Perimenopause May Be Your Heart’s Most Critical Health Window—Here’s Why

It’s easy to think about the health problems associated with different stages of life as a problem for tomorrow. Take perimenopause, for example. It’s just a precursor to menopause. You don’t experience real health challenges until you’ve hit menopause, right? Not quite. New research shows perimenopause is not only an important life stage to keep your eye on, but it might be the most important when it comes to your heart health. Here’s why experts say this transition deserves your attention now and how to support your heart through it.

What is perimenopause?

“Perimenopause is the transition phase leading up to menopause and is your body’s way of winding down its reproductive years,” explainsEbony Nicole Parson, MD, co-owner of Femelle Gynecology and Wellness. “During this time, estrogen and progesterone levels start fluctuating in unpredictable ways, and that hormonal instability is what drives most of the symptoms women notice, [including] irregular periods, hot flashes, sleep disruption, mood changes, brain fog and changes in libido. It typically starts in a woman’s mid-to-late 40s—though some women experience symptoms in their late 30s—and can last anywhere from a few years to a decade.”

How perimenopause impacts heart health

You’ve probably heard that menopause can bring with it a lot of side effects, including an increased risk of heart disease, high blood pressure or high cholesterol levels, but you may not realize perimenopause can also have an impact.

In a new Journal of the American Heart Association (JAHA) study, researchers analyzed heart-health data from more than 9,000 women collected between 2007 and 2020 to better understand how cardiovascular health changes during the menopause transition. While average heart health declined from premenopause to postmenopause, researchers found that perimenopausal women were nearly twice as likely to have poor overall heart health as premenopausal women. They were also 76 percent more likely to have poor cholesterol scores and 83 percent more likely to have poor blood sugar scores, suggesting perimenopause is a crucial time for supporting your heart health in the long term.

Hormone shifts play a key role in heart health

Kardie Tobb, DO, MS, FASPC, FACC, a board‑certified preventive cardiologist and the medical director for the Cone Health HeartCare Women’s Heart Health and Cardio-Obstetrics Clinic, explains that the hormonal shifts during perimenopause help explain these findings.

“Fluctuating estrogen levels during perimenopause negatively affect cholesterol, insulin resistance, blood pressure and weight management,” says Dr. Tobb. “Estrogen has genuine cardioprotective properties: It supports endothelial [blood vessel] function, promotes favorable lipid profiles and regulates glucose metabolism. When its levels become erratic, we see downstream effects across multiple cardiometabolic pathways simultaneously.”

Why we should take perimenopause seriously

While perimenopause is often discussed as an afterthought compared to larger conversations around menopause, it deserves a new narrative.

“There’s a widespread cultural framing that menopause is the health checkpoint and perimenopause is just the waiting room,” says Dr. Tobb. “Women are often told, implicitly or explicitly, to get through the symptoms until they reach menopause, at which point the ‘real’ conversations about heart health will begin. That framing is not only wrong, it’s harmful.”

“By the time a woman reaches postmenopause, meaningful cardiovascular changes have already accumulated,” adds Dr. Tobb. “The lead author noted that perimenopause is ‘the critical time when the increase in cardiovascular risk seems magnified.’ Waiting for menopause to act means missing our best window. We need to reframe perimenopause not as a prelude, but as a call to action.”

How to support your heart during perimenopause

Our experts share simple tips that will set you and your heart up for success as you navigate perimenopause.

Prioritize resistance training, not just cardio

Dr. Parson says women often prioritize cardio when it comes to exercise, but resistance training is particularly important during perimenopause. “Muscle is metabolically active, which means it helps with insulin sensitivity and glucose regulation,” she adds. “As estrogen drops, women also lose muscle mass faster. Strength training is one of the most effective tools we have to counter that.” She recommends aiming for two to three resistance training sessions per week.

Get your numbers now, not later

If you haven’t done so recently, get your blood pressure checked, along with an HbA1c or fasting blood glucose test and a fasting lipid panel. “I recommend women in perimenopause get these checked at least annually, even if they feel fine. The changes happening to cholesterol and blood sugar during this transition are often silent. There are often no symptoms until there’s a problem,” she continues.

Dr. Tobb adds that a comprehensive cardiometabolic workup should also include measuring your body weight and BMI. “Catching a rising LDL or impaired fasting glucose now rather than after years of postmenopausal exposure gives us a meaningful head start,” she explains.

Take sleep seriously

“Poor sleep and heart disease are interconnected, and perimenopause is when sleep really starts to suffer [with] night sweats, insomnia [and] fragmented sleep cycles,” says Dr. Parson. “Chronic sleep deprivation raises blood pressure, worsens insulin resistance and increases inflammatory markers, all of which impact the cardiovascular system.”

Aim for seven to nine hours of sleep a night and treat sleep problems as a medical issue and cardiovascular risk factor rather than just an inconvenience.

Adopt a heart-healthy diet

“Shift toward a dietary pattern rich in vegetables, fruits, legumes, whole grains, fatty fish and healthy fats while reducing ultra-processed foods, added sugars, refined carbohydrates and excess sodium,” recommends Dr. Tobb. “The DASH or Mediterranean diet are excellent, evidence-based starting points.” Making healthy changes to your diet should be gradual and sustainable rather than drastic short-term changes.

The bottom line on perimenopause and heart health

In life, there’s beauty in enjoying where you are, and perimenopause is no exception. Rather than thinking about the life stage as a waiting period before you get to menopause, consider it as an opportunity to support your health right now.

Copyright 2026 A360 Media

This story was originally published June 26, 2026 at 6:00 PM.