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  • Review Article
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The menopausal transition period and cardiovascular risk

Nature Reviews Cardiology volume 21, pages 203–211 (2024)Cite this article

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Abstract

The menopausal transition period spans, on average, 2–8 years before the final menstrual period and is associated with an increase in clinical and subclinical cardiovascular risk. In this Review, we discuss the metabolic and cardiovascular changes that occur during the menopausal transition period and the role of ovarian ageing, chronological ageing and other ageing-related risk factors in mediating these changes. Disentangling the relative contributions of chronological and reproductive ageing to cardiovascular risk is challenging, but data from longitudinal studies in women transitioning from premenopause to post-menopause have provided valuable insights. We also discuss evidence on how cardiovascular risk is altered by premature or early menopause, surgical menopause, and vasomotor and other menopausal symptoms. Whether targeted interventions can slow the progression of atherosclerosis and subclinical disease during the menopausal transition, thus delaying or preventing the onset of cardiovascular events, remains to be determined. Furthermore, we consider the recommended strategies for cardiovascular risk reduction in women undergoing menopausal transition using the framework of the American Heart Association’s Life’s Essential 8 key measures for improving and maintaining cardiovascular health, and discuss the cardiovascular risks and benefits of menopausal hormone therapy. Finally, we also discuss novel therapies that might benefit this population in reducing cardiovascular risk.

Key points

  • The menopausal transition period heralds a dynamic change in a woman’s reproductive lifespan and is associated with substantial hormonal, metabolic and cardiovascular changes.

  • Some of the cardiometabolic changes that occur throughout the menopausal transition period are independent of chronological ageing and are instead largely driven by reproductive ageing.

  • Individuals who undergo premature menopause, early menopause or surgically induced menopause have an increased risk of adverse cardiometabolic changes.

  • Strategies to reduce the cardiometabolic risk during the menopausal transition period include lifestyle modifications and pharmacological therapy.

  • Depending on the timing of initiation, menopausal hormone therapy might portend neutral-to-beneficial cardiometabolic effects during the menopausal transition period.

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Fig. 1: Timeline of menopausal transition and postmenopausal period10.
Fig. 2: Cardiometabolic changes during the menopausal transition and postmenopausal period.

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Authors and Affiliations

  1. Allegheny General Hospital Internal Medicine, Primary Care Institute, Allegheny Health Network, Pittsburgh, PA, USA

    Jaya M. Mehta

  2. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    JoAnn E. Manson

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    JoAnn E. Manson

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  1. Jaya M. Mehta
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Mehta, J.M., Manson, J.E. The menopausal transition period and cardiovascular risk. Nat Rev Cardiol 21, 203–211 (2024). https://doi.org/10.1038/s41569-023-00926-7

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