Most women dread the “change of life” — but what if it could offer a chance to save yours?
A new study found that women are more than twice as likely to have a poor score on a key health metric as their reproductive years wind down.
But there’s a silver lining: Experts say the menopause transition offers a “window of opportunity” for women to act and reduce their risk of the nation’s leading cause of death.
The study focused specifically on women in perimenopause — the hormonal shift that comes before the final menstrual period and can stretch on for years.
It typically begins in a woman’s mid-40s, when levels of estrogen and progesterone start to fluctuate. As this happens, menstrual cycles may become irregular, and symptoms like mood swings, hot flashes and insomnia are common.
After 12 straight months without a period, a woman is officially considered postmenopausal, typically around age 52.
In the study, researchers analyzed health data from more than 9,200 women ages 18 to 80 who took part in the National Health and Nutrition Examination Survey between 2007 and 2020.
They then used the American Heart Association’s “Life’s Essential 8” (LE8) metric to gauge the participants’ cardiovascular health.
The score, based on a 100-point scale, factors in diet, physical activity, smoking, sleep, blood pressure, blood sugar, cholesterol and body weight.
A higher score reflects better heart health and is strongly linked to a lower risk of cardiovascular disease, stroke and all-cause mortality.
Using the LE8 results, the team divided the participants into three groups: premenopausal women (average age 34), perimenopausal women (average age 50.5), and postmenopausal women (average age 60).
The differences between them were stark.
Premenopausal women had an average score of 73.3. That dropped to 69.1 in the perimenopausal group, and fell further to 63.9 among postmenopausal women.
Using those results, the team divided participants into three groups: premenopausal women (average age 34), perimenopausal women (average age 50.5), and postmenopausal women (average age 60).
They were also 76% more likely to have poor cholesterol scores and 83% more likely to have low blood sugar scores — both tied to a higher risk of heart problems.
Across all groups, diet consistently scored the lowest and continued to decline over time.
“Our analysis highlights that perimenopause, women’s reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified,” lead author Dr. Amrita Nayak, a research fellow in the division of cardiovascular disease at the University of Alabama at Birmingham, said in a press release.
“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,” she added.
While heart disease can affect women at any age, the findings align with previous research showing that the risk rises after menopause.
The researchers said fluctuating estrogen levels during perimenopause may play a role, potentially affecting cholesterol, insulin resistance, blood pressure and weight control.
“Mid-life women should think of the perimenopausal period as a ‘window of opportunity,’” said senior author Dr. Garima Arora, a professor of medicine at the University of Alabama at Birmingham.
“They should be proactive and not wait until menopause to check their blood pressure, cholesterol and blood sugar,” she said.
“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.”
Looking ahead, the researchers are planning to follow a group of women over several years, tracking their hormone levels and heart health.
This, they said, will hopefully help clarify the long-term impact of perimenopause, as well as how lifestyle changes may help reduce cardiovascular risk.
“We hope these findings encourage clinicians to begin screening for high blood pressure, cholesterol and Type 2 diabetes earlier in the perimenopausal transition,” Arora said, “leading to earlier diagnosis, prevention and intervention at a critical time in women’s lives.”
While heart disease remains the leading cause of death in the US, it affects men and women differently.
For instance, men tend to experience heart attacks earlier in life, but women face a higher risk of dying afterward. Women are also more likely to be misdiagnosed, often because their symptoms are more subtle or less typical.
Overall, projections suggest nearly six in 10 American women will develop at least one form of cardiovascular disease by 2050. Today, about one in three women die from it — more than all forms of cancer combined.
