The Cardiometabolic Effects of Menopause

Cardiovascular disease (CVD) remains the leading cause of death among women, yet CVD risk is frequently underrecognized during midlife, when the menopause transition is accompanied by significant biological changes. Emerging evidence demonstrates that menopause represents a critical window for adverse cardiometabolic and vascular changes that extend beyond the effects of chronologic aging alone. Because obstetrician-gynecologists often serve as the primary clinicians for midlife care in women, they are uniquely positioned to recognize emerging cardiovascular risk, implement preventive strategies, and coordinate care with primary care or cardiology when appropriate. This Clinical Expert Series synthesizes current evidence on menopause-related characteristics associated with CVD risk, including timing and type of menopause, as well as menopause-related symptoms, including vasomotor symptoms, sleep disturbances, and depression. We also review longitudinal data characterizing changes in lipids, blood pressure, glucose metabolism, body composition, and vascular structure and function across the menopause transition. Collectively, these data support framing menopause as a key opportunity for CVD risk identification and early intervention. Incorporating menopause-specific factors into routine CVD risk assessment may enable earlier prevention strategies and ultimately improve long-term cardiovascular outcomes for women.