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Menopause and your heart

The lowdown on cardiovascular disease, palpitations and hormones

A healthy heart is crucial for your overall health.

But what impact can the perimenopause and menopause have on your cardiovascular health?

Here, we look at how to maintain a healthy heart during the perimenopause, menopause and beyond.

How can the menopause affect my heart?

Cardiovascular disease – a general term for conditions affecting the heart and blood vessels, such as coronary heart disease and stroke.

While cardiovascular disease is often thought to be more of a men’s health issue, it is actually the leading cause of death in post-menopausal women [1]. In addition, the risk of heart attack is five times higher post-menopause than before [2].  

RELATED: Heart disease, perimenopause and menopause factsheet

This is thought to be because estrogen has an important protective role for your heart.

When estrogen falls during the perimenopause and menopause, the cholesterol in your blood often rises, which can lead to fatty deposits building up inside the large blood vessels.

This narrowing of the arteries can increase the risk of heart attacks and strokes [3].

Estrogen also has an anti-inflammatory effect on the lining of the blood vessels and increases the levels of chemicals that protect your heart and the blood vessels [4].

As you get older, the blood vessels can become stiffer, caused by high blood pressure. This is a risk factor associated with heart attacks and stroke [5].

RELATED: High blood pressure factsheet  

What kind of heart-related symptoms could I experience during the perimenopause and menopause?

Many women report during the perimenopause and menopause that they become particularly aware of their heart beating, and that their heart rate can feel irregular or particularly fast.

This sensation of the heartbeat being more noticeable or beating irregularly or fast is called ‘palpitations’. 

This can be described as heart palpitations, which can last from a few seconds to a few minutes. They can coincide with a hot flush or a night sweat, a dizzy spell or happen on their own.

Palpitations can be due to changing or declining levels of estrogen, which can affect the pathways in your heart through which electrical impulses travel.

While they can feel alarming, in most cases they are usually harmless.

But you should see a healthcare professional if you are worried, or if your palpitations last for more than several minutes, are accompanied by shortness of breath or chest pain, or you notice they are becoming more severe and/or frequent, or if they haven’t resolved within three months of starting HRT.

RELATED: Podcast: Jill’s experience of heart attacks and hormones

What about the symptoms of coronary heart disease?

When the blood vessels to your heart start to become blocked, the most common symptoms are chest pain (angina) and breathlessness [6]. It can also cause pain in the jaw,neck or arm and feeling sick or faint. However, some people have no symptoms before they are diagnosed. Seek an urgent GP appointment if you have any chest pain that comes on with exercise/exerting yourself.

When an artery becomes completely blocked, it can cause a heart attack. If you think you are experiencing this, or you have any chest pain that doesn’t stop, you should dial 999 immediately.

What can help protect the health of my heart?

Following a healthy and active lifestyle can help protect your heart and reduce your risk of future health problems.

Eating a healthy, balanced diet, which is low in fat and high in fibre, with plenty of fruit and vegetables is recommended by the NHS [7].

Combining a healthy diet with regular exercise is the best way of maintaining a healthy weight. Having a healthy weight reduces your chances of developing high blood pressure.

Regular exercise will make your heart and blood circulatory system more efficient, lower your cholesterol level, and also keep your blood pressure at a healthy level.

RELATED: How much should I exercise during the perimenopause and menopause?

Any aerobic exercise, such as walking, swimming and dancing, makes your heart work harder and keeps it healthy. A strong heart can pump more blood around your body with less effort.

Don’t forget you can download the balance menopause support app to log food, drink and activity.

If you smoke, quitting is crucial, as smoking is a major risk factor in furring up and narrowing your arteries. In addition, try not to exceed recommended alcohol limits and reduce your drinking if it is above these.

RELATED: Healthy eating for the menopause factsheet

Can HRT help my heart?

Taking HRT can help protect the health of your heart, according to a growing body of research. Reviews of evidence have shown that the risk of dying from heart disease in women taking HRT is reduced by about 30% [8].

By replacing the missing estrogen, there is less furring and clogging of the lining of the arteries, which reduces the risk of heart disease. HRT can also lower blood pressure, reduce the risk of heart failure and reduce the numbers of people who experience an irregular heartbeat.

RELATED: My story: HRT and heart health

I have a history of heart problems. Is HRT suitable for me?

Many people who have a history of heart disease, such as a heart attack or blocked arteries, or have had a stroke, assume (or have been told) that they can’t take HRT but many of these women can safely take HRT.

It is important you receive personalised advice, so your cardiologist and a menopause specialist may need to work together to manage your cardiovascular and hormone health in tandem.


1. El Khoudary, S.R. et al. (2020), ‘Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association’, Circulation, 142 (25), e506-e532. doi:10.1161/CIR.0000000000000912

2. Boardman, H. et al. (2015), ‘Hormone therapy for preventing cardiovascular disease in post-menopausal women’, The Cochrane database of systematic reviews, doi:10.1002/14651858.CD002229.pub4

3. Lobo R.A. (1990), ‘Cardiovascular implications of estrogen replacement therapy’, Obstetrics and Gynecology, doi: 10.1016/0020-7292(90)90539-w

4. Xiang, D. et al., (2021), ‘Protective effects of estrogen on cardiovascular disease mediated by oxidative stress’, Oxidative Medicine and Cellular Longevity, doi:10.1155/2021/5523516

5. British Heart Foundation, ‘Menopause and Heart Disease’,

6. (2021), ‘Angina’,

7. (2020), ‘Coronary heart disease’,

8. Boardman, H. et al. (2015), ‘Hormone therapy for preventing cardiovascular disease in post-menopausal women’, The Cochrane database of systematic reviews, doi:10.1002/14651858.CD002229.pub4

Menopause and your heart

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