What does the menopause do to my heart and bones in the long term?

Menopause lowers your oestrogen levels, and that has clear long-term consequences for both your heart and your bones. After menopause, your risk of cardiovascular disease rises. You gradually catch up with the risk profile of men. With an early menopause, before the age of 40, that risk is even higher. Cardiologists now regard this as an official risk signal that belongs in a cardiac check-up, alongside severe pre-eclampsia.

Women who experience frequent hot flushes and night sweats more often have higher blood pressure and signs of disrupted heart-rate regulation. Whether that directly leads to heart disease has not yet been definitively proven. But the association is present in multiple studies and strong enough to take seriously. If you have severe symptoms, discuss them with your doctor from a cardiovascular perspective as well.

For your bones the same pattern applies. Oestrogen protects bone tissue, and when it falls away, your bone density decreases. This is most pronounced with an early menopause, because you then miss years of that protection. As a result, the risk of bone loss (osteoporosis) and fractures increases considerably.

Hormone therapy is the only treatment for which a large Cochrane analysis found real evidence that it prevents fractures¹. After 5 to 7 years of therapy the number of fractures fell noticeably. However: combined hormone therapy increases the risk of heart attacks, stroke, breast cancer, thrombosis and gallbladder problems in women over 60. The absolute increase per person is small, but well established. Oestrogen without a progestogen, only possible after a hysterectomy, carries a different risk profile and actually appears to slightly lower breast cancer rates.

There are indications that starting hormone therapy early, before the age of 60 or within ten years of menopause, is more favourable for the heart^2,3,4,5. This 'timing window' is biologically plausible, but has not yet been sufficiently tested in studies specifically aimed at younger postmenopausal women. One thing is certain: hormone therapy is not a preventive treatment for cardiovascular disease or dementia. In women over 65, combined hormone therapy even increased the risk of dementia in research. Use it therefore for specific symptoms and bone protection, not as a general anti-ageing pill.