transition
During perimenopause (typically ages 40–55), cardiovascular risk increases significantly — even if you feel completely fine.
Research shows:
- Carotid intima-media thickness (an early marker of atherosclerosis) increases steeply during this time.
- Arterial stiffness rises independent of age.
- Cholesterol and blood pressure can shift quickly — even in women who previously had “normal” numbers.
- These changes often happen silently.
No symptoms.
No warning signs.
Just a gradual vascular change beneath the surface.
Which is why this window matters so much.
Perimenopause (or earlier!) is the ideal time for cardiovascular screening
This is the moment to be proactive — not reactive. Even if your labs have always looked great, this is the time to:
- Run regular blood work
- Monitor blood pressure
- Assess lipid markers
- Review metabolic health
- Recalculate cardiovascular risk
Prevention is significantly easier than trying to reverse established cardiovascular disease later.
We need to move beyond one-size-fits-all care
Menopause is not just a hormonal shift — it’s a cardiometabolic turning point.
A comprehensive approach must consider:
- Age-related vascular changes
- Sex-specific cardiovascular risk (i.e. time of first period, pregnancy complications, reproductive history - yes, these all can impact your cardio risk profile!)
- Hormonal transitions
- Individual metabolic health
Many women are unaware that cardiovascular disease risk accelerates during menopause.
Education is power. Screening is prevention.
A note on Hormone Therapy (HT)
Hormone therapy is nuanced — timing matters.
For women:
- Under 60
- Within 10 years of menopause onset
- Without pre-existing cardiovascular disease
HT may actually reduce cardiovascular disease risk and all-cause mortality.
However:
For women over 60 or more than 10 years past menopause, initiating HT may increase the risk of:
- Cardiovascular disease
- Venous thromboembolism*
- Stroke
*The form of hormone used may mitigate this and should be discussed with your HCP
This is why hormone therapy is not recommended solely for primary prevention of coronary heart disease beyond that window. It's nuanced, and everyone's risk profile is unique. We need to map out the best course of action for YOU.
There are very effective strategies for the prevention and treatment of cardiovascular disease - this is a preventable condition if we can catch things early. Know your risk.
If you want to learn more, schedule a free 15-minute discovery call.
In Health,
Dr. Ashley Damm, BSc. ND, MSCP
Naturopathic Doctor - Vancouver, BC
Women's Health & Fertility
References:
- Agarwala, A., Michos, E. D., Samad, Z., Ballantyne, C. M. & Virani, S. S. The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk. Circulation 141, 592–599 (2020).
- Ambikairajah, A., Walsh, E. & Cherbuin, N. Lipid profile differences during menopause: a review with meta-analysis. Menopause 26, 1327–1333 (2019).
- Ferry, A. V. et al. Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex-Specific Criteria. J Am Hear Assoc Cardiovasc Cerebrovasc Dis 8, e012307 (2019).
- Ivey, S. L. et al. Early identification and treatment of women’s cardiovascular risk factors prevents cardiovascular disease, saves lives, and protects future generations: Policy recommendations and take action plan utilizing policy levers. Clin Cardiol (2022) doi:10.1002/clc.23921.