Heart health in midlife and beyond

Written by the Progyny Editorial Team. Reviewed by the Progyny Clinical Team — September 2026.

The hormone estrogen has many functions in your body. This includes a big one that not everyone knows about: estrogen helps keep your heart healthy.

Estrogen fluctuates during the perimenopause transition and drops after menopause. This raises our risk for cardiovascular disease (including heart attack and stroke) at midlife. Unfortunately, heart disease is the leading cause of death in the U.S.

Let's learn more about why peri/menopause (perimenopause and menopause) is a critical time for heart health. The earlier you can get started with prevention, the better. And it's never too late to take steps to protect yourself.

How does peri/menopause affect heart health?

Estrogen is protective against heart attacks and strokes. It helps:

• Increase HDL (good) cholesterol
• Decrease LDL (bad) cholesterol
• Prevent inflammation
• Improve blood flow by helping the blood vessels to widen

Estrogen does so much for our cardiovascular health. This helps explain why men typically develop heart disease earlier than women. (We'll use the terms men and women to describe sex at birth.)

However, our risk for heart disease and stroke goes up after menopause. The risk is even greater if you have premature menopause (before age 40) or early menopause (before age 45). Premature and early menopause may be caused by surgical removal of the ovaries or treatments such as chemotherapy. It may also happen naturally.

It's not just estrogen.

In addition to the effects of low estrogen, peri/menopause may cause symptoms that are associated with heart disease risk. For example:

• Hot flashes and night sweats are linked with high blood pressure. This doesn't mean it's a cause, but they often happen together.
• Lack of sleep is linked with high blood pressure, weight gain, and diabetes. It also saps the energy you need for a healthy lifestyle.
• Depression is linked with cardiovascular disease risk.

Peri/menopause also happens in midlife - a time when other heart disease risk factors may worsen, including:

• Weight gain: We tend to gain more in our belly as we age, and belly fat is worse for our heart health.
• Physical activity: It's common to have less time to exercise with all the pressure of midlife. But physical activity is highly protective for our heart and overall health.
• Higher blood pressure: This may damage artery walls and make it easier for cholesterol and plaque to build up (hardening of the arteries).
• Higher cholesterol: Cholesterol often rises during the year of the final menstrual period. Cholesterol and plaque in the arteries can slow or block blood flow to the heart (heart attack) or brain (stroke).
• Metabolic syndrome: Our heart risk goes up if we have metabolic syndrome (3 or more of the following):
  • High triglycerides (a type of fat in the blood)
  • Low HDL (good) cholesterol
  • High blood pressure
  • High blood sugar
  • Extra belly fat

Steps you can take, starting now

Early perimenopause - and any point in midlife - is the perfect time to check in with your healthcare provider about your heart health.

Your provider will help you manage any specific risk factors you may have. And going to checkups over time will help you catch any changes early.

Even though it might not be the most cutting-edge, a healthy lifestyle still offers the best protection for your heart. Aim to:

• Get plenty of physical activity
• Choose balanced and nutritious foods
• Manage stress and prioritize sleep
• Avoid risk factors like smoking and too much alcohol

We know this can be easier said than done, but you don't need to make changes alone. Your provider and Progyny Care Advocate can give you personalized support.

What about menopause hormone therapy?

Menopause hormone therapy (MHT) supplements estrogen and sometimes a progestogen during peri/menopause. It is one of the most effective treatments for bothersome symptoms and can be safely used by many women. But it is not prescribed to prevent heart disease for people who undergo menopause after age 45.

Some studies have shown MHT is linked with improved cholesterol. Experts aren't sure if the improvement is caused by MHT, though. Some research suggests the benefits may be greater for Black women, or if it's started within 10 years of menopause.

Long-term MHT use may also raise certain cardiovascular risks, such as triglycerides and risk of stroke. And it's not recommended if you've had a heart attack, stroke, or mini-stroke. Ask your provider to discuss the risks and benefits for your case. With personalized information, you can make your decision together.

Support as you protect your heart

There's no question: peri/menopause brings a lot of change. There are many years ahead, and protecting your heart health is a lifelong journey. Your healthcare team, family, and friends can help you along the way.

You can also reach out to your Progyny Care Advocate anytime for education, coaching, and support.

Explore related:

• What health screenings do I need in my 40s and beyond?

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.