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Two Diseases That Become More Common During Menopause — and How to Lower Your Risk
Estrogen loss can affect your bones, heart and more — but preventive steps and treatment can help protect your health
Kyle Hilton
Key takeaways
- Estrogen loss in menopause raises the risk of osteoporosis and cardiovascular disease.
- Adding strength training to your workout routine can help strengthen your bones, and experts say some women may benefit from a bone scan before the age of 65.
- A heart-healthy diet, sleep and medication can help lower cardiovascular risks during menopause.
Anxiety, hot flashes and night sweats are the hallmarks of menopause. But even if your symptoms are mild, you shouldn’t ignore them. That’s because they indicate that you are losing estrogen, a natural part of aging that impacts your whole body.
“Menopause is not just the reproductive organs and ovaries. It’s a whole-body event that affects the mind, brain, sleep, heart, arteries and blood vessels, bone health — nearly every organ in the body,” says Dr. Erin Michos, professor of medicine in the division of cardiology at Johns Hopkins School of Medicine.
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Here are the surprising ways that changes during the menopause transition increase your risk of disease — and what you can do about it.
Osteoporosis
Osteoporosis occurs when bones lose density and strength, making them more fragile and more likely to break. Its link to menopause? Estrogen tells bones to rebuild, explains Katie Lavery, a certified nurse-midwife and certified menopause practitioner with Henry Ford Health in Michigan. So when estrogen levels decline, bones weaken and become more brittle.
The disease is incredibly common: About 1 in 3 women over age 50 worldwide will break a bone because of osteoporosis, according to the International Osteoporosis Foundation. Among women, fractures are more common than stroke, breast cancer, heart attacks or coronary heart disease, according to a Women's Health Initiative study from 2008. For women, bone loss and destruction of bone architecture are most rapid in the two years before and two years after your final menstrual period, says Dr. Michael McClung, founding director of the Oregon Osteoporosis Center in Portland. That’s why, he says, “We need to think about bone health before women become officially menopausal” (defined as going a full year without menstruating).
Including calcium and Vitamin D in your diet is not enough to maintain bone health, he says, citing data from the Women’s Health Initiative and the Study of Women’s Health Across the Nation. Here’s what you can do.
Get a bone density scan. Current guidelines recommend that women have their bone density tested at age 65 with a DXA scan. The test, considered a gold standard for diagnosing osteoporosis, takes about 30 minutes and is similar to an X-ray.
But 13 percent of women already have osteoporosis by age 65. So McClung recommends that women get a DXA scan much earlier than that. He suggests doing so when your menstrual cycle becomes irregular, typically defined as changes of seven days or more in your cycle’s frequency. You should also get a DXA scan if you start having hot flashes and night sweats.
Many insurance plans will cover the scan if it is ordered by a doctor, even before you’re 65, but it’s important to check your individual coverage.
A bone scan before menopause is especially important for women who are underweight, have a family history of osteoporosis, or who take steroids for conditions like a thyroid disorder or autoimmune disease, all of which put a person at higher risk of developing osteoporosis, and who might benefit from early treatment.
Not sure if you’re high-risk? Check out FRAX, an online calculator that measures fracture risk, suggests Dr. Esther Eisenberg, a reproductive endocrinologist and professor emerita at Vanderbilt University School of Medicine.
Take medication. Research shows that estrogen therapy protects against bone loss. But it takes higher doses to protect bones than to ease hot flashes, says McClung.
Bisphosphonates, a class of medications that increase bone density, also work. They are available as twice-daily pills or IV infusions.
Bisphosphonates are also important to consider after ending hormone therapy. “As is true with almost every medicine, when estrogen is stopped, then the benefits go away very quickly,” says McClung. “Within the first year, almost all of the bone density benefit and the protection from fracture is lost.”
Lift weights. “The other big messenger to bones and muscles: exercise,” says Lavery. Strength training gives muscles and bones the message “to remain strong and not atrophy.”
But, McClung cautions, exercise alone is not enough.
Cardiovascular disease
While women typically have lower blood pressure and cholesterol levels than men, this changes at midlife. That’s due in part to decreased estrogen, which affects arterial walls.
“Just like estrogen is good for the collagen in the skin, it’s protective for our arteries and blood vessels,” explains Dr. Yamnia Cortés, associate professor of nursing and director of the Cortés MenoLab at the University of Iowa. “With declining estrogen, you’ll see arteries are stiffening more.” A decrease in estrogen also triggers increases in abdominal fat, which is itself a risk for heart disease.
