Women Who Reach Menopause Before Age 40 Face Higher Risk for Future Heart Disease

Could premature menopause be a predictor of heart trouble? New research hints at a link.

Women who reach menopause, defined as no menstrual periods for 12 consecutive months, before they reach the age of 40, have as much as a 40 percent increased risk of developing coronary heart disease compared with women who don’t go through the transition early, according to preliminary research presented on May 20 at the American Heart Association’s Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Conference 2021.

“Premature menopause was independently associated with a higher long-term risk of coronary heart disease, even when adjusting for major risk factors for heart disease,” says Priya M. Freaney, MD, a third-year cardiology fellow at Feinberg School of Medicine at Northwestern University in Chicago and lead author of the study.

What’s more, Black women were shown to be more 3 times more likely to experience early menopause than white women.

Black Women Are More Likely to Have Premature Menopause, And the Potential Risks That Come With It, Compared With White Women

While early-onset menopause was associated with future heart risks for all research subjects, a marked racial difference emerged. A total of 3522 Black women and 6514 white women were included in the analysis; early menopause occurred in 15.5 percent of Black women and 4.8 percent with white women.

The disparities between when Black women and white women go through premature menopause are striking, says Dr. Freaney. “We need to further study social determinates of health, systemic, and structural racism and get a better understanding in order to address those factors to try to get to the root of these disparities,” she adds.

Racial Differences in Early Menopause Have Not Been Highlighted Before

This aspect of the study shows a significant racial difference that hasn’t been brought out in other research on premature menopause, according to Stephanie S. Faubion, MD, the director of the Center for Women’s Health at the Mayo Clinic in Rochester, Minnesota, and the medical director of The North American Menopause Society (NAMS). Dr Faubion was not involved in the research.

Researchers Took a Long Term Look at Timing of Menopause and Heart Health

“Our goal was to assess how timing of menopause is associated with coronary heart disease or coronary artery disease, which is the buildup of plaque in the arteries that surround the heart,” Freaney says. Earlier research has shown an association between early-onset menopause and coronary heart disease (CHD), and menopause before 40 was classified as a risk enhancer for CHD in the 2019 AHA-ACC Primary Prevention guidelines. However, previous studies looked at the short term development of disease; this new study followed women for decades: Enrollment began in 1964 and follow-up lasted through 2017.

Most women reach menopause between the ages of 40 and 58, and the average age is 51 years old, according to NAMS.

To explore whether going through premature menopause would be associated with the same long-term burden for both Black and white women, researchers pooled data from postmenopausal women between the ages of 55 and 69 years old from six U.S. population-based groups. Then, to see if Black women and white women who go through premature menopause have similar increased lifetime burden of coronary heart disease, researchers compared women of the same race.

Black women who went through menopause before age 40 were compared with Black women who went through menopause after 40, and white women who experienced premature menopause were compared with those who did not go through menopause prematurely.

After controlling for major risk factors which included age, smoking, education level, obesity, high blood pressure, and type 2 diabetes, both Black and white women who experienced premature menopause had a 40 percent higher risk of developing CHD than those of their race who did not. Yet Black women were shown to be 3 times more likely to have premature menopause than white women.

Why Do Black Women Experience Early Menopause More Often Than White Women? Further Study Is Needed

“Right now, we don’t know why this difference exists. Is this purely related to genetics or could it be other factors such as economic and healthcare inequities?” says Dr. Faubion. “This finding drives home the point that we can’t assume that everybody is the same,” she stresses. It highlights why it’s so important to include all races and ethnicities in research in order to determine who is a higher risk for different diseases so that we may individualize and personalize recommendations, she adds.

Is Menopause Before Age 40 a Marker of Other Health Problems?

While this research indicates that premature menopause is associated with higher lifetime risk of coronary artery disease, it’s important to note that these results don't mean that premature menopause is causing that risk, Freaney stresses. “It could be that premature menopause is a marker; that question still has to be answered,” she notes.

A marker is something that can indicate the presence or increased probability of a disease or condition but isn’t what is actually causing that disease or condition. “Early menopause may be a sign that other areas of your health need to be investigated and more closely managed,” says Freaney.

Findings May Help Improve How Cardiac Risk Is Assessed in Women

These findings add to what we already know about early menopause and cardiovascular risk, says Laxmi Mehta, MD, professor in the division of cardiovascular medicine and director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus. Dr. Mehta was not involved in this research.

Since the recent 2019 primary prevention guidelines were released and premature menopause was added as a risk enhancer for coronary heart disease it’s helped to get physicians to start asking the question, ‘At what age did you go through menopause?’” says Mehta.

Findings Could Create New Opportunities for Improving Women’s Heart Health

These women were often not getting needed interventions or management of risk factors until they were older, and so this is important data to have, Mehta adds.

This study and others like it may help us further improve our ability to identify and estimate cardiovascular risk in women, says Faubion. “We are still using male calculators to determine cardiac disease risk in women,” she says.

Although premature menopause has now been identified as a risk enhancer, which means that it needs to be taken into account, it isn’t actually part of the formula for determining risk, she notes. “What we really need to do is to come up with a better calculator for women,” says Faubion.

Potential Reasons for Increased Heart Risks With Early Menopause

The increased likelihood of CHD in women who went through premature menopause could also be due to the cumulative effects of living with cardiac risk factors such as hypertension or diabetes for several years, says Freaney. Although the study controlled for those factors during the study when the women were in their fifties and sixties, the women who experienced premature menopause could have developed those health issues much earlier in life, she points out.

Woman and Their Doctors Should Discuss Age of Menopause

“The key takeaway here is that we need to be asking our patients about their menopausal history way earlier so that we can be proactive about investigating and modifying their cardiovascular risk factors to help them stay healthy over the next many decades,” says Freaney. If women have experienced menopause before age 40 and their doctor doesn’t ask about it, they should feel empowered to initiate the conversation, she adds.