Strong Hearts, Strong Women: Why Cardiovascular Health Matters in Perimenopause
When it comes to women’s health, we tend to talk a lot about hormones, hot flushes, mood swings, and sleep when perimenopause comes up. But there’s another part of the story that often gets overlooked – and it’s one that could literally save your life: your heart.
This topic is deeply personal for me. Following Dad's sudden passing from a heart attack, a nurse friend encouraged me to have my own cardiovascular health assessed. She explained that menopause can sometimes mask underlying heart health risks, making it even more important for women in midlife to be proactive.
It made me realise that heart health isn’t something we can afford to push to the side. I did some research, spoke to my Doctor about it and had some tests done. Turns out, I have high cholesterol. Well, had… I have managed to lower it into a ‘safe’ zone with medication.
So as a perimenopausal woman, I want to share some insights and information so you’re aware of what else is going on with our bodies during the menopause transition.
Why your heart health changes in perimenopause
Research shows cardiovascular risk begins increasing during the menopause transition due to hormonal changes and shifts in body composition, cholesterol and blood vessel function.
Estrogen does more than just regulate periods. It also helps keep our blood vessels flexible, supports healthy cholesterol levels, and even influences how our body stores fat. When estrogen starts to decline during perimenopause, several things happen that increase the risk of cardiovascular issues:
Cholesterol levels can shift – LDL (“bad” cholesterol) can rise, and HDL (“good” cholesterol) may drop.
Blood pressure often increases due to changes in blood vessel elasticity.Weight distribution changes – with more tendency to store fat around the abdomen, which is linked to higher risk of heart disease.
Insulin sensitivity may decrease, making it harder to manage blood sugar and increasing risk for metabolic syndrome.
These aren’t just “numbers on a blood test” – they directly impact your risk of heart disease, stroke, and sudden cardiac events.
Why women’s heart health is often missed
Perhaps you're in your 30s or 40s and think heart disease is something you'll worry about later.
But heart disease is the leading cause of death and responsible for one third of deaths of women worldwide*. According to the New Zealand Heart Foundation, on average 900** women die each year from a heart attack. That’s more than two women a day losing their life to a heart attack! Awareness, understanding and proactive care is important as we hit midlife.
What you can start doing today
The good news? There’s a lot you can do to support your cardiovascular health – and starting in perimenopause (or earlier) sets you up for a stronger, healthier future.
Here are some key areas to focus on:
🥦 Nutrition – Prioritise whole, nutrient-dense foods, especially fibre, healthy fats (omega-3s), and plenty of colourful fruits and vegetables to support cholesterol and blood vessel health.
🏋️♀️ Strength & cardio training – A mix of resistance training and cardiovascular exercise is the gold standard for both heart and bone health.
😴 Sleep & stress – Chronic stress and poor sleep raise blood pressure and increase inflammation. Building recovery and relaxation into your routine matters.
🩺 Check-ups – Don’t wait until something feels wrong. Get regular blood pressure checks, cholesterol and blood sugar testing, and advocate for yourself if something feels “off.”
🚭 Lifestyle habits – Limiting alcohol, not smoking, and keeping caffeine in check can all reduce cardiovascular strain.
Starting just one or two small changes and being consistent about it can make a difference.
Your heart is worth the effort
Looking after your heart isn’t about fear – it’s about freedom. For me, heart health is now non-negotiable. My Dad’s sudden passing was a devastating reminder that we don’t always get a second chance. But we do have the chance, right now, to make choices that protect our future.
Don’t wait until perimenopause is behind you. Make cardiovascular health a priority within your programme as your body transitions from perimenopause to post-menopause.
StrongHer with Meredith
Evidence-based coaching and education to help women navigate perimenopause and menopause with confidence.
The information in this article is intended for educational purposes only and should not replace personalised medical advice. Please consult your healthcare provider regarding your individual circumstances.
Sources:
* Data from 2025, https://world-heart-federation.org/what-we-do/women-cvd/
** Data from 2025, https://www.heartfoundation.org.nz/your-heart/post-heart-attack/women
Image credit: Photo by Jamie Street on Unsplash
