Heart disease accounts for 21.8% of deaths in women, and the menopause transition is 'a time of accelerated underlying vascular risk.'
Dr. Rebecca C. Thurston is the associate dean for women's health research and a distinguished professor of psychiatry, psychology, and epidemiology at the University of Pittsburgh. She presented 'Menopause and women's cardiovascular health: What the SWAN data tells us' at The Menopause Society 2026 Annual Meeting, held October 20 to 24, 2026, in San Diego, California. Her talk was part of the session '30 years of SWAN: Transforming what we know about menopause,' marking its 30th anniversary. She described how hormones, vasomotor symptoms (VMS), sleep, and mood relate to women's cardiovascular health.
The Study of Women's Health Across the Nation (SWAN) has followed 3302 women since 1996. 'We're not just focusing on one bodily system,' Dr. Thurston said.
How cardiovascular health changes across the menopause transition
In SWAN, body composition changed and low-density lipoprotein cholesterol rose steeply within 1 year of the final menstrual period. Dr. Thurston grouped the contributors into 4 factors: hormonal changes, VMS, sleep problems, and mood changes. 'Menopause is more than hormones,' she said.
Why vasomotor symptoms may be a female-specific cardiovascular risk factor
More than 70% of women experience hot flashes and night sweats during the transition. African American women reported VMS most often and Chinese and Japanese women least often, but by late perimenopause at least half of every group reported them.
Analyses of earlier hormone therapy trials showed that VMS modified the relationship between hormone therapy and cardiovascular events. 'So we began by asking, what roles do the vasomotor symptoms have in women's cardiovascular health?' she said. In SWAN, women with more frequent VMS at baseline had a higher risk of cardiovascular disease (CVD) events over about 20 years. In an observational study published this year, women with VMS who started hormone therapy within 6 years of menopause had a lower risk of CVD events.
Persistent insomnia symptoms over 20 years were associated with increased CVD risk, and recurrent major depression was associated with subclinical CVD. Childhood abuse or neglect was associated with later CVD, poor sleep, and VMS. Intimate partner violence was also associated with CVD risk.
Dr. Thurston described menopause as 'a crucial, universal, multi-system transition' and VMS as one of the 'somewhat novel risk factors, female-specific risk factors for cardiovascular disease.' For women who are highly symptomatic or trauma-exposed, she would 'engage in aggressive risk factor reduction.' 'We do not yet know whether treating those symptoms will improve women's cardiovascular health,' she said, noting that a trial is underway. SWAN will continue following women with more than $44 million in National Institutes of Health funding.
Abbreviations: VMS, vasomotor symptoms; SWAN, Study of Women's Health Across the Nation; CVD, cardiovascular disease.