The protection women have against heart disease before menopause is substantial, and it does not last. Before menopause, men are roughly twice as likely as women of the same age to have a heart attack or develop heart disease. Afterwards, the risk between the sexes is close to equal.
Dr Ashraful-Ur-Rahman, medicine specialist and cardiologist at the National Institute of Cardiovascular Diseases, attributes the earlier advantage to estrogen, which has a protective effect on the cardiovascular system. When estrogen levels fall, that protection goes with them, and the change is relatively quick rather than gradual.
The screening response is straightforward. From around age 45, an annual EKG along with a lipid profile and blood sugar check gives a baseline and makes change detectable. Women with a family history of cardiac disease have more reason to keep to that schedule.
Recognising an event is harder for women than the textbook description implies. Instead of chest pain, what shows up may be breathlessness, or exhaustion, or feeling sick, or an ache settling in the back, the neck or the jaw. Every one of those is easy to put down to pressure at work or simply getting older, and that misreading is a large part of why women arrive for treatment later than men.
There is also a link worth knowing about between menopausal symptoms and cardiovascular risk. Hot flashes and night sweats are associated with higher risk, particularly in women under 60, which makes them worth mentioning to a doctor rather than treating as a nuisance to be endured.
On modifiable risk, the advice is familiar but the timing is earlier than most people assume. Avoiding smoking and vaping from the teenage years, maintaining a healthy weight by BMI, and establishing physical activity and a reasonable diet in adolescence set the baseline that the menopausal transition is then layered onto.
Sleep and stress both need active management through that transition rather than being left to settle on their own, since both feed directly into cardiovascular risk.
One caution concerns treatment. Managing menopausal symptoms with hormone therapy obtained without medical supervision carries increased risk of stroke and blood clots. It is a decision that needs a doctor who knows the individual history.
