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how hormonal milestones impact heart health
6 minute read
researchers now recognize that at least two sex-specific cardiovascular risk factors exist: one is pregnancy and preeclampsia with all kinds of hormones at work, and the other one is menopause, with hormones like estrogen going down (estrogen protects the heart).
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heart disease is the leading cause of premature death for women in canada, even more so than breast cancer or cervical cancer. heart disease claims one woman’s life every 20 minutes. yet experts say many women don’t understand their risks or take preventive action.
one factor that science is uncovering more about is hormones, the biochemicals that change throughout a woman’s life, impacting body functions, mood and emotional health. in particular, hormonal milestones like menstruation and the transitions into perimenopause and menopause affect body chemistry and the heart. as well, the dramatic hormone shifts during pregnancy, when your body is developing a fetus and preparing for labour and breastfeeding, play a role.
dr. stella daskalopoulou, cardiologist, professor of medicine and director of the vascular health unit at mcgill university health centre in montreal, has always been interested in women’s health and sex, and how sex-specific hormonal shifts impact the heart.
arterial stiffness causes heart disease
“we have seen that even atherosclerosis, which is the blockages that happen in the arteries, are different in men and women. presentation of events is different in men and women, and unfortunately, women are underrepresented in all the studies that we have. so we extrapolate from men’s evidence, and we have a one-size-fits-all approach, which nowadays doesn’t hold,” she explains. as a clinician scientist, her research focuses on the continuum from very early vascular dysfunction all the way to blockages at advanced atherosclerosis.
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the basic problem is stiffening of the arteries. normally, the arteries, particularly the central arteries like the aorta, are elastic arteries. over time, risk factors including smoking, high blood pressure, high cholesterol, diabetes and aging cause the arteries to stiffen. this is a structural issue that makes pumping blood throughout your body more difficult.
dr. daskalopoulou also points to functional problems of the arteries when the body secretes certain substances that also stiffen the arteries. this can happen in pregnancy if a woman develops preeclampsia, a condition characterized by hypertension and protein in her urine, or other hypertensive disorders of pregnancy.
“hypertension can carry over and continue after your pregnancy. and that’s why we actually see that women who had preeclampsia and hypertensive disorders get strokes, heart attacks, hypertension and diabetes within 10 years after pregnancy. their vascular system is damaged.” she calls pregnancy a “metabolic stress test” that can have serious consequences because there is nothing that changes the body as much as pregnancy.
pregnancy is a stress test
she paints a compelling picture: “in nine months, you become double the size, you have obesity, there’s so many hormones that change you, you create another life, you support another life. so there’s so much that your system takes on.”
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the stress test of pregnancy can reveal pre-existing problems or lead to hypertension, damaging the vascular system, which can later cause heart disease.
researchers now recognize that at least two sex-specific cardiovascular risk factors exist: one is pregnancy and preeclampsia, with all kinds of hormones at work, and the other is menopause, with hormones like estrogen going down (estrogen protects the heart).
while there’s emerging science, clinical practice has yet to fully address the impacts of hormonal milestones. “has your doctor ever asked you if you had preeclampsia? no, that’s the thing. but at least there is some noise about it,” she says.
dr. olexandra koshkina, an endocrinologist and hormone expert at women’s college hospital in toronto, says that hormones influence every area of the body and the way different systems and organs function. conversations about hormone health need to happen.
“the whole nature of hormones, and the human body in general, is very dynamic, so nothing is really static. everything is changing minute to minute, hour to hour. hormones play a huge part in development, so through life.”
for women, the early pivotal milestone is menstruation. during puberty, brain hormones start to signal the ovaries in women to increase production of estrogen, leading to maturation of internal organs to then allow for the beginning of a productive life of menstrual cycles, dr. koshkina explains.
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but here’s the red flag that isn’t always talked about: irregular or missed periods that can happen in adolescence and adulthood.
“for a woman or a young girl, three years after her periods start, when we expect more regular periods, having irregular periods is never normal,” she says, adding irregular periods should be investigated by your doctor for conditions like premature ovarian insufficiency or polycystic ovary syndrome that affect fertility and cardiovascular health.
a study out of the uk, published in the journal of the american heart association, found that an irregular menstrual cycle is associated with incident cardiovascular disease, long and short menstrual cycles are associated with atrial fibrillation, and a short menstrual cycle is associated with a greater risk of coronary heart disease and myocardial infarction. as the study authors note, an irregular menstrual cycle throughout the reproductive lifespan may be a previously unrecognized risk factor for atrial fibrillation over time.
“the hope is that there’s more awareness of how these conditions also influence health later in life and the importance of diagnosing it early to promote lifestyle changes and monitoring that can reduce risk of complications later in life,” says dr. koshkina. “we don’t want to over-medicalize young people and adolescents, but we also don’t want them to fall through the cracks and not be treated.”
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early menstruation can harm your heart
another problematic trend is young girls starting to menstruate earlier—this, too, can affect arterial stiffness, putting them on a trajectory for heart disease and other health issues. why menstruation is beginning earlier isn’t understood, but some experts say sexual stimulation is happening from an early age. this is not sexual touching, but the sexual stimulation from the environment, media, advertising, gaming, music and so on.
“there’s more sexual stimulation from what they see. and that could be why we have periods that come in earlier,” notes dr. daskalopoulou. “hormones are also secreted based on stimulation.”
as development is influenced by society, so too is the body and mind, starting with children. “the plasticity of the brain is different. now kids are more on their devices. so everything changes and the body follows.”
another possible link to early menstruation is childhood obesity, a growing epidemic around the world, which is associated with arterial stiffness and heart disease.
these doctors and others would like to see hormonal health conversations and monitoring start at menstruation and build from there through women’s reproductive lives into perimenopause and then menopause. all these milestones signal hormonal changes and need attention.
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perimenopause (where the ovaries gradually produce less estrogen), menopause (the phase when menstruation has stopped for a full year) and the immediate post-menopause period are important.
“mentally, we see a lot of changes with brain fog, this and that, but also think that it’s the same thing for your vascular system, for your cardiometabolic system. so there are abrupt changes with the hormones starting and stopping,” dr. daskalopoulou says, adding that arteries have estrogen receptors that are no longer optimized because of the estrogen drop. this can lead to diabetes, high blood pressure and heart disease.
while night sweats and hot flashes are certainly common symptoms, she urges women to recognize that there are hidden health risks that should be monitored.
“we are building our future for healthy aging during that period (of menopause). there is this stigma of ‘i’m getting too old, i’m done’ and we don’t talk about that. we don’t even want to admit it ourselves,” she says, pointing to the need to break down stigma and talk about menopause and how to head into post-menopause. this is where healthy lifestyle habits like regular physical activity, not smoking and minimizing alcohol will continue to pay off.
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“we are building healthy aging. and in fact, these years are the better years because before that, you have the kids, you build a career, you’re always running. you never stop to smell the roses. but understand that you need to take care of yourself because it’s money in the bank. it will show up later in your life.”
dr. daskalopoulou and dr. koshkina featured at beyond the cycle: lifelong hormonal health event by the women’s health collective canada on march 11, 2026.
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