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Perimenopause, menopause and heart disease

Menopause (and the earlier stage of perimenopause) is an inevitable process of life for all women and is often misunderstood. Find out more about perimenopause and menopause and how they affect your heart disease risk.

Middle-aged menopausal woman in a blue shirt at home having a hot flush. She is cooling herself with a piece of paper, fanning in front of her face. With the other hand she holds her hair away from her neck.

In this article


What is perimenopause?

Perimenopause is when oestrogen levels begin to drop. Oestrogen is the primary female hormone produced by the ovaries. This can cause irregular periods.

Perimenopause can last for a few months and as long as four years. It is still possible to get pregnant. It can also be called the menopausal transition.

What are the symptoms of perimenopause?

Perimenopause symptoms include:

  • mood changes
  • changes in sexual desire
  • trouble concentrating
  • headaches
  • night sweats
  • hot flushes
  • vaginal dryness
  • trouble with sleep.

Once you have gone through twelve consecutive months without a menstrual period, you have officially reached menopause, signalling the end of perimenopause.

At what age can perimenopause happen?

It can begin in your mid-40s or later. Some women can experience perimenopause in their mid-30s. If you experience perimenopausal symptoms in your 30s, this is considered early menopause.

Signs perimenopause is ending can be difficult to pick up on. As symptoms vary from person to person, there is no way of knowing it is ending until a person stops having periods. A period that is heavier or lighter than usual may be the last, but it can be hard to tell.

Perimenopause is a process — a gradual transition towards menopause. No one test or sign is enough to determine if you've entered perimenopause.

How can perimenopause affect my heart?

The female hormone oestrogen helps to protect several different parts of our bodies, including our heart, blood vessels, and bones. It helps to protect our heart and arteries by reducing the build-up of fatty plaque inside the artery walls.

When oestrogen levels decline, it can affect our blood cholesterol levels, causing an increase in LDL (bad cholesterol), which increases our risk for heart disease.

Menopausal Hormone Therapy (MHT) is a form of oestrogen therapy that is a possible perimenopause treatment. It comes in a pill, skin patch, spray, gel, or cream. It remains the most effective treatment for relieving perimenopausal and menopausal hot flushes and night sweats. It can make a big difference in the quality of life for some women and offers some protection from coronary heart disease if started in the early years of menopause.

Can I experience heart palpitations during perimenopause?

The answer is yes!

The decrease in oestrogen levels can cause palpitations. The heart may beat faster than usual due to the changing hormone levels. Palpitations can sometimes occur when you are experiencing hot flushes.

Palpitations are usually harmless, but consult your GP (family doctor or healthcare provider) to rule out any other probable causes.

If you are experiencing shortness of breath, chest discomfort, or dizziness with palpitations, these are NOT typical signs of perimenopause - seek medical advice. 


What is menopause?

Menopause is a natural process in every woman's life when the ovaries stop producing eggs and less of the hormone oestrogen. Menstruation (periods) stops.

You are said to have reached menopause when you have had no consecutive periods for twelve months.

What are the symptoms of menopause?

In the months or years leading up to menopause (perimenopause), you might experience some signs and symptoms. These may include:

  • hot flushes (sometimes called hot flashes, a sudden feeling of warmth, usually most intense over the face, neck, and chest, with profuse sweating)
  • irregular periods (the length of your menstrual cycle or gap between your periods keeps changing)
  • vaginal dryness
  • chills
  • night sweats
  • problems sleeping
  • mood changes
  • weight gain and slowed metabolism
  • thinning hair and dry skin
  • loss of breast fullness.

Signs and symptoms, including changes in menstruation, can vary among women. You'll likely experience some irregularity in your periods before they end.

At what age can menopause happen?

Perimenopausal symptoms usually occur in a woman's 40s to 50s. The average age a New Zealand woman reaches actual menopause is 52. 

