Happy Healthy Hearts at Midlife

As women age, our bodies change in many ways; some of these changes are quite noticeable,  like disrupted sleep or muscle and joint aches, while others are more ‘silent’ or ‘invisible’ in nature, like cardiac symptoms. For example, many women may not be aware of common changes that occur in the cardiovascular system with age, which may influence day-to-day energy levels and even increase the risk for heart disease and stroke. 

Heart disease and stroke cause 1 in 3 deaths among women each year—more than all cancers combined (1). Read on to learn more and hear what I recommend to my patients in perimenopause and menopause to support their heart health.  

What is Cardiovascular disease?

While you may have heard of cardiovascular disease, many of us are unaware of the role that menopause symptoms play when it comes to our heart and vascular health as we age. The heart is a muscle that beats at regular intervals every minute of every day, pumping oxygenated blood and nutrients to every cell in our body. 

The heart is connected to blood vessels, also known as the vascular system, that bring blood both to and from the heart. Healthy blood vessels are like flexible pipes that work best without any obstruction, allowing blood to flow freely. As we age, it’s common for changes in blood vessels to occur. 

For example, blood vessels can accumulate plaque, a waxy substance made up of cholesterol, fats, blood cells, and other debris (2). This atherosclerotic plaque may narrow the channel where blood flows and may also cause some hardening of the vessels.  

Menopause and Heart Health

A woman’s risk for heart disease and stroke increases at and around menopause. As women transition into midlife and experience menopause, estrogen decline may contribute to stiffness of arterial walls (1). This means that blood vessels are less elastic and flexible. Hardening or stiffening of arteries, whether related to plaque or associated with estrogen decline, reduces blood flow and may increase the risk of high blood pressure, stroke, heart disease, and arrhythmias in menopausal women.

Prior to midlife, estrogen is considered cardioprotective. Research has shown that women who have surgical menopause prior to age 50 and experience an abrupt decline in their estrogen levels have an increased risk of cardiovascular disease (3).

Additionally, hormonal shifts, weight gain, and sleep disruptions at menopause contribute to a higher risk of cardiovascular disease (2). I have heard from many women at midlife describe the sudden appearance of belly fat and find it much harder to stay at a healthy weight. 

There are real changes in our metabolism with menopause causing this change, increasing the risk of diabetes and elevated cholesterol levels (4). In addition, if sleep is disrupted, our appetites increase, which can lead to even more weight gain and increases in blood pressure (2). It’s no wonder hormonal changes and palpitations can go hand in hand.

Managing Menopausal Symptoms and Staying on top of your Heart Health

While menopause may increase heart disease risk, there are a number of proactive steps women can take to support their heart health. No matter where you are right now, small changes and alterations in lifestyle can keep your heart pumping happily for decades so that you can do the things you enjoy. Let’s discuss some of the recommendations I tell my patients to stay on top of their heart health in and after menopause.

Heart Health During Menopause

First, it’s important to establish your baseline: start by checking your blood pressure and schedule your annual exam (5). 

Diet Changes for Heart Health

Next, work to incorporate vegetables and plant-based proteins and fats into your diet (5,6). Think chickpeas, edamame, and pumpkin seeds for added protein without saturated fats. It’s recommended to incorporate at least 3 servings of vegetables, 2 servings of fruit, beans, and whole grains each day. 

However, sometimes that’s just not feasible or practical, so many people look to supplements to fill in the gaps in their diets (7). Aim to avoid highly processed foods. Reach for baby carrots and cherry tomatoes over chips. And don’t forget to drink plenty of water throughout the day, which can curb appetite (8).

Exercise for Heart Health

When it comes to exercise, start slowly and work to increase the time you spend moving (5,6). Whether it’s walking, cycling, swimming or dancing, it doesn’t matter, what does matter is consistency and finding something you enjoy and will do regularly. Weight training, yoga or resistance training will help preserve muscle mass, which also tends to decline at midlife.

