17 October 2025
Cristina Cebrián Méndez - CNIC
Hot flashes, mood changes and sleep disturbances are often associated with menopause. But the real, silent threat may lie deeper: the cardiovascular system. Cardiovascular disease (CVD) remains the leading cause of death among postmenopausal women, yet awareness is still low.
Women typically develop heart disease later than men, thanks to the vascular protection offered by estrogen during their reproductive years. But once this hormonal shield declines, risk rises sharply. Estrogen helps regulate lipids, supports endothelial function, and controls inflammation. Without it, LDL cholesterol increases, arteries stiffen, and insulin resistance becomes more common.
📉 Menopause increases risk factors
As highlighted in research developed in Poland [1], the menopausal period is a critical window for cardiovascular risk acceleration. Several factors emerge or intensify during this time: lipid disorders, type 2 diabetes, obesity, hypertension, and lifestyle issues like smoking and physical inactivity. In simple terms, during menopause the body experiences more “wear and tear” at the cellular level (known as oxidative stress), and the nervous system becomes more active, which can tighten blood vessels. Substances like endothelin also cause blood vessels to narrow. All these changes can irritate the blood vessel walls and make them stiffer over time.
Physiologically, there’s also a rise in oxidative stress, sympathetic nervous activity, and vasoconstrictive agents like endothelin, contributing to vascular inflammation and arterial remodeling.
Hypertension, in particular, is often underdiagnosed and undertreated in women. In developed countries, about 30% of adult women live with it, many unknowingly. Postmenopausal women are twice as likely to develop hypertension compared to premenopausal women, and even borderline cases can cause more vascular damage in women than in men [2].
This hormonal shift doesn’t just mark the end of fertility, it fundamentally rewires the cardiovascular system. A meta-analysis confirmed that women with early menopause (before age 45) face a higher risk of hypertension, likely due to a steeper drop in estrogen and a lower estrogen-to-androgen ratio [3]. Regular monitoring and healthy lifestyle habits, such as exercise and a balanced diet, are crucial to managing these risks and maintaining heart health.
A gap that matters
Despite strong evidence, most cardiovascular risk assessments still overlook menopause as a critical factor. This oversight leaves many women underdiagnosed during a key phase of vulnerability. Menopause must be seen as a cardiovascular checkpoint. Risk models should integrate hormonal status, and clinicians should tailor prevention, screening, and even hormone therapy decisions with heart health in mind.
That’s where JACARDI comes in. One of the core objectives of the joint action is to address gender-specific gaps in cardiovascular care, including the urgent need to improve outcomes for women in midlife. Menopause can no longer be left out of the cardiovascular conversation.
Let’s bridge the gap. Women’s hearts deserve it!
#JACARDI #EU4Health #CardiovascularHealth #WomensHealth #MenopauseAwareness
Sources:
[1] Ryczkowska K, Adach W, Janikowski K, Banach M, Bielecka-Dabrowa A. Menopause and women’s cardiovascular health: is it really an obvious relationship? Archives of Medical Science. 2023;19(2):458-466. https://doi.org/10.5114/aoms/157308
[2] Miller, V. M., Lahr, B. D., Bailey, K. R., Heit, J. A., Harman, S. M., & Jayachandran, M. (2015). Longitudinal effects of menopausal hormone treatments on platelet characteristics and cell-derived microvesicles. Platelets, 27(1), 32–42. https://doi.org/10.3109/09537104.2015.1023273
[3] Anagnostis, P., Theocharis, P., Lallas, K., Konstantis, G., Mastrogiannis, K., Bosdou, J. K., … & Goulis, D. G. (2020). Early menopause is associated with increased risk of arterial hypertension: a systematic review and meta-analysis. Maturitas, 135, 74-79. https://doi.org/10.1016/j.maturitas.2020.03.006