Hormones And Heart Disease: Why You Should Care

Despite being the number one killer of humans, heart disease isn’t sexy. Most people tune out when it comes up—and I get it. But because it is the number one killer, I do need you to pay attention, at least sometimes. Your heart health directly impacts your health span. Plus heart health is a category you don’t usually feel until it’s too late, unlike hot flashes. 💗

What Is Heart Disease?

“Heart disease” refers to a group of conditions that affect the heart and blood vessels, including:

• Coronary artery disease

• Arrhythmias (heart rhythm disorders)

• Heart valve disease

• Congenital heart disease

• Heart failure

• Vascular disease

Certain factors increase your risk of developing one or more of these conditions:

High blood pressure, high cholesterol, high glucose, obesity, sleep apnea, sleeping less than six hours per night, chronic stress, smoking and vaping… and yes, aging. 👀

But where does the perimenopausal journey fit into this picture?

Hormones and Your Heart: What’s the Connection?

Many women hit menopause and suddenly see their cardiovascular markers (like cholesterol) take a turn for the worse.

Over the years, I’ve had countless friends and patients who always had normal—or even low—cholesterol suddenly hit 50 and boom: high cholesterol. They swear nothing changed with their diet, lifestyle, or exercise habits. And I believe them.

What did change?

Their hormones. 😫

This is a clear indication that hormonal shifts play a significant role in cardiovascular health.

What About Surgical Menopause?

We also know that women who go through surgical menopause—meaning both ovaries removed—but do not go on estrogen therapy, face a much higher risk of developing heart disease.

And we know that metabolic syndrome increases around menopause—separate from the natural effects of aging.

What the Research Says

👉 This study in Circulation by the American Heart Association explained:

“The evidence supports cardiovascular benefit for MHT initiated early among women with premature or surgical menopause and within 10 years of menopause in women with natural menopause. The benefits of MHT (ie, including lower rates of diabetes, reduced insulin resistance, and protection from bone loss) appear to outweigh risks for the majority of early menopausal women. Perimenopausal women should be provided individualized guidance on MHT and options for treatment, particularly when vasomotor symptoms are present.”

Translation?

Hormone therapy—when started within 10 years of natural menopause, or quickly after surgical or early menopause—has cardiovascular benefits.

👉 The Menopause Society’s 2022 Position Statement also states:

“For healthy symptomatic women aged younger than 60 years or within 10 years of menopause onset, the favorable effects of hormone therapy on CHD and all-cause mortality should be considered against potential rare increases in risks of breast cancer, VTE, and stroke. (Level I).”

The consensus is clear: Hormones have the most cardiovascular benefit when started within 10 years of your last period—or right away if your period stopped before age 45 or you had your ovaries removed.

It’s Not One-Size-Fits-All

The type, route, and dose of hormones all matter—and so does your current health status. If you already have heart disease or strong risk factors, proper evaluation is critical before starting anything.

And to be clear—hormone therapy is not a first-line treatment for heart disease. But it can be an important piece of your overall prevention and health optimization strategy.

You STILL have to address things like diet, exercise, stress, inflammation, habits, etc. that can worsen your risks.

Labs to Consider

If you haven’t checked your cardiovascular markers in a while, ask your practitioner to order a fasting panel that includes:

• Standard Lipids + Triglycerides

• Optional: Advanced lipids with particle size/count

• Apolipoprotein B

• Glucose

• Insulin

• HbA1c

• hsCRP (inflammatory marker)

• Lipoprotein(a) (a genetic marker—usually tested once)

• Homocysteine

Most doctors stick to a basic cholesterol panel and glucose/HbA1c. But if you have a strong personal or family history—or symptoms that raise concern—don’t be afraid to ask for deeper testing.

The Bottom Line

Menopause and perimenopause are major hormonal shifts—and they don’t just affect your mood, periods, or sleep. They directly impact your heart even if you don’t feel it.

Knowing what to look for, what questions to ask, and how to advocate for yourself can make a massive difference in your long-term health span. ❤️