Early Menopause and Heart Disease: What Studies Show
Menopause & HormonesArticleWhen periods stop early, the heart may feel it. Pooling data on 301,438 women from five regions, researchers found that menopause before 40 went with about 1.55 times the risk of a first heart attack, angina or stroke, and menopause at 40 to 44 about 1.3 times, compared with menopause at 50 or 51. Surgical removal of both ovaries added more risk, and HRT appeared to lower it. Here is what this means.
For women whose periods stop much earlier than usual, large studies suggest the change can matter for the heart, not just for hot flashes.
The big pooled study
Researchers combined data from 15 studies in Australia, Scandinavia, the US, Japan and the UK, covering 301,438 women who reached menopause naturally.1 They tracked first heart attacks, angina and strokes.1
| Age at natural menopause | Risk versus menopause at 50 to 51 |
|---|---|
| Before 40 | About 1.55 times1 |
| 40 to 44 | About 1.3 times1 |
| 45 to 49 | About 1.1 times1 |
- The link held in women who had never smoked.1
- It was strongest before age 60: about 1.9 times for menopause before 40.1
- It faded at 60 to 69 and disappeared after 70.1
When the ovaries are removed
A second analysis of 203,767 women compared natural menopause with surgical menopause, meaning both ovaries were removed.2
- Surgical menopause carried about 22% higher risk than natural menopause overall.2
- Removal before 35 carried about 2.5 times the risk of natural menopause at 50 to 54.2
- Among women with surgical menopause before 50, those who took HRT had a lower risk of coronary heart disease than those who didn’t.2
These are observational studies, so they show links rather than proof. See should you keep or remove your ovaries at hysterectomy?
What this means for you
UK health advice says it’s important to replace missing hormones if menopause starts before 45, because of the higher chance of bone and heart problems.3 The main options are the contraceptive pill or HRT.3
If your periods stopped early:
- Tell every clinician your age at menopause, and whether it was natural or surgical.
- Ask about hormone replacement, the pill or HRT.3
- Ask about heart health checks. See does menopause raise my risk of heart disease? and what early menopause is.
Try: “My periods stopped at 41. Given what’s known about early menopause and heart risk, should I be on hormone replacement, and which heart checks do I need?”
My Body Changed. Now What? covers this in Chapter 3, “Isn’t This Just Aging?,” in a section called “The Red-Flag List,” which flags periods stopping before 45, and especially before 40. Its Visit Brief puts your stage, top three changes and health history on one page, so your age at menopause isn’t missed. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Call emergency services for chest pain or pressure, breathlessness, pain spreading to the arm, jaw or back, or sudden weakness or trouble speaking. Discuss hormone treatment with a clinician who knows your history. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Lancet Public Health journal (abstract via PubMed), 2019Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data (opens in a new tab)abcdefgh
- Human Reproduction journal (abstract via PubMed), 2020Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies (opens in a new tab)abcd
- NHS, 2026Early or premature menopause (opens in a new tab)abc
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