Lifestyle Changes for Heart Palpitations

Many of my patients who only smoke when they’re out with friends socially don’t consider themselves smokers, and yet, even occasional smoking is harmful to our blood vessels. Stopping smoking is one of the most cardioprotective things you can do right now (5).

Medications for Palpitations and Heart Health

Though few of us want to hear that we have high blood pressure, high cholesterol, or heart palpitations during menopause and would benefit from medication, the fact is these can improve our heart health and may prevent worsening cardiovascular disease (5).
 
If you have questions or concerns about prescribed medications, it’s always best to speak with your healthcare professional. 

Stress Management Techniques

Stress management techniques (9) play a crucial role in maintaining heart health during menopause. Menopausal women experiencing hormonal fluctuations and associated symptoms, such as heart palpitations and increased stress levels, can benefit greatly from incorporating stress management strategies into their daily routine. 

Techniques like mindfulness meditation, deep breathing exercises, yoga, and progressive muscle relaxation can help reduce stress, manage blood pressure, and maintain overall cardiovascular function. (10) By prioritizing stress management techniques and adopting a holistic approach to well-being, menopausal women can effectively manage their stress levels and promote a healthy heart throughout this life transition.

Understanding the risk factors associated with cardiovascular disease can empower women of all ages and life stages to take steps to improve their heart health, whether it’s with diet, exercise or lifestyle changes; these changes can help midlife women live longer healthier lives.

Resources

1. Go Red for Women. (n.d.). Learn about heart disease in women. https://www.goredforwomen.org/en/about-heart-disease-in-women 
2. Menopause Society. (n.d.). Keeping your heart healthy at menopause. The North American Menopause Society, NAMS. https://www.menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/keeping-your-heart-healthy-at-menopause 
3. Pandey, A., Abbas, Sz., Sangawan, V., & Das, A. (2018). Assessment of cardiovascular risk in natural and surgical menopause. Indian Journal of Endocrinology and Metabolism, 22(2), 223. https://doi.org/10.4103/ijem.ijem_620_17 
4. Marsh, M. L., Oliveira, M. N., & Vieira-Potter, V. J. (2023). Adipocyte metabolism and health after the menopause: The role of exercise. Nutrients, 15(2), 444. https://doi.org/10.3390/nu15020444 
5. Mayo Foundation for Medical Education and Research. (2022, January 20). How heart disease is different for women. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167 
6. American Heart Association. (2023, November 2). Menopause and heart health – 4 tips for a healthy heart while your body is changing. https://newsroom.heart.org/news/menopause-and-heart-health-4-tips-for-a-healthy-heart-while-your-body-is-changing 
7. Devarshi, P. P., Legette, L. L., Grant, R. W., & Mitmesser, S. H. (2021). Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age. The American Journal of Clinical Nutrition, 113(4), 1042–1052. https://doi.org/10.1093/ajcn/nqaa392 
8. Vij, V. A., & Joshi, A. (2014). Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants. Journal of Natural Science, Biology and Medicine, 5(2), 340. https://doi.org/10.4103/0976-9668.136180
9. Kaiser Permanente. (2023, September 12). Stress and menopause: How to cope. My Doctor Online. Retrieved March 26, 2025, from https://mydoctor.kaiserpermanente.org/mas/news/stress-and-menopause-how-to-cope-2241585[1](https://mydoctor.kaiserpermanente.org/mas/news/stress-and-menopause-how-to-cope-2241585)
10. American Heart Association. (2022, November 6). Mindfulness shows promise as an effective intervention to lower blood pressure. American Heart Association Newsroom. Retrieved March 26, 2025, from https://newsroom.heart.org/news/mindfulness-shows-promise-as-an-effective-intervention-to-lower-blood-pressure[1](https://newsroom.heart.org/news/mindfulness-shows-promise-as-an-effective-intervention-to-lower-blood-pressure)

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