Heart Health

The hormonal changes that occur during menopause bring about physiological shifts that can increase the risk of certain diseases in the future. One significant risk is cardiovascular disease, consistently ranking among the top three leading causes of death in women over 35 years of age.

Despite these future health risks, there are proactive measures to reduce the likelihood of developing heart disease..

Understanding Cardiovascular Disease

Cardiovascular disease encompasses various conditions affecting the heart and blood vessels, primarily characterised by two main issues. 

The first involves the narrowing of blood vessels due to the accumulation of fatty deposits or plaque (a condition known as atherosclerosis), or the blood vessels can become obstructed, leading to disrupted blood flow throughout the body.

When blood flow to the heart is obstructed or reduced, it can result in chest pain (angina), heart attacks, or heart failure. Interruptions in blood flow to the brain can cause strokes or transient ischaemic attacks (TIAs, or mini strokes). Issues with blood flow to the legs and feet (peripheral arterial disease) can lead to pain while walking, weakness, or ulcers, while the disease may also affect the aorta, the body’s largest blood vessel, causing it to weaken, bulge, or, in severe cases, form an aortic aneurysm.

These changes in blood vessels and blood circulation are also associated with increased blood pressure, alterations in cholesterol levels, and challenges in glucose regulation, potentially leading to hypertension, type 2 diabetes, and obesity.

How do females hormones impact on heart health?

Oestrogen plays several crucial roles that contribute to overall heart and blood vessel health.

  • It promotes the relaxation and dilation of blood vessels, reducing blood pressure and improving blood flow.
  • It helps lower levels of “bad” cholesterol in the blood, which can otherwise clog arteries.
  • It aids in regulating blood sugar (glucose) and insulin levels and reduces inflammation in the blood vessel linings. These functions collectively maintain the health and clarity of blood vessels, reducing the risk of heart attacks or strokes.
  • It supports the heart’s conducting system, which initiates and coordinates heart muscle contractions, and promotes stable heart rhythms.


A decline in oestrogen levels can lead to certain heart-related symptoms in some women.

These symptoms may include:

  • Increased awareness of the heart beating (palpitations).
  • Episodes of a faster, racing heartbeat.
  • Irregular heartbeat or a sensation of missed beats.


These symptoms can occur during moments of anxiety or hot flashes. Sensations of missed beats or a racing heart can be concerning, particularly for those without prior experience. Women with a history of heart problems may find these symptoms even more alarming. Palpitations are of particular concern when they are accompanied by chest pain, nausea, dizziness, faintness, or breathlessness.

Understandably, some women seek medical evaluation and reassurance when they first experience palpitations. This assessment typically involves a physical examination and may include blood tests to rule out potential causes such as thyroid abnormalities or anaemia. An electrocardiogram (ECG) might be performed to ensure the heart’s electrical circuits function normally. While some cases may warrant referral to a cardiologist for further evaluation, many investigations do not reveal abnormalities, and the palpitations often resolve with oestrogen replacement through HRT.

Progesterone may have a vasodilatory effect on blood vessels, helping to regulate blood pressure. It works in conjunction with oestrogen to maintain cardiovascular balance.

Testosterone contributes to cardiovascular health, affecting factors such as blood vessel tone and cardiac function.

What are the potential benefits of using HRT on heart health?

HRT, particularly with oestrogen, may offer cardiovascular protection by improving blood vessel function, reducing the risk of atherosclerosis and related cardiovascular issues.

Oestrogen in HRT can contribute to stable heart rhythms, potentially reducing the incidence of palpitations and irregular heartbeats.

HRT, with the combined influence of oestrogen and progesterone, may help regulate blood pressure, contributing to overall cardiovascular health.

Oestrogen’s vasodilatory effects, supported by HRT, may improve blood flow, reducing the strain on the heart and promoting optimal cardiovascular function.

Palpitations and cardiovascular changes are sometimes associated with menopause. HRT can help alleviate these symptoms by addressing hormonal imbalances.

HRT, by supporting cardiovascular health, contributes to overall well-being and may reduce the risk of cardiovascular issues associated with hormonal changes.

Can HRT reduce the risk of heart disease?

For women starting HRT during perimenopause, particularly before the age of 60 or within ten years of menopause, current evidence suggests a reduced risk of heart disease compared to not using HRT.

However, if menopause occurred before the age of 40, the risk of cardiovascular disease is significantly higher. Therefore, discussing hormone treatments with a healthcare professional or menopause specialist is crucial in such cases.

The evidence is less definitive regarding heart disease risk when initiating HRT more than ten years after menopause. Studies suggest either a neutral effect, meaning it doesn’t significantly alter risk levels, or it may be beneficial in lowering the risk of heart disease, especially when using oestrogen through skin application and micronized progesterone.

Having a history of heart problems, such as heart attacks, strokes, blocked arteries, or other cardiac conditions, does not automatically render HRT unsafe. In fact, HRT may offer some heart-related benefits.

Oestrogen administered through skin patches, gels, or sprays does not increase the risk of blood clots or strokes. If progestogen is needed alongside oestrogen, micronized progesterone (Utrogestan) is a safe option, as it doesn’t elevate the risk of blood clots.

Individualised advice from a menopause specialist and consultation with a cardiologist, if necessary, can help address concerns about personal risk levels when using HRT. These healthcare professionals can collaborate to optimise hormone and heart health concurrently.

Adopting a healthy lifestyle...

The evidence is clear that specific lifestyle measures can significantly reduce the risk of cardiovascular disease.

Consider the following recommendations:

  • Quit smoking (seek support to quit this habit)
  • Increase physical activity and incorporate more movement into your daily routine, even simple changes like taking stairs or walking more.
  • Follow a healthy diet, such as the Mediterranean diet, which is low in saturated fats. Aim to consume a diverse range of fruits and vegetables.
  • Reduce salt intake to lower the risk of high blood pressure.
  • Limit alcohol consumption to within government guidelines (less than 14 units per week, or less than 5 units per week for those with a history of breast cancer).
  • Prioritise quality sleep, as sleep deprivation strains the heart.
  • Monitor your pulse; a normal adult pulse falls between 60 and 100 beats per minute. Seek medical attention if your pulse is fast and irregular, especially when accompanied by chest pain, nausea, dizziness, or breathlessness.
  • Check your blood pressure regularly and follow up with a healthcare professional if you have high blood pressure. You can measure your blood pressure at home or consult a local pharmacy for assistance.


Taking these proactive steps to protect your cardiovascular health can contribute to a healthier, heartier life during perimenopause and menopause.

The British Heart Foundation has more useful resources. We recommend all our patients monitor their own blood pressure at home and discuss this with their GP