Research Highlights:
- Women should undergo screening for cardiovascular risk factors throughout adulthood, however, perimenopause, which is the transition into menopause, offers a "window of opportunity" to reassess risk and prompt lifestyle changes, according to the analysis of data from a nationwide U.S. population-based study.
- Using the American Heart Association's Life's Essential 8™ (LE8) health metrics, researchers found that perimenopausal women were twice as likely to have an overall lower cardiovascular health score compared to women who were still having regular menstrual cycles.
- The findings indicate that the low cardiovascular health scores were largely driven by significantly higher cholesterol and blood sugar levels.
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DALLAS, May 13, 2026 — Perimenopausal women were two times more likely to have a low cardiovascular health score compared to women having regular menstrual cycles, according to an analysis of nationwide U.S. data published today in the Journal of the American Heart Association , an open-access, peer-reviewed journal of the American Heart Association.
Perimenopause is defined as the transitional period from the reproductive to the non-reproductive phase and is marked by hormonal and metabolic changes when cardiovascular health can decline in comparison to the premenopausal years. A 2020 scientific statement from the American Heart Association emphasized that the transition to menopause can increase cardiovascular disease risk and is an important time for women to implement early intervention strategies.
During perimenopause, estrogen and progesterone levels fluctuate, menstrual periods may become irregular, and women often experience mood changes, sleep problems and hot flashes. When 12 consecutive months pass after a woman's final menstrual period, she is considered postmenopausal.
"Mid-life women should think of the perimenopausal period as a 'window of opportunity.' They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels," said Garima Arora, M.D., senior author of the study and a professor of medicine in the division of cardiovascular disease at the University of Alabama at Birmingham. "Women should talk with their health care team about their reproductive status and any changes they are experiencing. It may be the perfect time to get a baseline for their heart health."
Life's Essential 8™ (LE8) scores are scientifically based measures of optimal cardiovascular health defined by the American Heart Association. These recommendations encapsulate effective management of lifestyle/behavior (diet, physical activity, tobacco use and sleep) and health factors (blood pressure, cholesterol levels, body weight and blood sugar levels) to achieve optimal cardiovascular health. Using the LE8 score, an average measure of all eight factors on a 100-point scale, researchers assessed participants' heart health.
The analysis revealed:
- Median LE8 scores among all participants declined with advancing reproductive stage, from 73.3 out of 100 (in premenopausal women) to 69.1 (in perimenopausal women) to 63.9 among women in postmenopause.
- Among the individual LE8 components, diet consistently received the lowest scores and continued to decline over time among all reproductive stages.
- After accounting for the effect of aging, perimenopausal women were twice as likely to have an overall low LE8 score compared to premenopausal women. They were 76% more likely to have a low cholesterol score and 83% more likely to have a low blood sugar score.
- Fluctuations in estrogen levels during perimenopause may contribute to the decline in cardiovascular health because varying estrogen levels may negatively affect cholesterol, insulin resistance, blood pressure and weight management.
- Sleep duration scores remained high across all reproductive stages, despite perimenopausal women reporting difficulty sleeping, suggesting that sleep quality may be more affected than sleep duration.
"Our analysis highlights that perimenopause, women's reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified. When we compared women's LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health," said Amrita Nayak, M.D., lead author of the study and a research fellow in the division of cardiovascular disease at the University of Alabama at Birmingham.
"Nutrition can be a central factor for early and proactive intervention. Focusing on heart-healthy habits early, especially getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt can help improve cardiovascular health for perimenopausal women in the years to come," added Dr. Arora.
"This research highlights yet another aspect of the unique factors that increase a woman's risk of cardiovascular disease throughout the stages of her lifespan. Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times," said Stacey E. Rosen, M.D., FAHA, volunteer president of the American Heart Association. "I encourage women to talk with their primary care and specialty health care teams to learn about early detection and modification of traditional and 'female-specific' risk factors. Women can take proven steps to improve their cardiovascular health at all ages." Rosen, who was not involved in this study, is also executive director of the Katz Institute for Women's Health and senior vice president of women's health at Northwell Health in New York City.
"Our next step is to follow women over several years to track hormone levels and heart health, which will help clarify the long-term impact of perimenopause and how lifestyle changes can reduce risk," Arora said. "We hope these findings encourage clinicians to begin screening for high blood pressure, cholesterol and Type 2 diabetes earlier in the perimenopausal transition, leading to earlier diagnosis, prevention and intervention at a critical time in women's lives."
Study details, background, design and limitations:
- The analysis included 9,248 women between 18 and 80 years of age who participated in the National Health and Nutrition Examination Survey between 2007 and 2020.
- Based on interview questions, the participants represent a broad cross-section of the U.S. population: included 65% self-identified as non-Hispanic white women, 11% self-identified as non-Hispanic Black women, 9% self-identified as Mexican American women, 7% self-identified as other Hispanic women, and 8% self-identified as women from other races including Asian.
- Based on interview questions, 5,882 participants were classified as premenopausal (median age of 34 years), 205 were grouped as perimenopausal (median age of 50.5 years), and 3,161 were in the postmenopausal group (median age of 60 years). Women who were pregnant or breastfeeding or had a history of cardiovascular disease were excluded from the study.
- Scores between 0-100 on Life's Essential 8 were calculated and categorized in this study as low (less than 50), intermediate (50-79) or ideal (80 or higher).
- All data were collected via home interviews, and a single medical exam that was done at a mobile examination center.
- LE8 scores were compared among the women at different reproductive stages to track changes due to advancing age or changes in reproductive status. Then, scores adjusted for age were compared among women at different reproductive stages to isolate the direct influence of the menopausal stage.
- The women's menstrual history to determine their reproductive stage was self-reported, so some participants may have been misclassified.
- Information about other risk factors that can influence hormone levels and heart health, such as ovary removal or the use of hormone replacement therapy, was not complete or unavailable for participants.
- In addition, information about participants' lifestyle factors, such as levels of physical activity and smoking status, was self-reported.
Co-authors, disclosures, and funding sources are listed in the manuscript.
