Overlap Between Heart Failure and Menopause: Diagnostic Challenges and Clinical Implications

Heart failure and menopause commonly coexist in middle-aged women, but overlapping symptomatology often complicates diagnosis. Moreover, physiological changes during menopause and normal ageing can predispose patients to cardiac symptoms and cardiovascular disease. Oestrogen exerts cardioprotective effects through anti-inflammatory and vasodilatory pathways and its decline has been proposed as a mechanistic explanation for myocardial fibrosis and diastolic dysfunction. Epidemiological studies consistently show that early menopause independently predicts incident heart failure with a graded increase in risk at younger ages of onset. Despite this, many traditional symptoms during the perimenopausal period including fatigue, shortness of breath, sleep disturbance, and palpitations may represent unrecognised cardiac pathology. Heightened awareness of this overlap is essential for timely identification and management. Objective investigations including natriuretic peptides, echocardiography, electrocardiography, and chest X-ray remain reliable diagnostic tools in this group. When identified, both heart failure and menopause can be treated independently with guideline directed therapies. This review synthesises current evidence on the intersection between menopause and heart failure, elucidates shared pathophysiological mechanisms, and proposes strategies to enhance diagnostic accuracy and therapeutic decision-making in perimenopausal women.