Jeremy London, cardiac surgeon, on how menopause affects the heart: "Most of the impact is due to the decline in estrogen."

Women's hearts experience a turning point with the arrival of menopause . Although many women identify this stage with the end of the menstrual cycle, the hormonal changes it brings also directly influence cardiovascular health . After age 50, the risk of heart disease equals that of men, a fact linked to the decline in estrogen.

According to the Spanish Heart Foundation , women have a lower incidence of heart attacks and strokes than men before menopause. However, after hormone production ceases, this balance is lost. At age 65, the figures are comparable, and in cases of early menopause—that is, before age 45—the risk skyrockets. This is reflected in the meta-analysis published in JAMA Cardiology , which associates this condition with increased cardiovascular and overall mortality .

Cardiac surgeon Jeremy London , with over 25 years of clinical experience, explained on his TikTok account that the main trigger for these changes is falling estrogen levels. “ Most of the impact is due to the expected decrease in estrogen ,” he notes. This hormone, he details, promotes the production of nitric oxide, a substance that helps relax blood vessel walls and maintain their flexibility.

When this function is reduced, blood vessels tend to harden, which can lead to high blood pressure , one of the most significant factors in the development of heart attacks. Furthermore, estrogen acts directly on the liver by promoting the expression of LDL cholesterol receptors—known as "bad cholesterol"—which helps keep its levels low. Without this action, the risk of plaque buildup in the arteries increases considerably.

Jeremy London also warns that menopause affects other aspects of metabolic balance. The hormonal decline contributes to an accumulation of visceral fat and a decrease in glucose metabolism. This combination of factors promotes a state of chronic inflammation that can affect the cardiovascular system.

“ Estrogen is a potent anti-inflammatory , and menopause decreases a woman's ability to balance this increased inflammatory state,” the specialist explains. This can translate into increased oxidative stress and a progressive impairment of the protective mechanisms of the heart and blood vessels.

How to protect your heart after menopause

Faced with this situation, the surgeon proposes a series of strategies to reduce cardiovascular risk in menopausal women. “ A diet based on whole foods helps control systemic inflammation,” he says. He also recommends regular physical exercise to maintain muscle mass and promote a more efficient metabolism.

Another fundamental pillar is nightly rest. “ A solid sleep hygiene program is key to rest and recovery,” she emphasizes. Together, these habits can help counteract the impact that menopause has on heart health, especially in women with pre-existing risk factors or a family history. Harvard University also agrees on the need to closely monitor the cardiovascular health of women over the age of 50, noting that menopause is not only a hormonal change but also a critical stage for preventing heart disease.