Perimenopause nearly doubles women’s odds of poor heart health

By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Lauren HardakerMay 15 2026

The menopausal transition may be a critical window for detecting hidden cardiovascular risks, with perimenopausal women showing significantly worse lipid and glucose health scores than expected for age alone.

Study: Cardiovascular Health Characterization Using Life's Essential 8 Score in Perimenopausal Women: An Analysis of the National Health and Nutritional Examination Survey. Image credit: Monkey Business Images/Shutterstock.com

A new study published in the Journal of the American Heart Association reports that perimenopausal women had nearly 2-fold higher age-adjusted odds of having a poor overall Life's Essential 8 score, primarily driven by poor blood glucose and lipid scores.

Hormonal shifts during perimenopause may harm heart health

Perimenopause is the natural transition period preceding menopause, characterized by irregular menstrual cycle and fluctuation in reproductive hormone levels in the blood. Among reproductive hormones, estrogen plays a significant role in regulating cardiometabolic parameters, including blood pressure and lipid profile. A fluctuation and gradual decline in estrogen levels may therefore contribute to poorer cardiovascular and metabolic health.

Despite known risk factors, cardiovascular health in perimenopausal women remains an underexplored area in scientific research. To bridge this gap in the literature, researchers conducted this study to assess and compare cardiovascular health among pre-, peri-, and postmenopausal women using the American Heart Association’s Life's Essential 8 (LE8) score.

The updated LE8 score was introduced in 2022, with sleep added as a new component because inadequate sleep is associated with poor cardiovascular outcomes. Existing evidence indicates that perimenopausal changes are associated with sleep disturbances. More than 50 % of women reported having less than seven hours of sleep per day during this period.

Read our exclusive interview with menopause specialist Dr Katie Barber

NHANES data used to compare menopausal heart health

The researchers analyzed data from the National Health and Nutritional Examination Survey cycles conducted between 2007 and 2020. The final study population comprised 9248 women aged 18 to 80 years who were not pregnant or breastfeeding and had no prior cardiovascular disease.

Participants’ LE8 scores were calculated as the mean of eight components: four health behaviors (physical activity, diet, smoking status, and sleep) and four health factors (blood pressure, blood lipid levels, blood glucose levels, and body mass index). The calculated LE8 scores were categorized as poor, intermediate, or ideal.

Perimenopause linked to worse lipid and glucose scores

The calculation of participants’ LE8 scores indicated a gradual decline across the reproductive stage, from premenopause to postmenopause. Among the eight components, the lowest score was obtained for diet, and the highest score was obtained for sleep in all women, regardless of menopausal stage, although the LE8 sleep component assessed only sleep duration, not sleep quality.

In both premenopausal and postmenopausal women, significant worsening of body mass index (BMI) scores and improvement in lipid and sleep scores were observed across NHANES survey cycles. However, a gradual decline in diet scores was observed over time across all menopausal stages.

The age‐adjusted analyses of LE8 scores revealed that perimenopausal women had nearly 2-fold higher odds of having a poor overall LE8 score than premenopausal women (reference population). Specifically, perimenopausal women exhibited 76 % and 83 % higher odds of having poor scores for blood lipid and blood glucose, respectively.

The probability of perimenopausal women having an ideal score for the blood lipid component was 46 % lower than that of the reference population. The overall prevalence of ideal, intermediate, and poor LE8 scores was 23 %, 62 %, and 14 %, respectively.

Estrogen fluctuations may drive metabolic and cardiovascular decline

The study reveals that perimenopausal women had the highest age-adjusted odds of having a poor overall LE8 score and poor blood lipid and glucose scores compared to premenopausal women. These findings clearly indicate worsening of cardiovascular health in perimenopausal women and highlight the need for in-depth research on this transition period.

Notably, the study found high scores for the sleep component across all participants. However, existing evidence links the perimenopausal period to sleep disturbance. Since sleep score in LE8 is measured by sleep duration, it remains possible that sleep quality, rather than quantity, may be more affected during this transition.

Several physiological factors can explain poor cardiovascular health in perimenopausal women. The known fluctuation in estrogen levels during this period is a major contributor to the substantial effects on both cardiovascular and metabolic functions.

Estrogen fluctuations depend on body weight; the decline is less pronounced in obese women due to extraglandular conversion and reduced estrogen availability. This is why obese women experience lower vasomotor symptoms than non-obese women during this period.

Perimenopausal women often experience hot flashes, emotional distress, insomnia, fatigue, and poor quality of life. These factors can significantly increase the risk of hypertension, further leading to a decline in cardiovascular health during this period. Perimenopausal women also experience changes in body composition, including fat gain and loss of lean mass, approximately two years before the final menstrual period. These changes can potentially contribute to increased risk of metabolic syndrome.

Overall, the study findings have strong clinical and public health implications. Healthcare professionals should consider perimenopausal women as a potentially higher-risk population for cardiovascular and metabolic complications and consider earlier cardiovascular assessment and preventive strategies to reduce the future risk of these diseases.

The menopausal stage classification of study participants was based on self‐reported menstrual history, which may lead to misclassification. Some components of the LE8 score, such as physical activity and smoking status, are also prone to recall bias because they are assessed via self-report. Further longitudinal research with a larger sample size is needed for causal inferences.

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