Cardiovascular health and menopause: how exercise reduces heart disease risk

Menopause brings changes throughout your body, and your heart is no exception. During and after the menopause transition, shifts in hormones, cholesterol, blood pressure, blood sugar, and body composition can all affect your cardiovascular health.

Heart disease is the leading cause of death among women, so paying attention to these changes is important. “I explain to patients that while cardiovascular risk can increase around menopause, there’s a lot we can do with lifestyle to help protect heart health,” says Renee Bullis, PT, DPT, a physical therapist at Hinge Health. Staying active and getting quality sleep each night are just two lifestyle habits that can help support your heart health long-term.

Regular movement — including aerobic activity and strength training — is one of those tools. Here’s a closer look at menopause and heart disease, plus exercises and everyday habits that can help support cardiovascular health.

Why menopause affects your heart

The hormonal and metabolic changes that happen during the menopausal transition can affect several factors tied to your cardiovascular risk. Some contributors include:

• Changing estrogen levels. Estrogen plays an important role in heart health, helping support healthy blood vessels and regulate cholesterol levels. As estrogen levels fluctuate and eventually decline during the menopausal transition, these changes can contribute to an increased risk of cardiovascular disease.

• Rising cholesterol levels. You may notice changes in your cholesterol levels around menopause, even if your diet and exercise habits haven’t changed. That’s partly because declining estrogen affects how your liver processes and removes cholesterol from your blood. As a result, LDL (or “bad”) cholesterol and total cholesterol levels often rise, while healthy cholesterol (HDL) may trend downward. Over time, excess LDL cholesterol can contribute to plaque buildup in your arteries, increasing your risk of heart disease and stroke.

• Metabolic changes. Your body composition can change during midlife, with fat more likely to accumulate around your abdomen, colloquially known as “menopause belly.” This type of fat, known as visceral fat, is associated with increased cardiovascular risk. Your fasting blood sugar levels may also rise during the menopause transition, too, due to this drop in estrogen, which research shows can make you more insulin resistant.

• Blood pressure changes. High blood pressure becomes more common with age, including during the years surrounding menopause. Because high blood pressure is an important risk factor for heart disease and stroke, knowing your numbers becomes especially important during midlife.

• Early menopause. Going through menopause before age 45 is associated with higher cardiovascular risk later in life, particularly if menopause occurs before age 40. One possible reason is that estrogen levels decline earlier than usual. Estrogen helps support healthy blood vessels and cholesterol levels, so an earlier drop may contribute to changes that increase heart disease risk over time. If you experience early or premature menopause, talk to your healthcare provider about steps you can take to protect your heart health.

What heart problems does menopause cause?

Some people notice heart palpitations during the menopause transition, and hormonal changes can play a role. But new or concerning palpitations shouldn’t automatically be chalked up to menopause, especially if they’re accompanied by chest pain, fainting, shortness of breath, or other symptoms.

Other cardiovascular risk factors that can become more common during and after menopause include:

• High blood pressure

• Elevated cholesterol

• Higher blood sugar and insulin resistance

• Changes in body composition, including more abdominal fat

Regular physical activity can help improve many of these risk factors while also supporting your overall health during menopause.

How movement can help protect your heart

Movement is one of the most powerful tools available to protect your heart during menopause. “Regularly engaging in aerobic cardiovascular activity, like walking, running, swimming, or biking, strengthens your cardiovascular system and can help improve blood pressure, cholesterol, blood sugar, and endurance,” says Dr. Bullis.

Resistance training is important, too. Research has long shown that it can improve several cardiovascular risk factors, including blood pressure, blood sugar regulation, muscle mass, and body composition. 

Muscle is especially important because it helps your body use and store glucose, which supports healthy blood sugar and insulin sensitivity. Maintaining muscle can also support a healthier body composition as you age, especially as muscle mass tends to decline and abdominal fat may increase during the menopausal transition. Together, these benefits can help reduce some of the factors that contribute to cardiovascular disease.

