Table of contents
Women's hearts beat differently – and are often overlooked
The numbers speak for themselves: According to the Federal Statistical Office, approximately 180,000 women die from cardiovascular diseases in Germany each year – making it the most common cause of death among women, far ahead of breast cancer. Yet while we all undergo regular breast screenings, very few regularly monitor their blood lipid levels or blood pressure.
Fact : Women under 55 have a 2-3 times higher mortality rate after a heart attack than men of the same age. The reason? According to the German Society of Cardiology, women more often exhibit different symptoms and receive medical attention an average of one hour later.
Menopause plays a crucial role in this: During the fertile years, the hormone estrogen protects the heart. With the onset of menopause, this protection gradually decreases. The consequences: higher blood pressure, lower cholesterol levels, and an increased risk of atherosclerosis.
In short : After 40, your cardiovascular system undergoes fundamental changes. Time to not only look at your breasts, but also listen to your heart!
Heart in transition - what changes after 40
Estrogen is not only responsible for fertility and the menstrual cycle – it also has a massive protective function for the heart and blood vessels . It:
Expands blood vessels , keeps them elastic and regulates blood pressure
Increases “good” HDL cholesterol and lowers “bad” LDL
Prevents arteriosclerosis through its anti-inflammatory effect
When your hormone levels begin to change, this also has a direct impact on your heart. The once-reliable protective shield of estrogen disappears, and your cardiovascular system suddenly has to adapt. This transition brings with it some challenges—but if you understand them, you can play an active role in shaping them.
Stiffer arteries & rising blood pressure
Estrogen promotes the production of nitric oxide (NO) – a molecule that relaxes blood vessels and is important for their elasticity.
If estrogen levels drop, NO decreases → the vessels stiffen, blood pressure rises.
High blood pressure is so insidious because many people don't notice it until it's too late—namely, when a secondary condition, such as a stroke or heart attack, has occurred.
Did you know? Women after menopause have twice the risk of high blood pressure as before.
Cholesterol explosion & atherosclerosis – Why your blood vessels are now more at risk
Estrogen keeps your blood lipids in balance: more "good" HDL cholesterol, less "bad" LDL cholesterol . But with menopause, this balance is thrown off track:
HDL decreases, and with it the protection of your arteries. LDL increases and can build up on the artery walls.
The result? LDL can oxidize in the arteries and trigger inflammation. This causes plaques to form that narrow the vessels ( atherosclerosis ). If one of these plaques ruptures, it can lead to a heart attack or stroke .
Therefore, it is now important to have your blood lipid levels checked regularly
Out of rhythm - cardiac arrhythmia
Many women suddenly notice unusual heart rhythms during menopause—their heart beats faster, irregularly, or even stops for a moment. This is often due to declining estrogen levels, which affect not only the blood vessels but also the heart's electrical control .
The heart beats due to electrical impulses generated in a special area of the heart (sinus node) and transmitted in a specific sequence. Estrogen stabilizes this process. If estrogen levels drop, the transmission of the impulses can be disrupted—the heart beats irregularly or faster than usual .
Possible consequences:
Extrasystoles (extra heartbeats) that feel like a “skip” or “flutter”
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Atrial fibrillation , in which the heart beats uncoordinatedly – if left untreated, this can lead to blood clots and strokes
Permanently elevated pulse , which overloads the heart and can weaken it in the long term
Fact: Women have a three times higher risk of sudden cardiac death after menopause than before.
Physical warning signals – When you should especially listen to your heart
Your heart often sends subtle warning signals long before things get serious. Especially during menopause, your body changes—and your heart could be giving you small but crucial signs that it needs support. Women often experience heart problems differently than men, which is why many warning signs go unnoticed. Let's change that!
You should take these symptoms seriously:
Unusual exhaustion – Do you suddenly feel completely drained after a normal day? When your heart is no longer pumping enough blood to your body, your organs lack oxygen, leading to fatigue and weakness. Women with heart problems often report feeling unusually exhausted even after simple activities like shopping or housework.
Shortness of breath during light exertion – climbing stairs or walking. Does walking suddenly feel strenuous? Your heart may be struggling to transport enough oxygen. This could be a sign of heart failure or narrowed coronary arteries (CAD) .