In early menopause (before the age of 40), the ovaries don't produce normal amounts of the hormone oestrogen or release eggs regularly. Infertility is common. However, it's possible a woman could still get pregnant with treatment. Symptoms include irregular periods, hot flashes, sleep problems, irritability, and infertility.

How can menopause affect my heart?

Once women's hormone levels change during menopause, women are no longer as protected from heart disease as they once were. Oestrogen levels decline, and the risk of heart disease increases.

The female hormone oestrogen helps to protect several different parts of our bodies, including our heart, blood vessels, and bones. Oestrogen offers women some protection against coronary artery disease that menopausal women don't have.

Oestrogen helps to control cholesterol levels and helps to reduce the build-up of fatty plaques inside the artery walls. Once oestrogen levels decline, a woman's risk of narrowing the coronary arteries and developing heart disease increases.

  • Cholesterol Levels: The decline in oestrogen levels can alter blood cholesterol levels, causing an increase in LDL (bad cholesterol), which increases the risk of heart disease.
  • Blood Pressure: Our blood pressure generally increases after menopause. In addition, as we get older, our blood vessels can also become stiffer, caused by high blood pressure. Our blood pressure can also increase due to increased body mass, often with extra weight distribution around the middle. This is a risk factor for having a heart attack or stroke.
  • Insulin resistance: There is evidence that the decline in oestrogen levels contributes to increased intra-abdominal fat, causing extra weight distribution around the middle. This is a risk factor for heart disease and for developing Type 2 Diabetes.
  • Heart palpitations: A decrease in oestrogen levels can cause palpitations, where the heart beats faster. Palpitations are usually harmless but consult with your GP (family doctor) to rule out any other possible causes.

If you are experiencing shortness of breath, chest discomfort, or dizziness with palpitations, these are NOT normal signs of menopause - seek medical advice.

At what age should women have a heart check?

  • Women without known risk factors – from 55 years of age.
  • Women with significant known heart disease risk factors – from 45 years of age.
  • Māori, Pacific, or South Asian women – from 40 years of age.
  • Women with type 2 diabetes – as part of the annual diabetic review.
  • Women with severe mental illness – from 25 years of age.

What is Menopausal Hormone Therapy (MHT)?

Menopausal Hormone Therapy (MHT) is one of the treatment options once menopause occurs. It can involve using tablets, creams, or patches to replace the oestrogen your ovaries are no longer making. It can also help to relieve some of the symptoms of menopause. Starting MHT during perimenopause can significantly enhance the quality of life for some women while providing a degree of protection against coronary heart disease.

Is Menopausal Hormone Therapy (MHT) safe?

MHT is safe for most women if started in their 50s or for the first ten years after menopause. If you experience early menopause before age 45, you should continue treatment until the average age of menopause, which is 52.

Different types of MHT can be associated with an increased risk of certain health conditions, such as blood clots, heart disease, stroke, and breast cancer. Different treatment options are available, and each has its positives and negatives. You should discuss your individual needs with your healthcare provider. They will be able to assess your personal risk in more detail and discuss which options are best for your circumstances.

Early menopause

If you experience early menopause (before age 40), you are at a higher risk of premature coronary heart disease. So, treatment is very important. Common treatments include MHT and the combined contraceptive pill. Discuss whether these suit you when starting treatment with your GP or other health care provider.

Menopausal symptoms or heart attack warning signs?

Heart disease is the leading cause of death in New Zealand women.

The latest Ministry of Health figures show that almost three thousand women die yearly due to heart disease. That's nearly sixty women every week or eight per day.

Women are more likely than men to experience a heart attack without chest pain or discomfort.

As women go through menopause, it is possible that their symptoms can also be misinterpreted as menopausal symptoms. There tends to be more of a delay in getting women treated because of this. Women are more likely to be misdiagnosed or under-treated than men.

For more information on heart attack warning signs for women, click on the button below.

Heart attack warning signs for women