Heart, bones and long-term health

The menopause transition changes long-term health risks, not just symptoms. LDL cholesterol rises fastest in the year around the final period, bone loss speeds up from about a year before it, and blood pressure climbs faster after menopause in some women. Heart disease is the leading cause of death for US women, and the American Heart Association calls midlife a critical window for prevention. Most of these changes are silent, which is why a few well-chosen checks in your 40s and 50s matter.

Where to start

Begin with menopause and heart disease, which explains why risk rises and which numbers to track. For bones, preventing osteoporosis covers what to start in perimenopause, and osteopenia explains what a low bone density result means. If memory is on your mind, read menopause and brain health.

What changes and what to check

Area	What changes around menopause	What to check	Read the guide
Heart	Cholesterol, body fat distribution and blood vessel health shift	Blood pressure, lipids, lipoprotein(a) and A1C, combined into a 10-year risk estimate	Menopause and heart disease
Cholesterol	In SWAN, LDL rose about three times faster in the 12 months around the final period	A lipid panel, plus lipoprotein(a) at least once	Cholesterol changes
Blood pressure	About a third of women in SWAN had a faster rise after menopause	Yearly screening from 40; confirm high readings outside the clinic	Blood pressure in midlife
Bone	Most of a decade’s spine bone loss happens between one year before and two years after the final period	Fracture risk assessment; bone density scan if risk is increased or from 65	Osteoporosis prevention
Blood sugar	Body composition, sleep and activity shift in ways that raise risk	A1C or fasting glucose from 35, repeated at least every 3 years if normal	Type 2 diabetes risk
Brain	Brain fog in the transition is usually temporary	Blood pressure control and other modifiable risk factors	Menopause and brain health
Breast	Screening now starts at 40	Mammogram every 2 years from 40 to 74 (USPSTF)	Breast cancer screening

Where hormone therapy fits

Hormone therapy is FDA-approved to prevent postmenopausal osteoporosis, but it is not approved to prevent heart disease and is not recommended at any age to prevent cognitive decline or dementia. For healthy women under 60 or within 10 years of menopause who take it for symptoms, its effects on heart disease appear favorable; starting later carries greater absolute risks. Is hormone therapy safe? walks through the trade-offs. The main levers for long-term health remain blood pressure, cholesterol, blood sugar, not smoking, activity, sleep and weight, and weight training helps both muscle and bone.

Women whose menopause came before 40 face higher cardiovascular risk, especially after surgical removal of the ovaries; see premature ovarian insufficiency and surgical menopause.

When to see a clinician

Book a visit if you have not had your blood pressure, cholesterol and blood sugar checked in the past few years, if your periods stopped before 45, if you had preeclampsia or gestational diabetes, or if you broke a bone in a minor fall after 40. Call 911 for chest pain or pressure, or for upper back or neck pain, nausea, extreme fatigue, dizziness or shortness of breath that comes on suddenly; women can have heart attack symptoms other than chest pain. The symptom check helps you prepare, and the directory lists clinicians near you.