If your cholesterol suddenly starts creeping up in your 40s or 50s, it may not be just your diet.

The menopause transition is associated with important changes in cardiovascular health, including changes in cholesterol, blood sugar, body composition, blood pressure, and other factors that influence long-term heart disease risk.

In fact, a 2026 study published in the Journal of the American Heart Association found that women in perimenopause were about twice as likely to have poorer overall cardiovascular health compared with premenopausal women. Higher cholesterol and blood sugar were major contributors.

In this video, I explain:

• Why cholesterol can change during perimenopause and menopause
• Why cardiovascular risk deserves more attention in women after 40
• What women should be monitoring during midlife
• How exercise, nutrition, sleep, blood pressure, glucose, and other modifiable factors can protect your heart
• What we currently know about menopausal hormone therapy (HRT) and cardiovascular health
• Why the timing of hormone therapy matters

Hormone therapy is not recommended solely for the prevention of cardiovascular disease, but research suggests that cardiovascular outcomes differ depending on when therapy is initiated. For healthy women with bothersome menopausal symptoms who begin hormone therapy younger than age 60 or within approximately 10 years of menopause, the overall benefit-risk profile is generally more favorable than when therapy is initiated later.

As a primary care nurse practitioner who has spent years caring for adults and older adults, I think midlife represents an important opportunity to identify cardiovascular risk factors early—before they become cardiovascular disease later in life.

Menopause isn't only about managing symptoms. It's also an opportunity to think about how we want to age.

This video is for educational purposes only and does not replace individualized medical care.

Maira Luettinger, DNP, APRN, AGPCNP-BC
Founder, MIDVI Health
Primary Care • Midlife & Menopause • Healthy Aging