Around 830,000 women live with coronary heart disease in the UK, and it kills twice as many women as breast cancer, the British Heart Foundation says. Before menopause, women generally have a lower risk of coronary heart disease. After menopause, that risk rises, and perimenopause is often the point when cardiovascular prevention should get more deliberate, not a phase of symptoms that leaves appointments focused only on flushes, sleep or cycles.
Why the perimenopause window matters
The menopause transition is not a single day but a stretch of time. A British Menopause Society clinician tool puts the median age of menopause at 51. It gives the transition a median length of 7.4 years and says menopausal symptoms affect up to 80% of women. That gives a long runway for blood pressure, lipids, body composition and glucose to drift in the wrong direction before anyone joins up the dots.
A 2020 American Heart Association scientific statement says the menopause transition contributes to the increase in coronary heart disease risk and that future risk assessment guidance should include menopause among cardiovascular risk factors in women. A 2021 review in the International Journal of Environmental Research and Public Health links the transition with adverse changes in lipids and vascular function, while the European Society of Cardiology has highlighted possible connections between menopause and cardiovascular health through blood-fat profile changes.
What a proper GP review should cover
A cardiovascular risk evaluation for menopausal women should cover family history, cigarettes per day, alcohol consumption, menopausal status, age, chronic kidney disease, diabetes, existing cardiovascular disease, body mass index, waist circumference, physical activity, blood pressure, SCORE rating, diet, lipid profile and blood glucose, as set out by the International Menopause Society.
A menopause-aware review should ask not only whether periods have changed, but whether blood pressure has crept up, waist measurement has widened, cholesterol has risen, or smoking and alcohol patterns are compounding risk. The follow-up assessment should revisit cigarettes per day, alcohol consumption, menopausal status, age, physical fitness, diet, BMI, waist circumference, blood pressure, SCORE rating, lipids and glucose, because risk is not static across a 7.4-year transition.
A useful UK checklist to take into an appointment is simple:
- blood pressure
- lipid profile, including cholesterol
- smoking status and cigarettes per day
- weight and waist circumference
- family history, especially premature heart disease
- blood glucose
- kidney disease, diabetes and any existing cardiovascular disease
- physical activity, diet and alcohol intake
- a SCORE-style risk discussion, not just symptom review
How NICE guidance fits in
NICE guideline NG238 covers identifying and assessing cardiovascular disease risk in adults without established CVD, and it includes lifestyle changes and lipid-lowering treatment such as statins for primary and secondary prevention. It also includes guidance for people with diabetes or chronic kidney disease, both of which matter in the menopause clinic because they can push risk higher and change how aggressively doctors should act.
NICE guideline NG23, Menopause: identification and management, sits alongside that prevention work rather than outside it. Together, the two guidelines place cardiovascular risk review alongside symptom control and hormone therapy decisions, particularly when periods are changing.
What British Menopause Society standards add
British Menopause Society practice standards say assessment should include cardiovascular risk factors such as raised blood pressure, raised cholesterol and obesity.
If symptoms affect up to 80% of women and the transition can last a median of 7.4 years, there is enough time for a routine review to catch rising pressure, worsening lipids or weight changes before a first heart event. In practical terms, that means menopause appointments should not wait until symptoms have settled to check standard risk markers.
How to use a SCORE-style risk conversation
SCORE and similar calculators estimate future cardiovascular risk using age, smoking, blood pressure and cholesterol-type inputs. In a perimenopausal review, that discussion should be grounded in the full picture the International Menopause Society sets out: family history, menopausal status, BMI, waist circumference, activity, diet, blood pressure, lipids and glucose, plus kidney disease, diabetes or known cardiovascular disease where relevant.
If you are approaching perimenopause or already in it, the useful question is not “Do I have heart disease?” but “Has my risk profile changed enough that I need earlier prevention?” That is where a blood pressure check, lipid profile and waist measurement belong in the discussion.
What to ask for now
A focused review should include a blood pressure reading, a cholesterol or lipid panel, and a discussion of weight, waist circumference, smoking, family history and glucose. If you have diabetes, chronic kidney disease, a strong family history of early heart disease, or a rising BP reading, that review becomes more urgent because NICE NG238 specifically brings those conditions into cardiovascular risk assessment.