Heart and menopause: how to take care of your cardiovascular health

Heart and menopause are more closely linked than many people think. In fact, cardiovascular diseases are the leading cause of death among women, and the risk increases significantly after menopause. Despite this, many women are still unaware of the direct link between the menopausal transition and heart health.

Another aspect complicates the picture: the symptoms of a heart problem in women are often different from those typically experienced by men, and this sometimes leads to delays in diagnosis.

In this article, we look at how heart health and menopause are connected, what to watch for in terms of palpitations and changes in blood pressure, and what you can do to protect your heart health during the menopausal transition.

Why do we talk about menopause and heart health? The role of hormones

As we know, most of the changes a woman experiences during perimenopause and throughout the menopausal transition are caused by changes in hormone levels.

Estrogen plays a fundamental role in cardiovascular protection. It helps the arteries dilate, supporting better blood pressure regulation, and contributes to the balance between LDL and HDL cholesterol. It also has a protective effect against the inflammatory processes that promote plaque buildup in the arteries.

As estrogen levels decline, which can characterize the menopausal transition, some of these protective mechanisms are reduced. The arteries may tend to become stiffer, lipid metabolism changes, and body fat tends to be redistributed more toward the abdominal area, creating what is commonly called a “menopause belly”. This last factor is associated with a cardiovascular risk profile, and the risk of heart disease increases in the 10 years following menopause.

According to the consensus document published in the European Heart Journal by European cardiologists, gynecologists and endocrinologists, the menopausal transition is a key time to observe how cardiovascular health evolves, precisely because of this combination of changes.

Menopause and palpitations: when are they common and when should you monitor them?

Feeling your heartbeat more strongly, with sudden accelerations or the sensation that your heart “skips a beat”, is an experience many women report during perimenopause and menopause.

As we have already mentioned, in most cases this phenomenon is linked to hormonal fluctuations because the decline in estrogen affects the autonomic nervous system, which also regulates heart rate, and can make the heart more sensitive to stimuli such as stress, caffeine or hot flashes themselves.

A resting heart rate generally considered normal for an adult woman is between 60 and 100 beats per minute, but this range may vary according to individual factors such as fitness level, medications and overall health. Occasional, brief palpitations without other associated symptoms often fall within this physiological variability.

However, it becomes important to discuss them with a doctor when palpitations are accompanied by dizziness, shortness of breath, chest pain, or when they occur very frequently and for prolonged periods. In these cases, further investigation with an electrocardiogram or a Holter monitor may be helpful to rule out arrhythmias or other conditions that need to be assessed.

On this point, again according to the European consensus document published in the European Heart Journal, between 30% and 50% of women develop hypertension before the age of 60, and the onset of high blood pressure may present with symptoms such as palpitations, hot flashes, headaches or fatigue. These are signs of menopause that are often attributed generically to this phase without checking blood pressure. For this reason, if you notice frequent palpitations, it may be useful to measure your blood pressure more often during the same period.

Hot flashes during menopause and heart health: is there a link?

Another question women going through this phase ask is whether there is a link between menopausal hot flashes and heart health. Hot flashes are not only an uncomfortable symptom to manage, and some studies associate them with a cardiovascular picture that should be observed more carefully.

Women who experience frequent and intense hot flashes, particularly in the early stages of the transition, seem to present certain cardiovascular risk factors more often, such as reduced elasticity of the blood vessels. This does not mean that hot flashes directly cause heart problems, but that they can be a useful sign to consider alongside other aspects of your health and to discuss with your doctor or during a specialist menopause consultation.

Menopause and high blood pressure: when is it considered hypertension?

In addition to palpitations, several women report an increase in blood pressure during this phase. In fact, increased blood pressure is one of the cardiovascular changes most frequently observed after menopause.

There is no different “normal” blood pressure value depending on age. However, according to the most recent European guidelines (ESC/ESH), the threshold that defines hypertension remains 140/90 mmHg regardless of your age. What changes, if anything, is how often this threshold is exceeded. On this subject, data from the Cardiovascular Observatory of the Italian National Institute of Health show that around 6 in 10 women going through menopause have hypertension, a figure that highlights how important it is not to assume that higher values are simply “normal for your age”.

Monitoring your blood pressure regularly, especially from perimenopause onward, is one of the most useful habits for observing how your body changes during this phase and acting early if necessary.

Menopause and low blood pressure

However, increased blood pressure is not the only possible scenario. During the same period of the menopausal transition, some women experience episodes of low blood pressure, often linked to sudden hot flashes, night sweats or drops in energy accompanied by lightheadedness or dizziness.

