- Women who go through natural menopause before age 40 face a 40% higher lifetime risk of coronary heart disease.
- Black women are three times as likely to experience premature menopause as white women.
- Untreated menopause symptoms like night sweats and sleep disturbances can undermine the heart-healthy habits that lower cardiovascular risk.
- Experts say women should share their menopause history with their doctors and focus on blood pressure, cholesterol, strength training, and stress management to protect long-term heart health.
Women who go through natural menopause before age 40 face a 40% higher lifetime risk of coronary heart disease, according to a new study published March 18 in
Premature menopause occurs when the ovaries stop functioning and menstrual periods end before age 40.
Current evidence suggests roughly 3–4% of women may experience some form of menopause before 40, which is higher than the previous 1% estimate for overt premature menopause. Black women are three times as likely to experience premature menopause as white women.
Researchers at Northwestern University analyzed data from more than 10,000 postmenopausal women across six major U.S. population-based studies from 1964 to 2018.
They found the 40% higher lifetime risk of heart attack or fatal coronary heart disease held up regardless of race.
Lead study author Priya Freaney, MD, assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine, said the findings should be viewed as empowering, not alarming.
“We’re talking about an event that happens before the midpoint of someone’s life,” she told Healthline. “That should be viewed as an opportunity…the earlier we can implement prevention, the more impact we can have in the long term.”
Stephanie Faubion, MD, medical director of The Menopause Society, told Healthline that the connection between menopause and heart health stems from hormones. Faubion wasn’t involved in the study.
“The connection has to do with the early loss of estrogen, which helps promote heart, brain, and bone health, especially in these younger women,” Faubion said.
Freaney described a cascade of changes that occur as natural estrogen declines, regardless of age.
“Our muscle mass decreases, our visceral fat increases, fat moves to the belly, our arteries stiffen, our cholesterol goes up, our blood pressure goes up,” she said.
“All of these things taken together in a few years before and after menopause lead to an environment that is less healthy for the heart.”
Most cases of premature menopause have no clear explanation, though conditions like autoimmune diseases, infections, inflammatory conditions, and genetic mutations can trigger it.
The study found that Black women experience premature menopause at more than three times the rate of white women — 15.5% compared with 4.8%.
While the 40% increase in heart disease risk applied regardless of race, the sheer frequency of premature menopause among Black women means the condition carries a far greater population-level impact.
Black women with premature menopause lived an average of 18.2 years free of heart disease after age 55, compared to 19.1 years for Black women who reached menopause at a typical age.
The study’s authors pointed to “weathering” — the theory that chronic racial stress accelerates biological aging — as one possible driver of the higher rates.
Rachel M. Bond, MD, co-chair of the Women and Children Committee at the Association of Black Cardiologists (ABC), said she takes that connection seriously in her practice. Bond wasn’t involved in the study.
“Chronic stress is not ‘just emotional’ — it can affect blood pressure, sleep, inflammation, eating patterns, physical activity, and how consistently someone can care for themselves,” Bond told Healthline.
Bond said she works to get a holistic picture of her patients’ lives, asking about caregiving responsibilities, financial strain, and what she described as “the pressure to keep pushing through.” She treats stress as a real cardiovascular risk factor.
She said weathering is one reason “we treat stress as a real cardiovascular issue.”
Perimenopause, the years before menopause, and postmenopause represent what the study’s authors call a unique “window of opportunity” to measure, monitor, and modify cardiovascular risk.
It’s the period when risk factors like blood pressure, cholesterol, and blood sugar often start to shift, and catching those changes early can make the biggest difference.
“I do not look at that finding and think, ‘It’s only one year.’ I look at it and think, ‘That is our opportunity to intervene sooner,’” Bond said.
She said she takes action the moment she learns a patient is experiencing premature menopause — checking blood pressure, cholesterol, blood sugar, weight, sleep, and smoking status; reviewing pregnancy and family history; talking through exercise and nutrition; and deciding whether to get more aggressive about risk-factor treatment.
A 2022 editorial commenting on a related study by Finnish researchers suggests that the menopausal transition may be an underappreciated opportunity to slow cardiovascular aging overall.
Seizing that window also means treating menopause symptoms. Faubion pointed out that untreated symptoms can undermine the very habits that protect the heart.
“If women are not sleeping because they are having night sweats or mood issues or menopause-related sleep disturbances, this makes it more difficult to do the things that we all know help with heart health, like exercising regularly and paying attention to diet,” she said.
Freaney said women approaching menopause need to “double down on efforts to maintain strength.” She advised strength training at least twice a week.
“Muscle regulates metabolism,” she said. “That can counter some of these adverse cardiac changes that occur around the time of menopause.”
All women can take charge of their cardiovascular health, even before they experience menopausal symptoms.
Bond recommended three starting points:
- know and control your blood pressure
- get regular screening for cholesterol and diabetes before symptoms arise
- prioritize physical activity, sleep, nourishing food, and stress support
These and the other recommendations from ABC’s ‘7 Steps to a Healthy Heart‘ are “core habits” that meaningfully affect long-term heart health, Bond said.
Women can also take initiative with their doctors by sharing their menopause history during visits. Bond said the responsibility goes both ways.
“We should be asking: At what age did your periods stop? Was menopause natural or surgical? Did you go through menopause before age 40?” she said.
“Menopause is not just a gynecologic milestone; it can be an important cardiovascular signal, especially when it happens early,” Bond said.
“Attention to lifestyle, including diet and exercise, is critically important and can significantly modify cardiovascular risk,” she said.
Freaney said the findings reinforce that reproductive history belongs in every cardiovascular risk assessment.
“A problem that was previously thought to be a gynecologic problem really needs to be considered by all clinicians,” she said.
Providers who routinely ask about the timing of menopause “can flag higher-risk women that traditional risk calculators may underestimate.”
