Another exciting step forward for women’s health: Four major health societies teamed up to create the first shared framework and clinical guidance for women’s heart health, tailored to distinct life phases — from first menstruation to postmenopause.
The much-needed update comes from the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine. Because while cardiovascular disease remains the leading cause of death in women, medical research has historically centered on men’s symptoms and physiology (which differ from women in myriad ways), thus reducing the quality of care women receive on average.
This landmark move seeks to change that. The new framework organizes women’s cardiovascular care into four chronological life stages that account for hormonal and biological transitions, plus pregnancy. In addition to getting clinicians on the same page about women’s cardiovascular health, the system and its accompanying guidance can help them identify risks earlier and take necessary action before problems worsen.
“Women experience their health care across clinical specialties, but it often is fragmented or disconnected,” Dr. Sadiya S. Khan, chair of the collaborative writing group and professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine, said in a news release. She noted that the updates, a trio of scientific papers published this week, “connect the dots” for providers across health domains, so holistic care can begin in adolescence.
Khan added that the approach emphasizes that cardiovascular health can’t be fully understood by looking only at the heart. “We need to recognize that women’s heart health is deeply interconnected with hormonal and emotional health,” she said.
The Stages
Stage 1: Perimenarche
The first stage comprises the transition that occurs around the first menstrual period, generally taking place between ages 8 and 15. In an essay for Time, Khan wrote that a first period before age 10 can serve as a signal of higher cardiovascular risk.
“Heart health begins long before adulthood,” Dr. Amanda Marma Perak, vice-chair of the collaborative writing group and a pediatric cardiologist at Lurie Children’s Hospital, added in the news release. “As pediatric clinicians, we have the opportunity to help every girl start strong and to ensure that what we learn about her health follows her as she grows.”
Stage 2: Ovarian Cycling
This stage represents the approximate ages of 15-44, when regular ovulation and hormone cycles are established. Pregnancy most often occurs during these years.
“Premenstrual syndrome (PMS) can frequently disrupt sleep, physical activity, and eating patterns, which are relevant to cardiovascular health,” Khan wrote for Time. “These symptoms are common, but being common does not make them inconsequential.” Heavy or irregular bleeding can also act as indicators. Polyendocrine metabolic ovarian syndrome (formerly known as PCOS), for example, has been associated with a significant increase in risk for heart disease.
Stage 3: Perimenopause
Stage 3 represents the transition from regular to variable cycles, skipped periods, and hormone changes, taking place around ages 45-51.
“Recognizing perimenopause as a distinct life stage acknowledges that its symptoms can disrupt daily life, persist for years, and deserve treatment,” wrote Khan. “Hormone and nonhormonal treatments can help, with decisions guided by symptoms, age, cardiovascular and cancer history, and a woman’s preferences. The same visit offers an opportunity to assess cardiovascular disease risk and address changes in cholesterol and cardiometabolic health.”
Stage 4: Postmenopause
Representing the years following menopause, which begins 12 months after one’s final period, this stage can account for 40% of a woman’s life. It occurs at approximately 51 years and older.
The news release notes that most heart attacks, strokes, and heart-failure events occur during this stage — but are more than 80% preventable when steps are taken early.
Pregnancy (in Any Life Stage)
The framework identifies the time before, during, and after pregnancy “as a biological ‘stress test’ that can identify cardiovascular risks that may have been previously unrecognized,” per the release, which highlights postpartum care as a “missed opportunity” for many women.
“Only about 60% of U.S. women with high blood pressure-related complications during pregnancy receive follow-up care for their high blood pressure within six months of delivery,” it states, noting that the American Heart Association is calling for immediate action to address that gap.
“All girls and women deserve more healthy years to live their fullest lives,” Khan said. “Advancing women’s health is a responsibility we all share.”
Share to:
