A New Way to Think About Women’s Heart Health

Women are speaking more openly about periods, pregnancy, perimenopause, and menopause, bringing once-taboo topics into public conversation. Clinicians and health systems need to now connect these experiences with what the science is telling us about how they influence a woman’s cardiovascular health throughout her life.A woman may see a gynecologist for her irregular periods, a therapist for her depression, and a primary care doctor or cardiologist for her high blood pressure. Each clinician may focus on an important concern. But what is often missing is a shared understanding of how those concerns fit together and what that means for her lifelong cardiovascular health. A narrow lens has too often been applied to women’s health, defining it as care of reproductive organs and pregnancy. Reproductive health is essential to a woman’s well-being, but women’s health is much broader. We now know that menstrual patterns, pregnancy, and menopause can provide important information about cardiovascular health. Our approach to care should reflect this.These missed connections matter because cardiovascular disease is the greatest threat to women’s health today. Approximately 1 in 3 deaths in women are due to cardiovascular disease every year. Yet fewer than half of women knew that heart disease was the leading cause of death for women, according to a 2019 survey performed by the American Heart Association. As a preventive cardiologist and epidemiologist, I study how women’s life events shape cardiovascular disease risk. We now know that unique signals of cardiovascular risk in women can be identified years and decades before heart disease develops. The challenge is making sure that this information changes the care women receive.This is what led the American Heart Association to bring together the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. Our three-part series, published today in Circulation, establishes a new framework for cardiovascular health in girls and women. The papers and accompanying videos introduce the new Female Life Stage tool, provide clinical guidance, and outline how health systems can deliver coordinated care throughout life. This framework gives clinicians a shared approach to cardiovascular disease prevention across specialties, interconnected areas of health, and life stages.What one clinician learns should inform the care a woman receives in different settings and from different clinicians. For example, pregnancy can act as a natural stress test, revealing cardiovascular risks that may otherwise go unrecognized. A history of preeclampsia should inform cardiovascular preventive care long after delivery. The 2026 Cardiovascular Kidney Metabolic Syndrome Guideline now explicitly recognizes pregnancy complications, as well as premature menopause, as one of the factors that can inform personalized prevention.Menstrual cycle patterns can also provide information relevant to cardiovascular care. A first period before age 10, irregular menstrual cycles, or menopause at a younger age can each serve as signals of higher cardiovascular risk. In a study of more than 10,000 women that my colleagues and I recently published, menopause occurring naturally before age 40 was associated with an approximately 40% higher lifetime risk of coronary heart disease. Mental health is also linked to hormonal and cardiovascular health. Premenstrual syndrome (PMS) can frequently disrupt sleep, physical activity, and eating patterns, which are relevant to cardiovascular health. These symptoms are common, but being common does not make them inconsequential. Mood symptoms during the menopause transition likewise deserve assessment and treatment as part of comprehensive care. A woman and her care team need to anticipate that her health needs will change from adolescence through older adulthood. The framework defines four Female Life Stages: the transition around the first period, the years of ovarian cycling (including pregnancy), perimenopause, and postmenopause. It gives clinicians and patients a shared language for recognizing changing health needs so everyone can know what to expect, identifying cardiovascular risk earlier, and guiding prevention across a lifetime. Recognizing perimenopause as a distinct life stage acknowledges that its symptoms can disrupt daily life, persist for years, and deserve treatment. Hormone and nonhormonal treatments can help, with decisions guided by symptoms, age, cardiovascular and cancer history, and a woman’s preferences. The same visit offers an opportunity to assess cardiovascular disease risk and address changes in cholesterol and cardiometabolic health. Women may spend nearly 40% of their life in the postmenopause stage. Yet conversations of hormonal health and their enduring impact often end with the last period. Hormonal health history should continue to inform cardiovascular care. But documenting information in the medical record will not be enough. We also need to change how care is delivered.An instructive historical example can be drawn from Vienna. In 1991, an art exhibition documented the daily lives of eight girls and women, including an eight-year-old, a student, a nurse, and a retiree. This resulted in the city incorporating women’s everyday needs into urban planning, including street lighting on walking routes for women’s safety.Health care should apply this principle; women’s experiences should shape how care is organized and delivered. But this redesign must be paired with structural change that addresses the barriers, bias, and discrimination that contribute to symptoms being dismissed, delays in care, and unequal access to health care and treatment for women. A shared framework—like the one we developed—can support implementation of existing evidence, but we also need better evidence for women. In 1993, the NIH Revitalization Act made women’s inclusion in NIH-funded clinical research a requirement. Yet underrepresentation in research persists. A 2025 systematic review of cardiovascular trials registered from 2017 through 2023 found that women comprised 41% of participants but only 22% in trials studying acute coronary syndromes, including heart attacks. Women’s health research also remains underfunded, though there may be some recent signs of progress. In October, President Trump signed an executive order to create a new division for women’s health in the National Institutes of Health, but no funding has been allocated at this time. These efforts are part of a larger movement that builds on decades of public advocacy for women’s health. Since its launch in 2004, the American Heart Association’s Go Red for Women campaign has helped bring women’s cardiovascular health into public view. Melinda French Gates’ investments through Pivotal are directing resources toward understudied areas in women’s health. Katie Couric and Dawn Porter’s forthcoming documentary “HORMONAL!” will add to this momentum by sharing women’s experiences. Girls and women represent half the population, and every clinician, every specialty, and every health system has a role to play in their health. Women can do much to protect their health, but they should not have to connect the dots in their care alone.