If you hit menopause before age 40, doctors say you’ve gone through premature menopause — an event that can lead to a range of serious health repercussions that go beyond the loss of fertility.
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Now, a new study suggests that women who go through premature menopause may have a 40 percent higher lifetime risk of developing coronary heart disease.
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Doctors have known for some time that premature menopause and early menopause (occurring before age 45) can increase the risk of heart disease. But most studies have focused on short-term and mid-term risk, says lead study author Priya Freaney, MD, director of the Women’s Heart Care Program at Northwestern University in Chicago.
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“We wanted to understand what this means over the course of a woman’s entire life,” she says. “By looking at lifetime risk, we hoped to better capture the long-term impact of premature menopause on heart health and help inform prevention earlier in life.”
Premature Menopause Raises Lifetime Heart Disease Risk
The new study, published in JAMA Cardiology, followed about 10,000 women for roughly 15 years on average. About one-third were Black, the rest were white, and the average participants were 61 and 60 years old, respectively. None of the women had heart disease when they entered the study.
Black women reported premature natural menopause more often (15.5 percent of participants) compared with white women (4.8 percent). Among the premature menopause group, Black women were more likely to have a history of diabetes, while white women were more likely to be current smokers.
About 1,000 women total went on to develop heart disease over the course of the study. Data analysis revealed that premature menopause was tied to a roughly 40 percent higher lifetime risk of coronary heart disease, regardless of race, compared with women who didn’t enter menopause prematurely.
The study “helps put the magnitude of the risk into a clearer context for both clinicians and patients,” Dr. Freaney says. “Importantly, we also looked at this question in a diverse and inclusive sample of women, which allowed us to better understand how these patterns may differ across populations.”
The findings also reinforce that “menopause timing isn’t just a reproductive issue; it’s also a heart health issue,” she says.
What Makes Menopause Happen Early?
In the United States, women typically enter menopause between ages 45 and 55. Doctors define menopause as the day when 12 months have passed since a woman’s last period. Estimates suggest about 5 percent of women go through early menopause, and 1 to 3 percent go through premature menopause.
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Scientists don’t know why some women experience menopause early or prematurely, says Heather Hirsch, MD, an internal medicine physician, founder of the telemedicine platform The Collaborative, and author of The Perimenopause Survival Guide. Dr. Hirsch wasn’t involved with the new study.
Risk factors for early or premature menopause include genetics, smoking, autoimmune diseases, and poor metabolic health, she says.
“Unfortunately, we don’t yet have a reliable way to predict who will experience premature menopause — which is why simply asking women about the age of menopause is such an important part of medical care,” Hirsch says.
How Might Premature Menopause Raise Heart Disease Risk?
The study wasn’t designed to “pinpoint the biological mechanisms behind the link, so more research is needed to understand exactly why this relationship exists,” Freaney says.
The connection between heart disease and premature menopause could be related to “a mix of social, environmental, and health factors,” she says. Chronic stress, differences in access to care, and higher rates of certain health conditions all influence menopause timing.
It may also be tied to the early loss of estrogen, says Stephanie Faubion, MD, director of the Mayo Clinic’s Center for Women’s Health in Jacksonville, Florida.
Menopause is marked by a sharp decrease in the ovaries’ production of this hormone, which aside from its reproductive functions, also helps promote heart, brain, and bone health, especially in younger women, says Dr. Faubion, who is also the medical director of the Menopause Society and was not involved with the new research.
Estrogen also supports vascular health, keeping blood vessels and arteries flexible, Hirsch adds. Lower levels of the hormone can stiffen blood vessels and accelerate blockages.
Caring for Your Heart After Menopause
Hirsch suggests that women experiencing premature menopause talk to their doctors about hormone therapy, which has been shown to benefit heart health. Faubion says this treatment can also help manage symptoms like hot flashes, which can also decrease heart disease risk.
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Paying attention to mental well-being and stress is also crucial, Rasgon adds. “Women tend to overlook that because they have other goals in young adulthood of family building, family planning, and career achievements.”
Women of any age should embrace the American Heart Association’s diet and lifestyle recommendations to lower their risk of cardiovascular disease, says Natalie Rasgon, MD, PhD, a psychiatry professor at the Icahn School of Medicine at Mount Sinai in New York City, who has studied the effects of menopause. Dr. Rasgon was not involved with the new study.
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These recommendations include:
- Quitting smoking
- Exercising regularly
- Maintaining a healthy weight
- Eating a diet rich in fruits, vegetables, whole grains, and lean proteins
- Manage conditions like high blood pressure and diabetes
Freaney suggests focusing on strength training during this time to maintain muscle, which helps regulate metabolism and counter adverse cardiovascular changes.
Menopause — or even perimenopause, when periods begin to become irregular — is a good time to start more closely monitoring cardiometabolic markers, since blood pressure, cholesterol, and glucose levels shift at this stage, Freaney says.
“Menopause is not just about symptoms; it’s a key moment to reassess long-term health, especially heart health,” Hirsch says.
