Later Menopause May Offer Cardiovascular Protection, New Study Suggests

Emerging evidence indicates that the age at which menopause occurs may significantly influence long-term cardiovascular health. According to a study published in Circulation Research on January 31, women who experience menopause later in life tend to have healthier blood vessels and are at a lower risk for heart attacks and strokes compared to those who enter menopause earlier.

The findings contribute to a growing body of research linking hormonal changes during menopause to cardiovascular health, and suggest that delayed onset of menopause may provide protective effects via mechanisms such as improved lipid metabolism, enhanced mitochondrial function, and reduced oxidative stress.

Study Overview and Key Findings

The study analyzed vascular health data from 92 women, including both premenopausal and postmenopausal individuals. The postmenopausal participants were categorized into two subgroups based on whether they had experienced “normal-onset” or “late-onset” menopause (defined as occurring after age 55).

Using brachial artery flow-mediated dilation (FMD) as a marker of endothelial function, researchers assessed how well blood vessels expanded in response to increased blood flow. They also examined mitochondrial function in vascular cells and measured biomarkers such as lipid profiles and oxidative stress indicators.

While all postmenopausal women exhibited worse vascular function compared to their premenopausal counterparts—a predictable result due to declining estrogen levels and aging—those in the late-onset group showed significantly less vascular deterioration. Specifically, blood vessel function in the normal-onset group was reduced by 51% compared to premenopausal participants, while the late-onset group showed only a 24% reduction.

In addition, women who went through menopause later displayed better mitochondrial efficiency, lower levels of oxidative stress, and more favorable blood lipid concentrations.

“Our data suggest that women who complete menopause at a later age have a kind of natural inherent protection from vascular dysfunction that can come from oxidative stress over time,” said senior author Matthew Rossman, PhD, from the University of Colorado Boulder.

The Role of Estrogen in Cardiovascular Health

Estrogen is widely recognized as a protective hormone for cardiovascular function. Before menopause, it helps maintain the flexibility of blood vessels, regulates cholesterol levels, and protects against oxidative damage. When estrogen production declines during menopause, this protective effect is diminished—often leading to increased blood pressure, elevated cholesterol, and heightened cardiovascular risk.

“Estrogen supports the healthy function of the coronary arteries,” said Brittany Owen, MD, a cardiologist at UTHealth Houston. “The longer you maintain estrogen production, the more resilient the arteries are to stress and inflammation.”

This aligns with prior research indicating that estrogen positively influences mitochondrial function and may reduce the generation of free radicals—unstable molecules that can damage blood vessels and other tissues. However, the exact biological mechanisms through which estrogen confers cardiovascular protection are still being investigated.

Implications for Hormone Therapy and Preventive Care

Although these findings underscore the cardioprotective role of estrogen, experts caution against generalizing the results to justify hormone replacement therapy (HRT) without further study. It remains unclear whether exogenous estrogen, such as that provided through HRT, can replicate the protective effects observed in naturally delayed menopause.

“If we can better understand the exact mechanisms behind estrogen’s role in cardiovascular protection, we may be able to develop more targeted interventions to prevent heart disease in postmenopausal women,” said Kimberly Skelding, MD, of RWJBarnabas Health.

Taking Action: Supporting Heart Health During and After Menopause

While age at menopause is largely genetically determined and cannot be modified, cardiovascular health can still be actively managed. The American College of Cardiology and the American Heart Association recognize age at menopause as a risk modifier in cardiovascular risk assessments.

Experts recommend several key strategies to protect heart health throughout menopause:

• Maintain a heart-healthy diet: Emphasize fruits, vegetables, whole grains, and plant-based proteins while reducing intake of red meat and high-fat dairy.

• Engage in regular physical activity: At least 150 minutes of moderate aerobic activity per week, combined with strength training, supports vascular health and regulates lipid levels.

• Monitor blood pressure and cholesterol: Routine screening can help identify and manage early warning signs.

• Prioritize sleep quality: Menopause-related symptoms can disrupt sleep, but good sleep hygiene—such as keeping a consistent bedtime and limiting screen time—can improve cardiovascular and metabolic health.

• Manage stress and mental health: Chronic stress is a known contributor to cardiovascular disease.

“Even if you can’t control when menopause begins, you can absolutely take steps to protect your heart,” said Nidhi Mehta, MD, cardiologist at Lehigh Valley Health Network.

Conclusion

The timing of menopause may offer valuable insight into a woman’s future cardiovascular risk, with late-onset menopause appearing to confer some degree of natural protection. As research into the physiological impact of estrogen continues, these findings highlight the importance of early prevention, personalized care, and public health awareness in addressing the growing burden of cardiovascular disease among women.