Cardiovascular disease remains the leading cause of death among women in the United States, accounting for one in every four deaths. Menopause significantly increases a woman’s cardiovascular risk, with vasomotor symptoms such as hot flashes and night sweats linked to higher blood pressure and other cardiometabolic risk factors.
According to new research, premature menopause (or premature ovarian insufficiency) can increase the risk of heart disease, including fatal and nonfatal myocardial infarction, by approximately 40 percent.
For Black women in particular, who face higher rates of premature menopause and heart disease, these findings highlight the need for clinicians to engage in earlier interventions to reduce the risk of future complications.
Key Findings From the Study
Premature menopause can increase a woman’s long-term risk of heart disease from clogged arteries by 40 percent, a new study says.
This risk is particularly important among Black women, as they are three times more likely to experience menopause prior to age 40, researchers reported March 18 in JAMA Cardiology.
The results suggest that doctors should routinely ask about older women’s age at menopause, as this can have an impact on their heart health, researchers said.
“When menopause happens before age 40, women still have more than half of their life expectancy ahead of them,” lead researcher Dr. Priya Freaney, an assistant professor of cardiology at Northwestern University Feinberg School of Medicine in Chicago, said in a news release. “Understanding their cumulative lifetime risk of blockage-related heart disease is critical.”
For the new study, researchers looked at the risk of coronary heart disease among more than 10,000 U.S. women followed for decades as part of six long-running health studies.
In the U.S., the average age of menopause is 51. Early menopause is typically considered between ages 40 and 45, and premature menopause is prior to 40.
Researchers found that premature menopause is linked to a 41 percent higher risk of heart disease among Black women and 39 percent among white women, even after accounting for other heart health factors.
Black women also have a three times higher rate of premature menopause, nearly 16 percent compared to 5 percent among white women.
Heart health is affected even by menopause that occurs around the average age, as declining estrogen levels affect a woman’s body, researchers said.
“As the natural estrogen declines, no matter what age it happens in, cholesterol and blood pressure go up, body fat distribution shifts to the abdomen, muscle mass gets lower, blood sugars can become dysregulated, and arteries stiffen,” Freaney said. “Together, these changes over a short period increase the risk of heart disease.”
Women who experience premature menopause need to keep close tabs on their heart health, Freaney said.
“Tell yourself: I have to be far more proactive than my neighbor about my own heart health,” she said. “The vast majority of heart disease is preventable, but people need to know that they’re at risk early in life because effective prevention takes decades.”
“Tell your doctor, ‘I experienced premature menopause. What can we do to protect my heart?’” Freaney added.
Understanding the Biology
The hormone estrogen is the link between menopause and cardiovascular risk, playing a significant protective role in women’s heart health.
Estrogren regulates cholesterol levels, maintains vascular flexibility, and supports healthy glucose metabolism. When levels begin to decline during menopause — especially when it occurs prematurely — these protective effects diminish quickly.
Rather than the gradual shift that occurs with typical menopause, premature menopause can actually accelerate cardiometabolic changes over a compressed timeframe, ultimately advancing a patient’s cardiovascular risk profile years earlier than expected.
For providers, this makes menopause timing a critical — and often overlooked — risk marker.
Why This Disparity Matters in Black Women
While the biological mechanisms may affect every woman, the impact is not evenly distributed. Black women already experience a disproportionate burden of cardiovascular disease, including higher rates of hypertension, heart failure, type 2 diabetes, obesity, and stroke. When premature menopause is added to their risk profile, the effects can be compounded across the lifespan.
The finding that Black women are three times more likely to experience menopause before age 40 raises important questions about contributing factors. While the study was not designed to understand causality, prior research points to a combination of factors, including environmental exposures, chronic stress, and underlying health conditions such as uterine fibroids, which disproportionately affect Black women.
The “weathering” hypothesis — the cumulative physiological toll of chronic stress and structural inequities — may also play a role in accelerated reproductive aging. Premature menopause, in this instance, may reflect broader systemic health disparities rather than isolated biological differences.
Implications for Clinical Practice
Despite its significance, menopause is not consistently integrated into cardiovascular risk assessment. This study highlights the need to change that.
Providers should routinely ask patients about when and how their menopause began. This information can provide helpful insights into a patient’s long-term risk trajectory.
Premature menopause should also be considered a cardiovascular “risk enhancer,” similar to how pregnancy-related complications like gestational diabetes or preeclampsia are viewed. Identifying this history early on can create an opportunity to intervene before significant disease develops.
Prevention and Management Strategies
Proactive cardiovascular care is critical for patients with a history of premature menopause. This can include:
- Earlier and more frequent screening for elevated cholesterol, hypertension, and impaired glucose metabolism.
- More aggressive management strategies based on individual risk, including earlier statin initiation or tighter blood pressure control.
- Lifestyle interventions, such as nutrition counseling, regular physical activity, and weight management.
At the same time, clinicians should also be aware of barriers that may affect adherence and access to care for Black women, including cost, transportation, and historical mistrust of the medical system. Tailoring care plans to meet patients where they are is key to improving both engagement and outcomes.
The Takeaway for Clinicians
Premature menopause is a significant and independent risk factor for coronary heart disease, with Black women being disproportionately affected. Earlier identification creates a window for long-term prevention. Menopause history should be implemented into routine cardiovascular risk assessment and patient counseling.
More information
Johns Hopkins Medicine has more on menopause and heart health.SOURCE: Northwestern University, news release, March 18, 2026