Heavy legs or swollen feet – Water retention (edema) that worsens throughout the day may indicate that your heart is no longer working efficiently. Blood is pooling in the veins, especially in the legs.
Sudden dizziness or lightheadedness – Do you feel faint, shaky, or like you're about to pass out? This could be related to an irregular heartbeat or low blood pressure . Your brain is then not getting enough oxygen.
Nausea, stomach pain, or pressure in the upper abdomen – women often mistake a heart attack for gastrointestinal problems! A persistent feeling of fullness, nausea, or unpleasant pressure in the stomach area can be signs that your heart isn't getting enough oxygen.
Heart attacks develop differently in women than in men! Instead of stabbing chest pain, fatigue, shortness of breath, and nausea are often the main symptoms.
Important: If you notice several of these symptoms, don't wait! It's better to see a doctor once too often than once too little. Your heart is worth it.
How to protect your heart during menopause
Exercise – your heart muscle needs training!
Regular exercise improves circulation, lowers blood pressure, and keeps your blood vessels elastic. But it all depends on how you exercise :
Strength training – protects blood vessels, lowers LDL cholesterol and improves insulin sensitivity.
HIIT (high-intensity interval training) – helps reduce visceral fat, which puts strain on the heart.
Daily walking & endurance training – reduces stress hormones and lowers the risk of high blood pressure.
Important: Even if you've been taking it easy so far, now's the time to add a little more activity to your life. Even small changes, like taking daily walks or taking the stairs instead of the elevator , make a difference. Your heart is a muscle—and every muscle gets stronger when you train it. Start at your own pace, but start!
Nutrition - your heart eats with you
An unhealthy diet is one of the biggest risk factors for cardiovascular disease. According to a study, one in three deaths in Europe due to cardiovascular disease is due to poor nutrition. But the good news is: With the right diet, you can actively protect your blood vessels, reduce inflammation, and strengthen your heart.
What matters:
Good carbohydrates – your fuel for stable energy
Carbohydrates aren't inherently bad—it depends on which ones you choose. Complex carbohydrates from whole grains, quinoa, legumes, and oatmeal help stabilize blood sugar levels and prevent blood sugar spikes that can cause long-term damage to blood vessels.Fiber – Underestimated Heart Protectors
Fiber lowers cholesterol, promotes healthy intestinal flora, and keeps blood vessels flexible. Cruciferous vegetables such as broccoli, cauliflower, and Brussels sprouts , which also contain anti-inflammatory substances, are particularly valuable during menopause.Healthy fats – good for your blood vessels
Fats are not the enemy—quite the opposite! Unsaturated fatty acids such as omega-3 fatty acids from fish and flaxseed, for example, have anti-inflammatory effects and protect blood vessels from plaque buildup. Olive oil, avocados, and nuts are also valuable heart protectors.Protein – Essential for your heart and muscles
Protein is important not only for muscle growth, but also for vascular health and blood pressure . Choose lean protein from fish, legumes, poultry, and fermented dairy products like yogurt or kefir.
Important: Avoid processed foods, sugar and trans fats – they promote inflammation and increase the risk of cardiovascular disease.
Your diet can be a game changer for your heart. Every bite counts! Start with small changes – your heart will thank you.
Support – simple and effective
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Know your values
A strong heart requires attention – and that means keeping an eye on your heart rate. Regular checkups help you take early action and provide optimal support for your heart.
Blood pressure – Healthy blood pressure protects your blood vessels and relieves strain on your heart. Have it checked regularly, especially if you frequently suffer from dizziness, headaches, or heart palpitations.
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Cholesterol levels – Elevated cholesterol levels don't hurt – but their consequences are all the more dangerous. Many cardiovascular diseases develop gradually over decades without being noticed. Therefore, it's crucial to have your blood lipid levels checked regularly.
Blood sugar – A stable blood sugar level is essential for your heart health. Fluctuations or persistently elevated levels can damage blood vessels and increase the risk of cardiovascular disease. Women with diabetes have an even higher risk of heart disease than men with diabetes. Therefore, we should do everything we can to prevent it!
Good sleep – balm for your heart
During sleep, our body undergoes important regenerative processes that are essential for heart health. Healthy sleep helps the body recover, and the heart directly benefits.