To maintain heart and metabolic health, Johns Hopkins University’s Michos suggests that women focus on the American Heart Association’s eight behaviors and modifiable factors associated with cardiovascular health:
- Getting seven to nine hours of sleep a night
- Exercising either 150 minutes a week at moderate intensity or 75 minutes a week at vigorous intensity
- Maintaining a healthy weight
- Keeping your cholesterol levels low
- Treating high blood pressure
- Treating high blood sugar
- Quitting smoking
- Eating a nutritious diet
But good cardiovascular health doesn’t only matter for your heart. It also reduces your risk of stroke, one of the leading causes of dementia, says Michos.Here are some tips to help with those essential eight.
Manage hypertension. High blood pressure, also called hypertension, appears to raise cardiovascular disease risk more sharply in women than men. Yet women’s hypertension remains undertreated.
To address it, try lifestyle interventions first, says Michos, who recommends keeping sodium intake under 1,500 milligrams a day, or a bit more than three-quarters of a teaspoon of salt. Doing so can have a big impact on your blood pressure, research shows.
Cutting out processed foods, which often contain considerable amounts of added salt, can help you reach that goal.
Michos also recommends increasing potassium to between 3,500 and 5,000 milligrams a day, ideally from the foods you eat. Some of the best sources are apricots, lentils, and squash.
Share your reproductive history with your clinician. Women who had high blood pressure, preeclampsia, or diabetes during pregnancy are at increased risk of these conditions at midlife. Even if the conditions “got better after birth,” Cortés says, they may have “unmasked an underlying risk that will again emerge in the menopause transition.”
But calculators meant to estimate people’s ten-year risk of cardiovascular disease often leave them out.
For that reason, “women may be higher risk than they appear,” Michos says, and may “benefit from more preventive-intensive therapies.” So even if your doctor doesn’t ask, or if it was a long time ago, tell your clinician about your reproductive history.
Eat a heart-healthy diet. Michos recommends following a DASH-style diet , which can reduce systolic blood pressure (the top number in a reading) by as much as 11 mm Hg in people with hypertension, and by as much as 3 mm Hg in people with normal blood pressure. For comparison, the average systolic reduction from blood pressure medication is around 9 mm Hg.
Overwhelmed by the prospect of big changes? In her clinic, Cortés emphasizes simple, healthy swaps. “Instead of using ground pork, use ground turkey,” she says. “Boil instead of frying. Don’t use lard — switch the oil you use.”
Prioritize sleep. Sleep disturbances play yet another role in the risk of cardiovascular disease, explains Cortés. And they’re very common: according to a 2025 review in the journal Menopause, between 40 and 69 percent of women suffer from sleep disturbances over the menopausal transition.
“If you’re not sleeping well, that’s going to lead to these increases in cardiovascular disease and weight,” says Cortés. So don’t be afraid to treat hot flashes and night sweats if they’re keeping you up. Doing so also ensures you have the energy you need for physical activity and stress management, which further protects cardiovascular health, Cortés says.
Still having trouble sleeping? Consider getting assessed for sleep apnea, a condition that becomes more common at midlife, and that’s also associated with hypertension.
Take medicine if you need it. When it comes to decreasing unhealthy (LDL) cholesterol, diet can only go so far, says Michos. Similarly, lifestyle changes alone may not be sufficient to reach blood pressure targets.
But often, she says, women are reluctant to take medication to control their lipids and blood pressure. “It’s not a personal failing” to use medication, Michos stresses.
That doesn’t mean diet and exercise don’t matter. You’re “still getting a lot of benefit even if you’re not seeing that in LDL numbers,” Michos says. Diet and exercise “reduce the risk of cancer, of inflammation.”
Care for your mental health. Cardiovascular disease risk is higher for people with depression and PTSD, among other mental health conditions. So if you are struggling, get help. Michos also recommends trying mindfulness and gratitude practices, which have been shown to improve cardiovascular health.
“Mental well-being is not just the absence of stress and anxiety, but having the positive framework” to cope with them, says Michos. “Positive psychological factors can be important buffers,” she says, such as “having a sense of purpose.”
So while we can’t avoid all stressors, “you can try to have healthy coping strategies. Those are really important to cultivate.”
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