Women in disadvantaged areas may face poorer heart health and faster decline as they approach menopause, new research suggests.

Researchers followed 1,200 women in eastern Massachusetts for more than 20 years, from pregnancy into midlife.

The study measured heart health at five points using a score based on eight health and lifestyle factors, including blood pressure, cholesterol, sleep, diet and physical activity.

Women living in the most socially vulnerable neighbourhoods scored about six to 10 points lower on heart health across more than two decades of follow-up than those in the least disadvantaged neighbourhoods.

The differences were already clear three years after enrolment and continued into midlife.

Researchers also found that women in these neighbourhoods had faster declines before menopause, the stage when periods stop and cardiovascular risk can rise. Cardiovascular health means the health of the heart and blood vessels.

Socioeconomic factors also appeared to shape outcomes. Women with lower income, less education, or who identified as non-Hispanic Black had lower heart health scores throughout the study.

The findings highlight how long-term exposure to social and environmental conditions may affect cardiovascular risk over time.

Even modest differences in heart health scores may matter, as previous research has linked small decreases in these scores with higher risks of cardiovascular disease and death.

Senior author Izzuddin Aris, associate professor at Harvard Medical School and the Harvard Pilgrim Health Care Institute, said: “Our study shows that heart health in midlife is shaped by more than personal choices. Income, education, and neighbourhood conditions may all play a role.”

Neighbourhood conditions continued to affect heart health even after researchers took income and education into account.

Women who lived for years in highly vulnerable neighbourhoods had persistently lower scores and poorer cardiovascular health trajectories.

Aris added: “The years before and around menopause may be an important time to support women’s heart health.

“This is especially true for women living in under-resourced neighbourhoods.”

The findings suggest prevention efforts could include better access to healthy food, safe places to be active and quality healthcare, particularly for women seeking to protect their heart health over time.

The study used data from Project Viva, a long-term research study that has followed women since pregnancy in the early 2000s through midlife.

Researchers collected repeated health data over more than two decades, allowing them to track long-term patterns in heart health.

One in three US women older than 35 are no sure whether they are in perimenopause, new research has revealed.

The findings suggest uncertainty remains common, largely because of knowledge gaps, symptom confusion and difficulty getting confirmation or care.

Perimenopause is the transitional stage before a woman’s final period, when hormone levels fluctuate and symptoms can change over time.

It usually begins in the mid-40s, although timing varies widely, and can last for around four to eight years.

Symptoms can include hot flushes, psychological symptoms and urogenital symptoms, which affect the urinary and genital areas.

Dr Stephanie Faubion, medical director for The Menopause Society and one of the study authors, said: “This large study showed that one in three US women aged older than 35 years are not sure whether they are in perimenopause.

“Further, the study highlights that symptom confusion, misconceptions, and barriers to care are leaving many women without the clarity and support they need during the menopause transition.

“Recognising perimenopause uncertainty as a common experience can help shift the conversation from searching for a diagnosis to providing women with the information, validation, and support they need to navigate this natural life transition with confidence.”

More than 7,600 US women aged 35 and older took part in the study, which looked at how common uncertainty around perimenopause is and what may be driving it.

Overall, 34 per cent of participants said they were unsure of their reproductive stage.

Uncertainty varied by age and symptom burden, reaching 42 per cent among women aged 40 to 44 and 37 per cent among those with severe symptoms.

Symptom confusion was the most common factor, cited in 56 per cent of responses.

This included difficulty making sense of bodily changes and telling perimenopause apart from other possible causes, such as premenstrual syndrome, thyroid disease or mental health conditions.

Knowledge gaps and information-seeking made up 28 per cent of responses, reflecting limited awareness, age-based assumptions and attempts to find reliable information.

Barriers to confirmation and care made up 16 per cent, including dismissive healthcare encounters and reluctance to acknowledge perimenopause.

Younger women aged 35 to 39 were more likely to cite knowledge gaps, while healthcare barriers were most common among women aged 40 to 44.

The researchers said clinicians should take a more flexible approach to recognising the emotional, cognitive and physical symptoms that can occur during perimenopause.

They said healthcare professionals should not rely too heavily on irregular periods as the main sign, because some women have symptoms before major cycle changes.

A new menopause drug has been approved for NHS use in Scotland, offering a non-hormonal option for women who cannot take HRT.

The Scottish Medicines Consortium has recommended that women can now be prescribed fezolinetant, also known as Veoza, for symptoms such as hot flushes and night sweats.

Some women cannot take HRT, leaving them with limited treatment options for symptoms that can be severe and long-lasting.

Dr Timir Patel, medical director of Astellas UK, said the company was “pleased that this important additional treatment option will be available to women in Scotland, helping to support more personalised care for those experiencing hot flushes and night sweats”.

Fezolinetant works by selectively blocking a neurotransmitter in the brain involved in triggering hot flushes.

Clinical trials have shown the drug can reduce both the frequency and severity of hot flushes and night sweats.

About 400,000 women in Scotland are said to be of menopausal age, with manufacturer Astellas Pharma Ltd saying up to 48,000 could benefit from the treatment.

Dr Rob Peel, chair of the Scottish Medicines Consortium, said: “We know that menopausal hot flushes and night sweats can substantially affect quality of life.

“For those who cannot take HRT, effective treatment options are limited. Fezolinetant provides a non-hormonal treatment option, and we know our decision will be welcomed.”

Dr Kay McAllister, consultant gynaecologist and clinical lead for menopause services at NHS Glasgow and Greater Clyde, said: “Today’s decision marks a positive development for the wellbeing of Scottish women.

“In clinical practice, I see how hot flushes and night sweats impact sleep and overall quality of life in my patients.

“The availability of this targeted treatment offers a welcome choice and further options for patients.”