A new analysis of nationwide U.S. data published today in the Journal of the American Heart Association reveals that perimenopausal women are twice as likely to have low cardiovascular health scores compared to women still having regular menstrual cycles. The findings underscore perimenopause as a critical window for reassessing heart disease risk and implementing early preventive measures.
Perimenopause, the transitional period leading up to menopause, is marked by hormonal and metabolic changes that can accelerate cardiovascular health decline. According to the study, which analyzed data from 9,248 women aged 18 to 80 who participated in the National Health and Nutrition Examination Survey between 2007 and 2020, median Life’s Essential 8 (LE8) scores declined with advancing reproductive stage: from 73.3 in premenopausal women to 69.1 in perimenopausal women, and further to 63.9 in postmenopausal women.
The American Heart Association’s Life’s Essential 8 metrics evaluate cardiovascular health based on diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight, and blood sugar levels. After accounting for age, perimenopausal women were twice as likely to have an overall low LE8 score compared to premenopausal women. They were also 76% more likely to have low cholesterol scores and 83% more likely to have low blood sugar scores.
“Women should think of the perimenopausal period as a ‘window of opportunity.’ They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol, and blood sugar levels,” said Garima Arora, M.D., senior author of the study and a professor of medicine at the University of Alabama at Birmingham. “It may be the perfect time to get a baseline for their heart health.”
The study highlights that diet consistently received the lowest scores among all LE8 components and continued to decline over time across all reproductive stages. Fluctuating estrogen levels during perimenopause may contribute to these declines by negatively affecting cholesterol, insulin resistance, blood pressure, and weight management.
“Perimenopause is the critical time when the increase in cardiovascular risk seems magnified,” said Amrita Nayak, M.D., lead author of the study and a research fellow at the University of Alabama at Birmingham. “When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association, emphasized the importance of recognizing female-specific risk factors. “Significant health changes during pregnancy, perimenopause, and menopause make it particularly important to pay close attention to increases in health risk factors during those times,” she said. “I encourage women to talk with their health care teams to learn about early detection and modification of traditional and ‘female-specific’ risk factors.”
The researchers plan to follow women over several years to track hormone levels and heart health, aiming to clarify the long-term impact of perimenopause and how lifestyle changes can reduce risk. “We hope these findings encourage clinicians to begin screening for high blood pressure, cholesterol, and Type 2 diabetes earlier in the perimenopausal transition,” Arora added.
The full study is available online in the Journal of the American Heart Association. More information on the American Heart Association’s Life’s Essential 8 can be found at heart.org.
