Pre-Menopause Menstrual Cycle Length And It’s Link To Heart Disease


Cardiovascular disease is the number-one killer of women (and men). It causes one in three deaths in women each year—more than all forms of cancer combined. Nonetheless, many of us fail to recognize the risk that cardiovascular disease poses to our health.

Heart disease can affect women at any age, and it’s vital that we understand our personal risk factors and family history. According to the American Heart Association, nearly 45% of females 20 and older have some form of cardiovascular disease, and pregnancy and menopause can further increase your risk.

Even though menopause doesn’t cause heart disease, it’s at this point in midlife when our cardiovascular risk factors can accelerate. At this stage of our lives, focusing on our heart health is absolutely crucial.

Previous research published by the BMJ has shown that long, irregular cycles in adolescence and adulthood are linked to a greater risk of early death, especially as a result of cardiovascular disease. So researchers were curious to look at the relationship between heart disease and menstrual cycles during the menopausal transition—and what they found may surprise you.

A Look At The Study

As we approach menopause, the length of our menstrual cycles usually gets longer. According to a new study published in Menopause, this change in cycle length could provide some clues about our individual risk of developing heart disease.

Researchers from the University of Pittsburgh collected menstrual cycle data from 428 different women aged 45 to 52 at the time of enrollment for up to 10 years or until they were post-menopausal. They focused on changes in cycle length during the menopausal transition, then assessed cardiovascular risk after menopause by measuring arterial stiffness or artery thickness.

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The study found that those who saw an increase in cycle length two years before their final menstrual period had better measures of vascular health than those who experienced stable cycle lengths during this time.

These results indicate that differences in cycle length—along with other menopause-related characteristics and health measures—could help predict which menopausal women are at greater or lesser risk of cardiovascular disease. It could also help doctors to recommend individualized strategies for preventive care.

“Cardiovascular disease is the [number one] killer of women, and the risk significantly increases after midlife, which is why we think that menopause could contribute to this disease,” explained lead author Samar El Khoudary, Ph.D., associate professor of epidemiology at Pittsburgh’s Graduate School of Public Health, in a University of Pittsburgh news release.

“Menopause is not just a click of a button,” she continued. “It’s a multistage transition where women experience many changes that could put them at higher risk for cardiovascular disease. Change in cycle length, which is linked to hormone levels, is a simple metric that might tell us who is more at risk.”

Analyzing The Findings

The results of the study noted three distinct trajectories in the length of the participants’ menstrual cycles over the course of their menopausal transition. The majority—62%—had stable cycles that didn’t change much before they entered menopause.

Approximately 16% experienced an early increase in cycle length (five years before their final period), while 22% showed a late increase (two years before their final period).

When compared to those with stable cycles, the women in the late-increase group had substantially more favorable measures of artery hardness and thickness, which indicates a smaller risk of heart disease. Those in the early-increase group had the poorest measures of artery health.

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These results are quite surprising, given the previous research about the link between menstrual cycle length in younger women and the risk of heart disease. Earlier studies suggested that high estrogen levels may protect the heart in young women with short cycles, but apparently, that can change as we age.

“These findings are important because they show that we cannot treat women as one group: Women have different menstrual cycle trajectories over the menopause transition, and this trajectory seems to be a marker of vascular health,” El Khoudary noted.

“This information adds to the toolkit that we are developing for clinicians who care for women in midlife to assess cardiovascular disease risk and brings us closer to personalizing prevention strategies.”

El Khoudary and her team hypothesize that the different menstrual cycle trajectories during the transition to menopause reflect hormone levels. It’s possible that estrogen is less protective in older women. The researchers plan on tracking hormone changes to test that theory in their future work.

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