That’s why strength training and aerobic exercise complement each other rather than compete. “The two together are key tools to manage menopause and heart disease,” explains Dr. Bullis.

How much exercise should you aim for?

The CDC recommends getting 150 to 300 minutes of moderate-intensity aerobic activity, like brisk walking or cycling, or 75 to 150 minutes of vigorous activity, like running, weekly. The guidelines also recommend strength training at least twice a week, working all your major muscle groups. 

Weight-bearing activities, such as walking or dancing, and balance exercises can also help support bone health and stability as you age. If you're not currently active, start with shorter sessions and gradually build up. Even small amounts of movement can benefit your heart.

Together, these exercises offer a mix of strength, cardiovascular activity, mobility, balance, and relaxation. Regular crescent lunges, squats, and knee push-ups maintain lower-body muscle and strength, helping you stay active as your body composition changes during perimenopause. Dynamic movements like alternating jacks add a cardiovascular challenge. Downward dog and diaphragmatic breathing can help with your overall mobility and stress management. Try doing all of these movements regularly to give your ticker some love.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for heart disease risk after menopause

Exercise is an important part of protecting your heart, but it’s not the only factor that matters. Your healthcare provider can help you understand your individual cardiovascular risk and whether you need additional treatment for conditions such as high blood pressure, high cholesterol, or diabetes. Consider the following holistic and clinical treatments:

• Try physical therapy and targeted exercises. Strengthening exercises, such as the ones above, can help support your heart by improving circulation and supporting healthy metabolism. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active. Targeted exercises like push-ups and squats can help increase your strength, but any type of regular movement — like walking, stretching, or even household chores — can improve cardiovascular health, weight management, blood pressure, and even your mood. 

• Promote quality sleep nightly. Getting enough quality sleep is important for heart health, but menopause can make that harder. Hot flashes and night sweats may wake you throughout the night, while stress and anxiety can make it difficult to fall asleep or get back to sleep after waking. Not getting enough quality sleep is linked to cardiovascular risk factors such as high blood pressure, blood sugar changes, and weight gain. Following sleep hygiene habits, such as developing a consistent sleep schedule and creating a cool, comfortable sleep environment, can help you get the restorative sleep your body and heart need. Note: If menopause symptoms are regularly disrupting your sleep, talk to your healthcare provider about treatment options. Obstructive sleep apnea risk also increases after menopause, so a sleep study may be helpful, especially if you’re not feeling rested in the morning.

• Eat for heart health. A heart-healthy eating pattern emphasizes vegetables, fruits, whole grains, legumes, nuts, seeds, fish, and other nutrient-dense foods. Focus on sustainable eating habits that support your overall health. For more personal guidance, consider working with a registered dietitian.

• Talk to your doctor about hormone therapy. Menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT), can be an effective treatment for vasomotor symptoms such as hot flashes and night sweats. As of right now, it isn’t prescribed specifically to prevent heart disease. Whether it’s appropriate for you depends on factors including your age, symptoms, health history, and how long it has been since menopause began. Talk to your healthcare provider about your individual risks and benefits.

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments such as massage or acupuncture. “These treatments may be helpful for managing stress, which is beneficial for heart disease,” says Dr. Bullis. 

How to protect your heart during and after menopause

There’s so much you can do to support your cardiovascular health throughout the menopause transition. Focus on habits you can sustain rather than trying to overhaul everything at once, such as the following: 

• Know your numbers. Keep up with recommended checks of your blood pressure, cholesterol, and blood sugar. Your healthcare provider can help you understand what your results mean for you rather than relying on a single universal target.

• Find movement you enjoy. “Consistency matters more than intensity,” says Dr. Bullis. Finding activities you actually like can make it easier to stay active over time.

• Build strength. Resistance training with your body weight, resistance bands, machines, or weights helps preserve muscle and can support blood sugar regulation, physical function, and cardiovascular health.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.