As millions of women across the globe approach menopause, a critical health warning is sounding loud and clear: midlife is a turning point for heart health. A recent study published in the journal Menopause reveals that only 1 in 5 menopausal women have ideal heart health scores, signaling a major wake-up call for women aged 45 to 55.
By 2025, over 1 billion women worldwide will be in menopause. The hormonal changes associated with this life phase have long been linked to increased risks of health problems such as osteoporosis, obesity, depression, urinary incontinence, and sleep disorders. Now, heart disease is under the spotlight — and new research is identifying four key habits that could help change the game.
The Life’s Essential 8 (LE8) Framework
The study is part of the long-running Study of Women’s Health Across the Nation (SWAN) and is based on data from 3,000 women who were around age 46 at the start. Researchers assessed their heart health using the American Heart Association’s Life’s Essential 8 (LE8) — a holistic framework designed to measure cardiovascular wellness.
The eight LE8 components are:
- Physical activity
- Cholesterol levels
- Healthy diet
- Sleep quality
- Blood pressure
- Blood sugar levels
- Healthy weight
- Tobacco use
While all eight are important, the study’s senior author, Dr. Samar R. El Khoudary, emphasized four critical factors as most predictive of future heart health:
- Blood sugar control
- Blood pressure management
- Sleep quality
- Tobacco use
These four components, the study concludes, are the biggest drivers of heart disease risk during and after the menopause transition.
Why Menopause Affects the Heart
According to Dr. Nissi Suppogu, Medical Director of the Women’s Heart Center at MemorialCare Heart & Vascular Institute, menopause is more than just the end of menstruation — it marks a significant drop in estrogen, a hormone that plays a protective role in cardiovascular health.
“Lower estrogen levels around menopause play an important role in cardiovascular health outcomes,” Dr. Suppogu explained. “Having established this connection, it is imperative to understand when and how we can alter the trajectory for better outcomes.”
Menopause impacts the body in complex ways:
- Estrogen loss can lead to increased cholesterol.
- Metabolism slows, often resulting in weight gain.
- Blood pressure may rise due to vascular stiffness.
- Sleep disruptions, mood changes, and fatigue can reduce physical activity.
In short, menopause is a perfect storm of changes that may put the heart at greater risk.
Four Habits That Matter Most
- Manage Blood Sugar
Insulin sensitivity declines during menopause, increasing the risk of type 2 diabetes — a major risk factor for heart disease. Monitoring and managing blood glucose through diet, exercise, and medical guidance is essential. - Control Blood Pressure
With age and hormonal shifts, hypertension becomes more common. Unchecked high blood pressure damages arteries and increases the risk of heart attacks and strokes. Regular monitoring and treatment are crucial. - Prioritize Quality Sleep
Hot flashes, night sweats, anxiety, and mood swings can disrupt sleep. Yet poor sleep has been directly linked to higher blood pressure, weight gain, and metabolic issues. Interventions like cognitive behavioral therapy for insomnia (CBT-I) and lifestyle changes can improve rest. - Quit Smoking
Tobacco use is one of the most significant modifiable risk factors for heart disease. Even occasional smoking drastically elevates cardiovascular risks. Support programs, nicotine replacement therapy, and behavioral coaching are all effective tools to help women quit.
A Low Number of Women Are Meeting Heart Health Targets
Dr. El Khoudary and her team found that despite the known benefits of the LE8 components, only 20% of menopausal women in their study achieved optimal heart health scores.
“There’s very low prevalence of optimal LE8 scores,” she said. “Unfortunately, many people still need to do more, including women who are in this vulnerable stage. That’s easier said than done!”
She emphasized the dual challenge of lack of awareness and barriers to change, particularly for women in midlife who may be juggling work, caregiving, and health concerns simultaneously.
Experts Call for Awareness and Action
Dr. Cheng-Han Chen, medical director at MemorialCare Saddleback Medical Center, stressed the broader relevance of this research:
“This study reinforces the importance of risk factor management in preventing cardiovascular disease — not just in perimenopausal women, but across all demographics,” he stated.
Both Dr. Chen and Dr. Suppogu advocate for:
- Public health campaigns to raise awareness
- Targeted clinical interventions for midlife women
- Expanded research into specific solutions, like sleep-focused treatments
Looking Ahead: What Women Can Do Today
While the findings may feel overwhelming, they also offer a clear call to action.
Women can begin making impactful changes now by:
- Scheduling regular health screenings for blood pressure and glucose
- Quitting tobacco and avoiding secondhand smoke
- Prioritizing seven to nine hours of quality sleep each night
- Staying active with at least 150 minutes of moderate exercise per week
- Consulting a healthcare provider about nutrition and hormonal support
Final Thoughts
The menopause transition may be inevitable, but its health consequences don’t have to be. By understanding and acting on the four most influential habits — managing sugar, pressure, sleep, and tobacco use — women can empower themselves to protect their hearts for years to come.
Let menopause be a new chapter of strength, not a turning point for decline.
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