Keeping Your Heart Healthy During Perimenopause and Menopause

Keeping your heart and blood vessels healthy during perimenopause and menopause

The hormonal changes that happen around the time of menopause causes various shifts in our physiology that result in an increased risk of developing certain diseases in the future.

One such risk is cardiovascular disease and it is a serious risk, appearing consistently in the top three leading causes of death in women over the age of 35 years.

As with all future health risks however, there are ways to reduce your risk of developing heart disease. This booklet describes how to do this and summarises the potential benefits of HRT on your heart health.

What is cardiovascular disease?

This term refers to any disease of the heart and blood vessels and generally describes two main problems that occur. There can be narrowing of the blood vessels due to a build-up of fatty deposits or plaque (a condition known as atherosclerosis) or the blood vessels can become blocked, interrupting blood flow to the rest of the body.

If blood flow to the heart is blocked or reduced it can lead to chest pain (angina), heart attacks or heart failure. If blood flow to the brain is interrupted, it can cause a stroke or transient ischaemic attack (TIA or mini-stroke). There may be problems with the flow of blood to your legs and feet (peripheral arterial disease) which can cause pain with walking, weakness or ulcers for example, or the disease may affect the aorta – the largest blood vessel that carries blood from the heart to the rest of the body – and cause it to weaken and bulge outwards or in severe cases, it can lead to an aortic aneurysm.

Changes to your blood vessels and the way blood is pumped around your body are also associated with increased blood pressure, alterations in cholesterol levels, and difficulties in how your body breaks down glucose. Some of the secondary problems due to this happening are hypertension, type 2 diabetes and obesity.

Influence of estrogen on your heart

The hormone estrogen has several roles that contribute to the overall health of your heart and blood vessels. It allows your blood vessels to relax and widen so that blood can flow easily, which helps keep your blood pressure down.

Estrogen helps to reduce the levels of ‘bad’ cholesterol in your blood which can clog your arteries, it improves the process of regulating sugar (glucose) and insulin levels in your blood, and it helps to reduce inflammation in the lining of your blood vessels. All of these functions help keep the blood vessels healthy, clear and the blood flowing well, thereby lowering your risk of having a heart attack or stroke.

Estrogen also supports the conducting system that initiates and coordinates contraction of the heart muscle.

Heart symptoms relating to low estrogen

Because estrogen helps the heart to function and blood to flow well, when estrogen levels decline it can cause some heart related symptoms in some women.

These can be:

• an increased awareness and sensation of your heart beating, known as palpitations
• moments of a faster, racing heartbeat
• an irregular heartbeat or sensation of a missed beat

These symptoms can happen during times of anxiety or during a hot flush. Sensing a missed beat or a racing heartbeat can be worrying if you’ve never felt something like this before. If you have a history of heart problems, these symptoms may be even more concerning. Palpitations are of most concern when they are associated with chest pain, nausea, dizziness, feeling faint or breathlessness.

Some women understandably, see a healthcare professional for further investigation and reassurance when they first experience palpitations. The assessment will involve having an examination and often some blood tests to exclude a cause for the palpitations. Abnormalities of the thyroid gland or anaemia for example, can often provoke palpitations. An electrical recording of the heartbeat (an ECG) may be carried out to ensure that the electric circuits in the heart are working normally. In some cases, they may be referred to a cardiologist for further investigations but in most of these cases, the investigations do not show anything abnormal. The palpitations often resolve when estrogen is replaced by taking HRT.

Will HRT reduce my risk of developing heart disease?

If you start taking HRT during your perimenopause, below the age of 60 or within 10 years of your menopause, current evidence suggests you will have a lower risk of developing heart disease than if you didn’t take HRT.

If your menopause happened before the age of 40, you do have a significantly higher risk of cardiovascular disease so it’s really important to discuss hormone treatments with your healthcare professional and/or a menopause specialist.

The evidence is less clear about heart disease risk when HRT is started more than 10 years after menopause. Studies suggest it either has a neutral effect e.g. it doesn’t alter your level of risk either way, or it may be beneficial in bringing down your level of heart disease risk, especially if you take estrogen through the skin and micronised progesterone.

Can I take HRT if I already have a history of heart problems?

If you have had a heart attack, a stroke, blocked arteries or any cardiac condition, it doesn’t automatically mean that HRT is unsafe for you, in fact it may even bring some heart benefits.

Estrogen taken through the skin in a patch, gel or spray does not raise the risk of a blood clot or stroke. If you need to take a progestogen with the estrogen, micronised progesterone (Utrogestan) is the safest option for you as this does not raise your risk of blood clot either.

It is important to receive individualised advice from a menopause specialist and your cardiologist if you have concerns about your own personal level of risk when taking HRT. Your health professionals can work together to optimise your hormone and heart health in tandem.

Adopt a heart-healthy lifestyle

One thing the evidence is clear about is that certain lifestyle measures significantly reduce your risk of cardiovascular disease.

Take a look at the following list and the associated links to see where further improvements could still be made:

1. Stop smoking. This is hard to do unsupported so reach out for support.
2. Exercise more. Any movement is better than no movement. Take the stairs instead of the lift. Park further away from your destination and walk more. Start low, build slow and try to get outside.
3. Eat well. A Mediterranean diet is recommended as it is low in saturated fat. Eat “the alphabet and the rainbow”. Maintaining a healthy weight puts less strain on the heart.
4. Reduce your salt intake. A high salt intake can contribute to high blood pressure.
5. Reduce alcohol. Alcohol can raise blood pressure and have a negative impact on the muscle of the heart. Keep within government guidelines of less than 14 units of alcohol per week or less than 5 units per week if you have a history of breast cancer.
6. Sleep well. Sleep can be elusive at this phase of life. Sleep deprivation puts additional strain on the heart.
7. Check your pulse. A normal adult pulse should be between 60 and 100 beats per minute. In athletes and fit people, it can often be slower. If your pulse is fast and/or irregular, you should see your doctor. If your fast or irregular pulse is associated with chest pain, nausea, breathlessness or dizziness, you should seek urgent medical help.
8. Check your blood pressure. High blood pressure increases your risk of a heart attack, stroke and heart failure. Your local pharmacy can check your blood pressure, or you can purchase a monitor for use at home. Find out more about measuring your blood pressure at home.

Last updated: June 2026