Women who enter natural menopause before age 40 face about a 40 per cent higher lifetime risk of developing coronary heart disease than women who experience menopause later, according to a large study that is the first to calculate lifetime heart risk associated with premature menopause.

The findings suggest that doctors should routinely ask women about age at menopause, using the menopausal transition as an opportunity to identify higher-risk women and intervene earlier.

Dr Priya Freaney is assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine.

She said: “When menopause happens before age 40, women still have more than half of their life expectancy ahead of them.

“Understanding their cumulative lifetime risk of blockage-related heart disease is critical.”

Coronary heart disease is a condition where the heart’s arteries become blocked or narrowed by a buildup of fatty deposits called plaque.

By restricting blood flow to the heart, these plaques can lead to sudden events (heart attacks) or gradual damage (weakened heart muscle).

The study of more than 10,000 U.S. women followed for decades also found that premature menopause was three times more common among Black women than white women (15.5 per cent vs. 4.8 per cent).

According to Freaney, the disparity likely reflects a complex mix of life-course exposures, health conditions and structural inequities rather than solely inherent biological differences.

Freaney and colleagues analysed data from 10,036 postmenopausal Black and white women who participated in six long-running U.S. studies, including the Framingham Heart Study, Atherosclerosis Risk in Communities Study and the Women’s Health Initiative.

The women were followed between 1964 and 2018.

During that time, the Northwestern scientists found more than 1,000 cases of coronary heart disease events in the data, including fatal and non-fatal heart attacks.

Even after accounting for cardiovascular risk factors such as smoking, obesity, hypertension and diabetes, premature menopause was associated with 41 per cent higher risk of coronary heart disease for Black women and 39 per cent increased risk for white women.

The scientists note in the study that the causes of premature menopause are not fully understood and are likely multifactorial.

Potential contributors include genetic, biological and environmental factors, as well as earlier age of the first menstrual period, health behaviors (such as smoking), obesity and the cumulative effects of chronic stress.

It is also unclear whether the menopausal transition itself creates a vascular environment that promotes disease, or whether women who experience premature menopause already have an underlying risk profile that predisposes them to both premature menopause and cardiovascular disease.

Even at the average age, menopause’s hormonal changes can affect cardiovascular health.

During menopause, declining estrogen levels trigger changes that increase coronary heart disease risk.

“As the natural estrogen declines, no matter what age it happens in, cholesterol and blood pressure go up, body fat distribution shifts to the abdomen, muscle mass gets lower, blood sugars can become dysregulated and arteries stiffen,” said Freaney, who also is director of the Women’s Heart Care Program at Northwestern Medicine Bluhm Cardiovascular Institute.

“Together, these changes over a short period increase the risk of heart disease.”

Freaney said women who experience premature menopause should think of it as an early signal to take their heart health seriously.

“Tell yourself: I have to be far more proactive than my neighbor about my own heart health,” Freaney said.

“The vast majority of heart disease is preventable, but people need to know that they’re at risk early in life because effective prevention takes decades.

“Tell your doctor, ‘I experienced premature menopause. What can we do to protect my heart?’” she suggests.

The findings also highlight a gap in how menopause is discussed in medical care, according to Freaney.

“All clinicians need to get comfortable asking about menopause because we have estrogen receptors from our head to our toes.”

For years, menopause has largely been treated as a gynecologic issue, she said. But the hormonal transition affects nearly every system in the body, including the cardiovascular system.

That means cardiovascular clinicians should routinely ask about menopause history when assessing long-term cardiovascular risk.

“Historically, women have been vastly understudied in cardiovascular science, and we still have much to learn about how menopause influences heart health,” Freaney said.

Cardiff’s first women’s health hub has opened, offering specialist perimenopause and menopause support for women aged 40 to 65.

Minister for mental health and wellbeing Sarah Murphy visited the East Cardiff Menopause Hub this week to learn about the new service, which brings together patient-centred advice, treatment and community support under one roof.

The hub forms part of a Wales-wide network of pathfinder women’s health hubs established during the first phase of delivering the Women’s Health Plan.

Women registered with one of the East Cardiff GP Cluster practices will be able to access extended 20-minute consultations, available face-to-face, by telephone or online, with GPs who have specialist experience in menopause care.

Practice nurses will also provide broader healthcare support, including blood pressure checks, lifestyle advice and guidance on hormone replacement therapy.

A Menopause Café, open to women of all ages, will offer a welcoming community space to share experiences and ask questions.

Sarah Murphy said: “It was fantastic to visit the Maelfa hub and see first-hand how Cardiff and Vale University Health Board is bringing high-quality, compassionate care closer to home for women in East Cardiff.

“Women’s health hubs will make it easier for women in Wales to get care when they need it.

“As the pathfinder hubs are rolled out, we’ll be listening to women’s feedback and adapting to make sure we are building a health service which meets the needs of women and girls, now and for generations to come.”

By March, every health board in Wales will have a pathfinder women’s health hub. Each health board has received an additional £300,000 this financial year to support their development.

The hubs form part of the Women’s Health Plan, which includes more than 60 actions to close the gender health gap and is based on feedback from around 4,000 women across Wales.

Dr Claire Beynon, executive director of public health at Cardiff and Vale University Health Board, said: “Too many women feel unsupported or unheard when seeking help for the symptoms of menopause.

“The East Cardiff Menopause Hub is a really positive step in bringing high-quality, compassionate care closer to home, with longer appointments and specialist expertise focused on women’s health needs.

“By combining clinical care with community support, this service helps women feel informed, confident and in control of their health. It also reflects our wider commitment to reducing health inequalities.”

Femtech World is to celebrate game-changing menopause innovations at its global awards event.

The Femtech World Awards, now in their third year, celebrates the brightest lights in women’s health innovation.

The event celebrates some of the best examples of leadership, innovation and impact in key areas that affect women’s health and wellbeing. 

The winner of the Menopause Innovation of the Year award will have shown exceptional innovation in addressing the health, wellbeing and quality-of-life needs of people navigating perimenopause, menopause and beyond.

Consideration will be given to impact, inclusivity accessibility and the ability to break stigma while delivering meaningful solutions.

This award celebrates those leading the way in redefining how menopause is understood and supported across healthcare and society.

The award is sponsored by Cross-Border Impact Ventures (CBIV) –  an impact venture capital firm on a mission to revolutionise venture investing in health technology.

CBIV invests in early-growth stage health technology companies commercialising medical devices, diagnostics, therapeutics, and digital health innovations and leveraging cutting-edge technologies like Artificial Intelligence (AI) and Machine Learning (ML).

All innovations CBIV finances are relevant to women’s, children’s, and adolescents’ health and located in North America and Europe, with the ability to scale technologies to emerging markets.

CBIV is driven by the belief that good health should not be restricted by gender, age, race, wealth, or borders and seeks to expand access to their portfolio’s world class technologies inclusively and globally. 

Annie Thériault, managing partner, Cross-Border Impact Ventures , said: “Being part of the FemTech World Awards gives us a front-row seat to the most exciting breakthroughs in women’s health.

“It’s a powerful way to stay connected to the pulse of innovation and the future of care.”

Find out more about the awards and enter for free here.