Good question: Does menopause increase the risk of heart disease?

January 30, 2026 | 10 min read

Many women experiencing the midlife transition into perimenopause and menopause find it to be an all-encompassing stage of life. As the body adjusts to a significant hormonal shift – one with far less estrogen – it experiences a wide range of physical, mental, and emotional symptoms, affecting the nervous system, the skeletal system, and virtually every organ – including the heart.

Heart disease is the most common cause of premature death for women in Canada,¹ and while common risk factors that can influence cardiac health² are becoming more widely recognized, the effect of menopause on the heart remains far less discussed.

“Many people aren’t aware of the degree to which menopause can affect the cardiovascular system,” explains Dr. Amelia Yip, a Cardiologist with the Waterloo Regional Health Network (WRHN), home to the PREVENT Clinic, which is powered by Manulife. “They don’t always make the connection that the hormonal changes that come during this stage of life can increase the risk of heart issues.”

To get to the heart of the matter, we asked Dr. Yip and her colleague Stefanie Cooper, Registered Nurse and Program Manager for Procedural Cardiology at WRHN, to share what perimenopausal and menopausal women, and the people in their lives, need to know about cardiac health. 

Dr. Amelia Yip: We know that it does increase the risk³ of heart disease.

Heart disease is a broad spectrum. People often think first about blockages – otherwise known as coronary artery disease – and this risk is definitely heightened for menopausal women. But the risk of other conditions goes up, too, including hypertrophic cardiomyopathy, heart failure, and conduction abnormalities.

We don’t yet have consensus on what, exactly, is behind this increased risk. Some thinking points to a combination of hormonal changes plus age, which generally increases the risk of heart disease.⁴

Stefanie Cooper: Lifestyle changes can also increase the risk at this stage of life. For instance, many perimenopausal women experience declining bone density,⁵ which can cause joint issues. That often leads to a more sedentary lifestyle, which we know is a strong risk factor for cardiovascular disease.⁶

Dr. Yip: Women experience heart disease differently. Symptoms often progress more slowly and can be easier to miss.

Cooper: Heart problems don’t always present themselves in the dramatic way you see on TV. For menopausal women, it’s very rarely a matter of a sharp pain radiating into your left arm that most people associate with heart attacks. Symptoms of heart problems are more often things you might not automatically associate with cardiovascular disease, such as indigestion. Or shortness of breath. Or jaw pain. Or shoulder pain, when you haven’t had a specific injury. Or even general upper-body aches.

These symptoms can be super subtle. And a lot of women write them off as menopause or perimenopause symptoms. Many women also delay care because they think: "I don’t have time to deal with this right now" and "It’s annoying, but it can’t be a heart attack because I’m not experiencing these big symptoms."

Dr. Yip: Aside from chest pain – which should always be checked out quickly – persistent shortness of breath and fatigue are major indicators that something might be wrong.

I often give my patients this gauge: If functionally you can do less than you did before, it’s best to get it checked out. For instance, if you are typically able to swim two laps and feel great afterwards, but all of a sudden you can’t, that may signal a problem.

Try not to dismiss these indicators as “just menopause” or aging. They may, in fact, be menopausal symptoms, but it’s better to be safe and rule out a potential cardiovascular issue than to sit around until something bad happens. And remember: Experiencing functional decline isn’t automatically a normal part of getting older. 

Dr. Yip: We don’t yet have consistent data on the relationship between hormone therapy and heart issues. When women supplement with hormone therapy during menopause, some do better in terms of cardiovascular health, and some do worse.

It depends on each woman’s individual cardiac background. For instance, some cardiovascular problems stem from stress. If a menopausal woman with no underlying heart problems is experiencing more stress – perhaps because she’s not sleeping well or because her body is dealing with so many symptoms – that can put her at a higher risk of cardiovascular problems. In a case like that, hormone therapy might help.

But it’s not a hard no or a hard yes. It’s different for every woman.

Dr. Yip: I don’t believe there is an optimal weight. I often see overweight patients with very low risk factors: They’re walking every day. Their cholesterol is at target. Their blood pressure is good. They just happen to have some extra body fat – that’s just how their bodies are. To me, that’s okay. I care a lot less about a patient gaining 10 pounds than I do about her living a sedentary life.

The caveat relates to abdominal obesity because there is a link between excess belly fat and cardiovascular disease in women.⁸ I do talk to patients about that. It’s often something that can be managed with physical activity: You rarely see abdominal obesity among people who exercise regularly, even if they’re heavier.

Dr. Yip: There are several ways that menopausal women can help reduce risk factors. Quitting smoking is a big one.

So is adopting healthier eating habits. The Mediterranean diet is one that is commonly recommended for heart health. Keeping an eye on portion size and applying common sense are good rules to follow.

My main recommendation tends to be physical activity because it can positively affect so many risk factors. I usually recommend patients spend at least 15 minutes a day doing some sort of cardiovascular activity – vigorous walking, swimming, cycling, anything that allows them to work all their major muscle groups and gets their heart rate up to a certain point. Patients often say: “I walk to the bus stop” or “I putter around the kitchen.” That’s a good start; but it’s important to get your heart to work a bit harder.

Exercise really is an investment in yourself. When you carve out 15 minutes to do some physical activity that you enjoy, it can help reduce major risk factors for cardiovascular disease, such as diabetes,⁹ hypertension,¹⁰ and cholesterol.¹¹ Regular exercise can also help with mental health,¹² stress management,¹³ and sleep.¹⁴ All of that can lower your risk of heart disease.

Cooper: Strength training is also very beneficial for women of this age because resistance builds resilience in your body. It increases bone density, which reduces the risk of injury, improves circulation, and increases cardiovascular health. It doesn’t have to be weight training. Bodyweight exercises can be enough. A little bit of movement paired with regular resistance training creates a cascade of wonderful benefits for your body.

Cooper: We often see menopausal women wait until symptoms are affecting their day-to-day abilities before seeing a doctor. It’s understandable. Many are in the sandwich generation, balancing care for children and parents with work and other commitments. With so much going on, mild symptoms can be easy to ignore. But delaying care can mean you’re getting help later than is ideal.

That’s why it’s so important for menopausal women to pay attention to changes in how they feel. If your ability to do everyday tasks shifts, or if something just doesn’t feel right, these are signs to check in with a healthcare provider.

Dr. Yip: You should never feel bad about advocating for yourself. You’re not wasting anybody’s time. And if you do get checked out and everything turns out to be fine, it shouldn’t discourage you from going back again if you experience symptoms later. Something that is not an issue in one visit might be cause for concern in another.

This is a message I’d like all women to hear, especially those in menopause: Don’t talk yourself out of being seen, especially if you’re feeling symptoms that aren’t normal.

This article is for informational purposes only. It is not intended to diagnose or treat a condition. If you have questions or concerns about your specific situation or are seeking medical advice, contact your medical doctor or your healthcare provider.

A note about gender
While we use the terms "women," "female," and "men" and "male" in this article, we recognize that these terms are not inclusive of all gender identities and that the health issues addressed here may be relevant to individuals across the gender spectrum.

Waterloo Regional Health Network (WRHN) PREVENT Clinic

In alignment with our Impact Agenda¹⁵ and our commitment to sustained health and well-being, Manulife Canada is proud to support the PREVENT Clinic powered by Manulife. Located within the WRHN Cardio Pulmonary Rehabilitation, the clinic serves as a multidisciplinary, risk-factor reduction program for primary prevention of cardiovascular disease.