There is therefore no single pattern that applies to everyone. Some women go through different phases during the transition, alternating periods of higher blood pressure with periods of lower blood pressure. More than a single episode, it is the persistence of symptoms over time that suggests when it may be worth speaking to a specialist.

When the heart needs attention: heart attacks and menopause

We have seen how palpitations, changes in blood pressure and hot flashes can be signs to monitor carefully during this phase. However, there is an even more important aspect to understand: women’s hearts are not only more vulnerable after menopause, but a heart attack can present very differently from the way it does in men. It is precisely this difference that makes it important not to dismiss unusual signs too quickly as simple tiredness or stress.

Many people associate a heart attack with severe chest pain that radiates to the left arm. In women, however, the signs can be more subtle and more easily mistaken for something else, which is why, according to the leading cardiology societies, women tend on average to go to the emergency room later than men.

In general, the most common heart attack symptoms in women:

• Sudden shortness of breath, even without exertion

• Pain in the jaw, neck, shoulders or between the shoulder blades

• Nausea, discomfort or cold sweats

• Palpitations or the sensation of an “irregular heartbeat”

• Extreme and unexplained fatigue

For this reason, if you experience unusual, intense or sudden physical sensations that you cannot explain, you should not minimize them or wait, but seek medical attention or go to the emergency room immediately.

How can you take care of your heart during menopause?

After looking at how palpitations, blood pressure and other signs can change during this phase, we come to the most practical part: what can you do, day by day, to support your heart?

The good news is that there are several practical habits that can support a woman’s cardiovascular health during the menopausal transition:

• monitor your values regularly: blood pressure, cholesterol and blood sugar, so that you can observe how they change over time and avoid discovering a problem only when it is already advanced;

• stay active: even regular physical activity, such as 30 minutes of brisk walking a day, makes a tangible contribution to cardiovascular wellbeing, while also supporting muscle tone and mood;

• take care of your diet: prioritize high-quality fats such as olive oil and fish, reduce salt and limit sugar and ultra-processed foods, which affect blood pressure and lipid profile;

• manage stress: tension and anxiety can contribute to raising blood pressure in the short term and, over the long term, keep cortisol levels high;

• do not ignore your body’s signals: unusual, persistent or intense sensations deserve a conversation with a specialist, not a do-it-yourself assessment.

One more tip. If you already use a smartwatch or another wearable device, it can be a small ally in keeping an eye on your heart rate over time and help you notice more easily if something changes. It does not replace a medical assessment: if you notice something that concerns you, the right step is always to discuss it with a specialist, but it can help you get to know your body better day by day.

Heart health and menopause: what to do from here

In this guide, we have seen how heart health may change during the menopausal transition. We hope this article has helped you find your way through the many changes the body goes through during this phase, without alarmism but with greater awareness.

At Pausetiv we consider cardiovascular health one of the aspects to monitor carefully during the menopausal transition, alongside all the other signs the body sends during this period.

Through the PauseTest, you can receive guidance on your overall hormonal balance, gaining a more complete picture from which to understand which specialist support may be most useful for you.

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Disclaimer: the information contained in this article is intended solely for informational and educational purposes. It does not replace in any way the advice, diagnosis or guidance of a doctor or health professional. If you have doubts or symptoms that concern you, always consult a qualified specialist.

Frequently asked questions about heart health and menopause

• What is a normal heart rate during menopause?

There is no specific heart rate value for menopause: the reference parameters remain the same as those for any adult woman, regardless of her stage of life. At rest, a heart rate between 60 and 100 beats per minute is considered normal, although the ideal value varies from person to person based on factors such as fitness level, certain medications and overall health.

• Are there natural remedies for high blood pressure during menopause?

There is no natural remedy that works in the same way for every woman, because the causes of increased blood pressure during this phase of the menopausal transition or during perimenopause can differ and overlap. Some daily habits, such as reducing salt, staying active and managing stress, can help support more regular values, but when blood pressure remains consistently high, the safest choice is to speak to a doctor and assess the most suitable path together.

• At what age should you start monitoring your heart during menopause?

There is no fixed age that applies to everyone, but perimenopause, which generally begins between the ages of 40 and 45, is the time to start regularly monitoring blood pressure, cholesterol and blood sugar, even in the absence of symptoms. The sooner you start observing these values, the sooner you can act if something changes over time.

• How often should you check your blood pressure during menopause?

In general, taking a measurement every few months is a good starting point for those who do not have abnormal values, while anyone who has already recorded higher-than-normal blood pressure can agree on more frequent checks with their doctor. Measuring it at home with a validated device can also be useful for monitoring the trend over time.