Cardiovascular health is becoming a more important part of menopause care. A peer-reviewed report published in Climacteric in February 2025, drawing on key themes from the International Menopause Society’s 19th World Congress on Menopause, highlighted the need to consider women’s reproductive history and midlife changes alongside traditional heart disease risk factors.
The report drew attention to factors such as early menopause or premature ovarian insufficiency, gestational diabetes, high blood pressure disorders during pregnancy and preterm birth. More recent International Menopause Society guidance also includes polycystic ovary syndrome and autoimmune disease as relevant considerations when assessing cardiovascular risk.
Researchers have also examined whether hot flushes and night sweats, known medically as vasomotor symptoms, may be linked to cardiovascular health. Several studies have found associations, particularly when symptoms are severe. However, this does not mean hot flushes cause heart disease, or that having them means a woman has cardiovascular disease.
Why does this matter for women?
Hot flushes and night sweats are usually discussed because of their effects on comfort, sleep and quality of life. Newer research suggests they may also fit within a wider picture of health changes during midlife.
Menopause occurs at an age when cardiovascular risk is already increasing, partly due to changes in body-fat distribution, cholesterol, insulin sensitivity, and blood pressure, which may directly influence cardiovascular health.
For some women, this may be particularly relevant when troublesome menopause symptoms occur alongside established risk factors such as high blood pressure, high cholesterol, diabetes, smoking or a strong family history of cardiovascular disease. Recognizing these factors emphasizes the importance of individual risk assessment, fostering a sense of personalized care and reassurance for women and clinicians.
Pregnancy and reproductive history can also provide useful information. Previous pre-eclampsia, gestational diabetes, preterm birth or unusually early menopause may be relevant when a clinician considers a woman’s longer-term cardiovascular risk.
What does the evidence say?
One large pooled analysis included 23,365 women from six prospective studies. Women who already had cardiovascular disease at the start were excluded. Researchers examined whether the frequency, severity and timing of hot flushes and night sweats were associated with later cardiovascular events.
After adjusting for other factors, hot flush frequency alone was not associated with cardiovascular disease. Severity appeared to matter more.
Women reporting severe hot flushes had an estimated 83% higher relative hazard of cardiovascular disease than women reporting none. Severe night sweats were associated with a 59% higher relative hazard, while severe vasomotor symptoms overall were linked with about twice the relative hazard.
These are relative comparisons between groups. They do not mean that 83% of women with severe hot flushes developed cardiovascular disease. A woman’s actual likelihood depends on her baseline risk, age, and other health factors.
A 2023 systematic review and meta-analysis of 11 prospective studies also found an association. Among women younger than 60 at the start of the studies, those with hot flushes or night sweats had a 12% higher relative risk of later cardiovascular events than women without these symptoms. In women over 60, the difference was not statistically significant.
Both sets of evidence were observational. They show associations, but they cannot prove that vasomotor symptoms directly cause heart disease. Clarifying this helps build trust and transparency with healthcare providers and women, emphasizing the current limits of scientific understanding.
What do we still not know?
The biggest unanswered question is why severe hot flushes and cardiovascular risk sometimes appear together.
Hot flushes may reflect underlying hormonal, metabolic, nervous-system or blood-vessel changes that are also linked with cardiovascular risk. Alternatively, women with severe symptoms may have other cardiovascular risk factors that partly explain the association.
Researchers do not yet know whether adding hot flushes or night sweats to formal cardiovascular risk calculators would improve prediction or prevention.
No evidence that treating hot flushes prevents heart attacks or strokes. A treatment may improve menopausal symptoms without changing long-term cardiovascular outcomes.
In the UK, NICE recommends cardiovascular risk assessment based on established risk factors and, where appropriate, QRISK3. Current NICE guidance does not say that frequent hot flushes or night sweats alone warrant cardiovascular investigation.
NICE also advises against offering combined or oestrogen-only HRT specifically to prevent cardiovascular disease. HRT may still be appropriate for menopausal symptoms after individual benefits and risks are considered.
Our take
Hot flushes should not be treated as a warning that heart disease is imminent. The more useful message is that menopause can be a good time to consider cardiovascular health as part of the whole picture, encouraging women and clinicians to feel empowered to take proactive steps for overall health.
For women with troublesome symptoms, it’s reasonable to mention them during a broader health review. It may also help to know your blood pressure, cholesterol, and diabetes risk, and to ensure important parts of your reproductive and pregnancy history are not overlooked.
The evidence suggests that severe vasomotor symptoms may be useful markers for researchers to study. It does not show that the symptoms themselves damage the heart or that every woman with hot flushes needs cardiovascular testing.
Individual risk depends on far more than menopause symptoms alone. The developing evidence supports a wider view of women’s heart health in midlife without turning common menopause symptoms into a diagnosis.
Sources
Source: Climacteric, the peer-reviewed journal of the International Menopause Society.
Original review: Simon JA, Davis SR, Lindén Hirschberg A, et al. State of the art in menopause: current best practice approaches from the IMS World Congress 2024, Melbourne. Climacteric. 2025;28(2):98–103. DOI: 10.1080/13697137.2025.2457993.
Supporting research: Zhu D, Chung H-F, Dobson AJ, et al. Vasomotor menopausal symptoms and risk of cardiovascular disease: a pooled analysis of six prospective studies. American Journal of Obstetrics and Gynaecology. 2020;223(6):898.e1–898.e16. DOI: 10.1016/j.ajog.2020.06.039.
Additional evidence: Vasomotor symptoms and risk of cardiovascular disease in peri- and postmenopausal women: A systematic review and meta-analysis. Maturitas. 2023.
UK guidance: NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238), and Menopause: identification and management (NG23).
