Perimenopause doubles heart disease risk in women, study finds

A woman in her mid-forties notices her periods are becoming unpredictable. She has trouble sleeping. Her mood shifts without warning. She assumes these are just the inconveniences of getting older, something to endure quietly until menopause arrives. What she may not realize is that her heart is already under stress.

Researchers at American universities have documented something that cardiologists have long suspected but now have numbers to prove: the years leading up to menopause—a phase called perimenopause that can last anywhere from two to ten years—carry a measurable cardiovascular cost. The study, which tracked nearly 10,000 women and was published in the Journal of the American Heart Association, found that women in perimenopause have roughly twice the likelihood of scoring poorly on cardiovascular health metrics compared to women still menstruating regularly. The culprit is hormonal instability. As the ovaries gradually reduce their output of estrogen and progesterone, these hormones fluctuate wildly, and the body pays a price the calendar never warns you about.

To measure cardiovascular health, the researchers used a scoring system called Life's Essential 8, which evaluates eight factors on a scale of zero to 100: diet, physical activity, smoking status, sleep quality, blood pressure, cholesterol, body weight, and blood sugar. The numbers tell a stark story. Women who were still menstruating regularly averaged 73.3 points. Those in perimenopause dropped to 69.1. Women past menopause fell further to 63.9. But when researchers removed the effect of simple aging from the equation, the picture became more alarming. Perimenopausal women faced double the risk of poor cardiovascular scores compared to their premenopausal peers. They had a 76 percent higher likelihood of dangerous cholesterol levels and an 83 percent higher chance of elevated blood sugar. The hormonal swings of perimenopause alter how the body processes cholesterol, increase resistance to insulin, spike blood pressure, and make weight management harder—all of which strain the heart.

One finding surprised the research team: sleep scores remained relatively high across all groups, even though many perimenopausal women reported struggling to sleep. The distinction matters. The problem is not how many hours these women spend in bed, but how restful those hours actually are. Garima Arora, a professor of medicine at the University of Alabama at Birmingham and the study's lead author, framed the moment differently than most women experience it. "Perimenopausal women should view this transition as a window of opportunity," she said. The implication is clear: waiting until menopause officially arrives to check your blood pressure, cholesterol, and blood sugar is waiting too long.

Amrita Nayak, a co-author of the study, noted that perimenopause was the first stage to show a significant jump in cardiovascular risk. "This is when the risk really starts to amplify," she explained. The good news is that there is still time to act. Regular exercise and a heart-healthy diet—such as the DASH diet, which is low in sodium—can improve cardiovascular health before disease takes hold. Stacey Rosen, president of the American Heart Association, was direct: women can take proven steps to improve their cardiovascular health at any age. The recommendation is straightforward: talk to a doctor about the changes happening during perimenopause and menopause rather than waiting for symptoms to worsen.

The research team plans to follow these women for years to come, measuring hormone levels and heart health over time. The goal is early detection of conditions like high blood pressure, elevated cholesterol, and type 2 diabetes—catching them when intervention still matters. Mildren del Sueldo, an Argentine cardiologist and incoming president of the Argentine Federation of Cardiology, emphasized that perimenopause should not be understood merely as a gynecological event but as a critical window for cardiometabolic action. The menopausal transition typically compresses some of the most intense changes in weight, abdominal fat, cholesterol, blood sugar, blood pressure, and sleep into just 24 to 36 months. This concentration of risk is precisely why the moment demands attention. Del Sueldo outlined the practical path forward: monitor blood pressure, cholesterol, and blood sugar; improve diet; maintain adequate physical activity; and protect sleep quality—all before symptoms appear or disease takes root. The window is open. The question is whether women and their doctors will step through it.