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Women who go through natural menopause<\/a> before age 40 face a 40% higher lifetime risk of coronary heart disease, according to a new study published March 18 in Premature menopause<\/a> occurs when the ovaries stop functioning and menstrual periods end before age 40.<\/p>\n<\/div>\n Current evidence<\/a> suggests roughly 3\u20134% of women may experience some form of menopause before 40, which is higher than the previous 1% estimate for overt premature menopause. Black women are three times as likely to experience premature menopause as white women. <\/p>\n<\/div>\n Researchers at Northwestern University analyzed data from more than 10,000 postmenopausal<\/a> women across six major U.S. population-based studies from 1964 to 2018. <\/p>\n<\/div>\n They found the 40% higher lifetime risk of heart attack<\/a> or fatal coronary heart disease<\/a> held up regardless of race.<\/p>\n Lead study author Priya Freaney<\/a>, MD, assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine, said the findings should be viewed as empowering, not alarming.<\/p>\n<\/div>\n \u201cWe\u2019re talking about an event that happens before the midpoint of someone\u2019s life,\u201d she told Healthline. \u201cThat should be viewed as an opportunity\u2026the earlier we can implement prevention, the more impact we can have in the long term.\u201d<\/p>\n<\/div>\n<\/div>\n Stephanie Faubion<\/a>, MD, medical director of The Menopause Society, told Healthline that the connection between menopause and heart health stems from hormones. Faubion wasn\u2019t involved in the study.<\/p>\n<\/div>\n \u201cThe connection has to do with the early loss of estrogen, which helps promote heart, brain, and bone health<\/a>, especially in these younger women,\u201d Faubion said.<\/p>\n<\/div>\n Freaney described a cascade of changes that occur as natural estrogen declines<\/a>, regardless of age.<\/p>\n<\/div>\n \u201cOur muscle mass<\/a> decreases, our visceral fat<\/a> increases, fat moves to the belly, our arteries stiffen, our cholesterol goes up, our blood pressure goes up,\u201d she said.<\/p>\n<\/div>\n \u201cAll of these things taken together in a few years before and after menopause lead to an environment that is less healthy for the heart.\u201d<\/p>\n<\/div>\n Most cases of premature menopause have no clear explanation, though conditions like autoimmune diseases<\/a>, infections, inflammatory conditions, and genetic mutations can trigger it.<\/p>\n<\/div>\n <\/div>\n The study found that Black women experience premature menopause at more than three times the rate of white women \u2014 15.5% compared with 4.8%. <\/p>\n<\/div>\n While the 40% increase in heart disease risk<\/a> applied regardless of race, the sheer frequency of premature menopause among Black women means the condition carries a far greater population-level impact.<\/p>\n<\/div>\n Black women with premature menopause lived an average of 18.2 years free of heart disease after age 55, compared to 19.1 years for Black women who reached menopause at a typical age.<\/p>\n<\/div>\n The study\u2019s authors pointed to \u201cweathering\u201d \u2014 the theory that chronic racial stress<\/a> accelerates biological aging \u2014 as one possible driver of the higher rates.<\/p>\n<\/div>\n Rachel M. Bond<\/a>, MD, co-chair of the Women and Children Committee at the Association of Black Cardiologists (ABC), said she takes that connection seriously in her practice. Bond wasn\u2019t involved in the study.<\/p>\n<\/div>\n \u201cChronic stress is not \u2018just emotional\u2019 \u2014 it can affect blood pressure, sleep, inflammation<\/a>, eating patterns, physical activity, and how consistently someone can care for themselves,\u201d Bond told Healthline.<\/p>\n<\/div>\n Bond said she works to get a holistic picture of her patients\u2019 lives, asking about caregiving responsibilities, financial strain, and what she described as \u201cthe pressure to keep pushing through.\u201d She treats stress as a real cardiovascular risk factor.<\/p>\n<\/div>\n She said weathering is one reason \u201cwe treat stress as a real cardiovascular issue.\u201d<\/p>\n<\/div>\n<\/div>\n Perimenopause, the years before menopause, and postmenopause represent what the study\u2019s authors call a unique \u201cwindow of opportunity\u201d to measure, monitor, and modify cardiovascular risk. <\/p>\n<\/div>\n It\u2019s the period when risk factors like blood pressure, cholesterol, and blood sugar<\/a> often start to shift, and catching those changes early can make the biggest difference. <\/p>\n<\/div>\n \u201cI do not look at that finding and think, \u2018It\u2019s only one year.\u2019 I look at it and think, \u2018That is our opportunity to intervene sooner,’\u201d Bond said. <\/p>\n<\/div>\n She said she takes action the moment she learns a patient is experiencing premature menopause \u2014 checking blood pressure<\/a>, cholesterol, blood sugar, weight, sleep, and smoking status; reviewing pregnancy and family history; talking through exercise and nutrition; and deciding whether to get more aggressive about risk-factor treatment.<\/p>\n<\/div>\n A 2022 editorial<\/a> commenting on a related study<\/a> by Finnish researchers suggests that the menopausal transition may be an underappreciated opportunity to slow cardiovascular aging overall.<\/p>\n<\/div>\n Seizing that window also means treating menopause symptoms<\/a>. Faubion pointed out that untreated symptoms can undermine the very habits that protect the heart. <\/p>\n<\/div>\n \u201cIf women are not sleeping because they are having night sweats<\/a> or mood issues or menopause-related sleep disturbances<\/a>, this makes it more difficult to do the things that we all know help with heart health, like exercising regularly and paying attention to diet,\u201d she said.<\/p>\n<\/div>\n <\/div>\n Freaney said women approaching menopause<\/a> need to \u201cdouble down on efforts to maintain strength.\u201d She advised strength training<\/a> at least twice a week.<\/p>\n \u201cMuscle regulates metabolism<\/a>,\u201d she said. \u201cThat can counter some of these adverse cardiac changes that occur around the time of menopause.\u201d<\/p>\n<\/div>\n All women can take charge of their cardiovascular health, even before they experience menopausal symptoms. <\/p>\n<\/div>\n Bond recommended three starting points: <\/p>\n<\/div>\n These and the other recommendations from ABC\u2019s \u20187 Steps to a Healthy Heart<\/a>\u2018 are \u201ccore habits\u201d that meaningfully affect long-term heart health, Bond said.<\/p>\n<\/div>\n Women can also take initiative with their doctors by sharing their menopause history during visits. Bond said the responsibility goes both ways.<\/p>\n<\/div>\n \u201cWe should be asking: At what age did your periods stop? Was menopause natural or surgical? Did you go through menopause before age 40?\u201d she said.<\/p>\n<\/div>\n \u201cMenopause is not just a gynecologic milestone; it can be an important cardiovascular signal, especially when it happens early,\u201d Bond said.<\/p>\n<\/div>\n \u201cAttention to lifestyle, including diet and exercise<\/a>, is critically important and can significantly modify cardiovascular risk,\u201d she said.<\/p>\n<\/div>\n Freaney said the findings reinforce that reproductive history belongs in every cardiovascular risk assessment.<\/p>\n<\/div>\n \u201cA problem that was previously thought to be a gynecologic problem really needs to be considered by all clinicians,\u201d she said. <\/p>\n<\/div>\n\n