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Blood pressure regulation : During the night, heart rate and blood pressure decrease, which relieves the strain on the cardiovascular system.
Stress reduction : During sleep, stress hormones such as cortisol are reduced, which helps to relax the blood vessels.
Vascular health : Cellular repair processes and anti-inflammatory activities are particularly active during sleep, which promotes blood vessel health.
Blood sugar regulation : Restful sleep optimizes sugar metabolism, which reduces the risk of diabetes and related heart problems.
Broken hearts are real – When emotions become a burden on your heart
Why is stress so dangerous for your heart?
Your body doesn't differentiate between mental and physical stress. It always activates the same survival mechanisms —and these can become dangerous in the long run:
Cortisol and adrenaline : These stress hormones put your body on constant alert. Your blood pressure rises, your heart rate increases, and your blood vessels constrict.
Blood sugar spikes & insulin resistance : Chronic stress causes your blood sugar levels to rise, which in the long term damages your blood vessels.
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Muscle loss & visceral fat : High cortisol levels attack your muscle mass, while fat accumulates exactly where it harms your heart the most – your belly.
Loneliness as an underestimated danger : A lack of social ties increases the risk of a heart attack by almost 30% – in terms of health, this corresponds to the effect of smoking 15 cigarettes a day .
How to protect your heart from emotional overload:
Focus on stress management! Yoga, meditation, or breathing techniques help regulate your cortisol levels.
Social connections are medicine. People with stable relationships are proven to live healthier and longer lives. So, nurture your friendships. And if you also make friends with a dog, you're doing something good not only for your soul but also for your heart. Pet owners have a lower risk of heart attack.
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Love is good for the heart. Touch, kisses, and sex release oxytocin —a hormone that lowers heart rate, stabilizes blood pressure, and even has anti-inflammatory effects.
Bottom line: Your heart doesn't just beat for you—it also beats for those close to you. Protect it by taking stress seriously, maintaining emotional balance, and surrounding yourself with people (or animals) who are good for you.
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Conclusion: Listen to your heart!
Perimenopause is a period of hormonal change and a time in which your heart deserves renewed attention. The good news: You can actively influence it. Exercise, a healthy diet, good sleep, and emotional balance aren't just nice-to-haves, but essential building blocks for your heart health.
Start small – but start! Every positive change, whether it's a daily walk, more healthy fats on your plate, or taking conscious breaks in your daily routine, strengthens your heart.
Listen to your heart – in every way! Whether physically through regular checkups or emotionally through healthy relationships – your heart is not just a muscle, but also your most important life center.
It's never too late to protect your heart! Proper prevention can significantly reduce your risk of cardiovascular disease.
So: Live, love and take good care of your heart – it beats for you.
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Frequently asked questions about heart health during menopause
Why does my blood pressure rise after menopause?
As estrogen levels drop, blood vessels lose elasticity. This means that resistance in the arteries increases – and with it, blood pressure. In addition, metabolic changes affect the cardiovascular system, increasing the risk of hypertension.
What role does nutrition play for my heart?
A heart-healthy diet is essential for regulating cholesterol levels, reducing inflammation, and maintaining stable blood sugar. Complex carbohydrates, healthy fats, fiber, and protein are particularly important .
How do I know if my heart is suffering from stress?
Physical symptoms such as heart palpitations, rapid pulse, sleep problems, exhaustion, or chest tightness can indicate stress-related strain on the heart. Emotional stress can also affect the heart – for example, through broken heart syndrome, which, under extreme stress, can trigger symptoms similar to a heart attack.
What can I do if I haven't done much exercise before?
It's never too late to start! Start with small steps: daily walks, taking the stairs instead of the elevator, or doing some light yoga exercises. Your heart is a muscle—and like any muscle, it gets stronger when you exercise it regularly. Most importantly, start at your own pace.
Dr. Catharina Hamm
Specialist in internal medicine and cardiology
As a cardiologist, I see every day how often women's heart health is underestimated – especially around menopause. I know how important it is to identify female risks early and take symptoms seriously. Therefore, I want to encourage women to actively shape their heart health – with clarity, responsibility, and the knowledge that prevention is the strongest heartbeat.
