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Women's Metabolic Clarity · Topic 10 of 15

Heart and Bone Risk After Menopause

Menopause is a key time to protect your heart and bones.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. Why does heart risk go up after menopause?
  2. How fast do women lose bone after menopause?
  3. Does hormone therapy protect my heart and bones?
Question 28 of 45

Why does heart risk go up after menopause?

Short answer

  • Heart disease is the top cause of death for women.
  • The American Heart Association says the menopause transition is a time of rising heart risk.
  • LDL cholesterol often jumps around menopause.
  • Frequent hot flashes have also been linked to heart risk markers.

What to look out for

  • LDL or blood pressure going up.
  • Early menopause (before 45).
  • Many years of hot flashes.

Top 3 things to act on or ask your clinician

  1. Ask: 'What is my heart risk now?'
  2. Ask: 'How have my cholesterol and blood pressure changed?'
  3. Ask: 'Does my menopause history change my heart plan?'
Sources for this answer
  1. Peer-reviewed El Khoudary SR et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142:e506-e532. PMID: 33251828. DOI: 10.1161/CIR.0000000000000912
  2. Peer-reviewed Matthews KA et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?. J Am Coll Cardiol. 2009;54:2366-73. PMID: 20082925. DOI: 10.1016/j.jacc.2009.10.009
  3. Peer-reviewed Thurston RC. Vasomotor symptoms and cardiovascular health: findings from the SWAN and the MsHeart/MsBrain studies. Climacteric. 2024;27:75-80. PMID: 37577812. DOI: 10.1080/13697137.2023.2196001
  4. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  5. Expert commentary, not research Dr. Peter Attia: Outlive: The Science and Art of Longevity (book, 2023)
Question 29 of 45

How fast do women lose bone after menopause?

Short answer

  • Bone loss speeds up in the years around the last period.
  • The SWAN study found the fastest loss starts about 1 year before the final period and lasts a few years.
  • Weak bones (osteoporosis) raise the risk of breaks.
  • Strength and impact training, protein, calcium and vitamin D all play a role.

What to look out for

  • Height loss.
  • A break from a minor fall.
  • Family history of hip fracture.

Top 3 things to act on or ask your clinician

  1. Ask: 'When should I get a bone density scan?'
  2. Ask: 'What is my fracture risk?'
  3. Ask: 'What steps protect my bones?'
Sources for this answer
  1. Peer-reviewed Greendale GA et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). J Bone Miner Res. 2012;27:111-8. PMID: 21976317. DOI: 10.1002/jbmr.534
  2. Peer-reviewed The North American Menopause Society (now The Menopause Society). Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-997. PMID: 34448749. DOI: 10.1097/GME.0000000000001831
  3. Peer-reviewed US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-2531. PMID: 29946735. DOI: 10.1001/jama.2018.7498
  4. Peer-reviewed Watson SL et al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018;33:211-220. PMID: 28975661. DOI: 10.1002/jbmr.3284
  5. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  6. Expert commentary, not research Dr. Stacy Sims (exercise physiologist): Next Level: Menopause and Beyond (book, Rodale, 2022)
Question 30 of 45

Does hormone therapy protect my heart and bones?

Short answer

  • Hormone therapy helps prevent bone loss and fractures. That is in society guidance.
  • For heart health, timing seems to matter. Starting near menopause looks safer than starting much later.
  • Hormone therapy is NOT approved to prevent heart disease.
  • Your personal risk is the key.

What to look out for

  • Starting hormones many years after menopause without a risk talk.
  • History of blood clots, stroke or breast cancer.
  • Using hormones as the only bone plan.

Top 3 things to act on or ask your clinician

  1. Ask: 'Would hormone therapy help my bones?'
  2. Ask: 'How does timing affect my heart risk?'
  3. Ask: 'What are other bone options?'
Sources for this answer
  1. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  2. Peer-reviewed The North American Menopause Society (now The Menopause Society). Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-997. PMID: 34448749. DOI: 10.1097/GME.0000000000001831
  3. Peer-reviewed Manson JE et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 2017;318:927-938. PMID: 28898378. DOI: 10.1001/jama.2017.11217
  4. Expert commentary, not research Dr. Peter Attia with Dr. JoAnn Manson, The Drive #253: Hormone replacement therapy and the Women's Health Initiative (podcast episode, May 2023)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed El Khoudary SR et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142:e506-e532. PMID: 33251828. DOI: 10.1161/CIR.0000000000000912
  2. Peer-reviewed Matthews KA et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition?. J Am Coll Cardiol. 2009;54:2366-73. PMID: 20082925. DOI: 10.1016/j.jacc.2009.10.009
  3. Peer-reviewed Thurston RC. Vasomotor symptoms and cardiovascular health: findings from the SWAN and the MsHeart/MsBrain studies. Climacteric. 2024;27:75-80. PMID: 37577812. DOI: 10.1080/13697137.2023.2196001
  4. Peer-reviewed Greendale GA et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women's Health Across the Nation (SWAN). J Bone Miner Res. 2012;27:111-8. PMID: 21976317. DOI: 10.1002/jbmr.534
  5. Peer-reviewed The North American Menopause Society (now The Menopause Society). Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-997. PMID: 34448749. DOI: 10.1097/GME.0000000000001831
  6. Peer-reviewed US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319:2521-2531. PMID: 29946735. DOI: 10.1001/jama.2018.7498
  7. Peer-reviewed Watson SL et al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018;33:211-220. PMID: 28975661. DOI: 10.1002/jbmr.3284
  8. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  9. Peer-reviewed Manson JE et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA. 2017;318:927-938. PMID: 28898378. DOI: 10.1001/jama.2017.11217
  10. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  11. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  12. Expert commentary, not research Dr. Stacy Sims (exercise physiologist): Next Level: Menopause and Beyond (book, Rodale, 2022)
  13. Expert commentary, not research Dr. Peter Attia: Outlive: The Science and Art of Longevity (book, 2023)
  14. Expert commentary, not research Dr. Peter Attia with Dr. JoAnn Manson, The Drive #253: Hormone replacement therapy and the Women's Health Initiative (podcast episode, May 2023)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
← Bloodwork: What to Ask ForHormone Therapy Basics →

All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Cortisol and Stress · Brain Fog, Mood and Anxiety · Thyroid · Bloodwork: What to Ask For · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol · The Shame and Guilt Cycle, and Identity