A new analysis of nationwide U.S. data published today in the Journal of the American Heart Association suggests that perimenopause may be a critical time for women to reassess their heart health. The study, which analyzed data from 9,248 women aged 18 to 80 who participated in the National Health and Nutrition Examination Survey between 2007 and 2020, found that perimenopausal women were twice as likely to have a low cardiovascular health score compared to women still having regular menstrual cycles.
Using the American Heart Association’s Life’s Essential 8 health metrics, researchers assessed participants’ heart health based on diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight, and blood sugar. The median Life's Essential 8 scores declined with advancing reproductive stage, from 73.3 out of 100 in premenopausal women to 69.1 in perimenopausal women and 63.9 in postmenopausal women. After accounting for the effect of aging, perimenopausal women were twice as likely to have an overall low score and were 76% more likely to have a low cholesterol score and 83% more likely to have a low blood sugar score.
“Mid-life women should think of the perimenopausal period as a ‘window of opportunity.’ They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels,” said Garima Arora, M.D., senior author of the study and a professor of medicine at the University of Alabama at Birmingham. “Women should talk with their health care team about their reproductive status and any changes they are experiencing. It may be the perfect time to get a baseline for their heart health.”
Perimenopause, defined as the transitional period from reproductive to non-reproductive phases, is marked by hormonal and metabolic changes that can increase cardiovascular disease risk. A 2020 scientific statement from the American Heart Association emphasized that this transition is a critical time for early intervention. The researchers noted that fluctuations in estrogen levels during perimenopause may contribute to declines in cardiovascular health by negatively affecting cholesterol, insulin resistance, blood pressure, and weight management.
“Our analysis highlights that perimenopause, women’s reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified,” said Amrita Nayak, M.D., lead author and a research fellow at the University of Alabama at Birmingham. “When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
The study also found that diet consistently received the lowest scores among Life's Essential 8 components across all reproductive stages, and these scores continued to decline over time. “Nutrition can be a central factor for early and proactive intervention. Focusing on heart-healthy habits early, especially getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt can help improve cardiovascular health for perimenopausal women in the years to come,” added Dr. Arora.
Stacey E. Rosen, M.D., volunteer president of the American Heart Association, who was not involved in the study, commented: “This research highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan. Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times.”
The study's limitations include reliance on self-reported menstrual history and incomplete data on other risk factors such as ovary removal or hormone replacement therapy. However, the researchers plan to follow women over several years to track hormone levels and heart health, aiming to clarify the long-term impact of perimenopause and how lifestyle changes can reduce risk.
The findings underscore the importance of early screening and lifestyle interventions during perimenopause, a time when cardiovascular risk accelerates. As Dr. Arora noted, “We hope these findings encourage clinicians to begin screening for high blood pressure, cholesterol and Type 2 diabetes earlier in the perimenopausal transition, leading to earlier diagnosis, prevention and intervention at a critical time in women’s lives.”
