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Most women enter menopause in their mid-40s or 50s, but for those hitting this transformational life stage earlier, scientists warn there could be a heightened risk of future health impacts such as heart attacks and dementia.
One headline-making study, published earlier this month in JAMA Cardiology, found a link between natural premature menopause — referring to the end of menstrual periods before the age of 40 — and a 40 per cent greater lifetime risk of coronary heart disease.
Entering menopause early may also increase the risk of Alzheimer’s disease. And it’s long been known that the earlier menopause occurs, the earlier this major hormonal shift will impact someone’s bone density, hiking the risk of osteoporosis.
Is any woman who goes through early menopause doomed to have brittle bones or a heart attack? No. Still, researchers say the elevated risks are real, even though the mechanisms at play aren’t fully understood.
“The changes in the circulation of different kinds of hormones affects all of these different body systems, which then can have an impact on your brain health, and on your sleep, and on your diet, and on your bones,” said Allison Sekuler, president and chief scientist at the Baycrest Academy for Research and Education and a professor at the University of Toronto.
Some individuals who go through premature menopause naturally — or experience a sudden surgical menopause — may endure severe side-effects, like hot flashes, sleep disturbances and night sweats far earlier as well, which could have a ripple effect on their broader health.
“And so you just have more decades, more years, where you are in this kind of critical period for increased risk if you don’t address it in the right way,” Sekuler warned.
Women can counter the hike in risk through healthy habits or, in some cases, hormone therapy, as scientists say long-term health issues after early menopause aren’t inevitable — and may even be preventable.
New research out of Northwestern University found that women who experienced premature menopause, meaning before the age of 40, had a 40 per cent higher risk of a heart attack. Doctors say this study adds to evidence that more research and education about women in this age group is needed.
Links between menopause, health risks not fully understood
Menopause is a natural biological process for roughly half the world’s population, marked by the end of someone’s menstrual periods and fertility, and preceded by a stretch of fluctuating hormones and irregular periods known as perimenopause that can last for years.
The number of women who actually experience an early, permanent end to their periods is relatively small. It’s thought that less than four per cent of women experience premature menopause in their 30s, while only about five per cent more enter menopause up to the age of 45, with the majority of individuals experiencing it at some point between 45 and 55.
When it comes to the impact of premature, natural menopause on heart disease, the latest research in JAMA Cardiology showed a striking spike in risk among both white and Black women — who are three times more likely to enter menopause early in the first place.
The study didn’t pinpoint a clear mechanism or cause, but lead author Dr. Priya Freaney, an assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine, suspects a combination of social, environmental and health factors are at play.
She said further studies are needed to probe how an earlier loss of estrogen — which permanently drops through menopause — could shift someone’s odds of developing heart attacks or heart failure down the line.
Researcher Glen Pyle, who runs the Laboratory for Women’s Heart Health at the University of Guelph in Ontario and who was not involved with the study, praised the research for a “significant finding” that suggests both a major increase in cardiovascular disease risk and a decades-long period where women could benefit from better monitoring.
The study also controlled for factors like high blood pressure and high cholesterol, which could contribute to someone’s risk level, suggesting premature menopause itself is a contributor to heart disease, Pyle noted.
“How this happens,” he added, “is not well understood.”
It’s a similar situation when it comes to eye-catching findings about the links between early menopause and the development of Alzheimer’s disease, the most common cause of dementia.
Entering menopause earlier may be tied to faster cognitive decline and a higher risk of Alzheimer’s, according to Canadian research from 2025. Another recent analysis from a different Canadian team showed women who had early surgical menopause, caused by having both ovaries removed, were four times more likely to develop Alzheimer’s when compared to those who had natural menopause later on.
Yet the reasons why still aren’t clear, multiple experts stressed, since menopause — and early menopause in particular — remains understudied.
“What is the mechanism?” questioned Sekuler. “Because if you can understand the mechanism better, maybe there’s a way of fine tuning the treatments you need at an earlier stage.”
Can breaking a sweat help cool your hot flashes? Amy Bell’s series “Hot and Bothered” takes a look at how exercise can help your hormones during perimenopause and menopause.
Early menopause not ‘nail in the coffin’
These signals of increased risk also don’t mean post-menopause health issues are inevitable. And, several researchers agreed, issues like dementia or heart disease may be somewhat preventable.
“It comes across as just a nail in the coffin: Anyone who has an early menopause is going to get a heart attack. And that’s not correct,” said Dr. Jerilynn Prior, a longtime researcher on menopause and a University of British Columbia professor emeritus.
She questioned how much timing plays a role in developing long-term health impacts, compared to the severity of menopause side-effects. Night sweats, hot flashes, insomnia — the most severe menopause-related effects, which often strike early on as hormones start to shift dramatically — are more than just unpleasant, Prior explained.
“These are whole body disruptive experiences that carry higher stress hormone levels, and that have been associated very consistently, and very dramatically, with an increased risk of [heart disease],” she said.
Sekuler agreed that future research needs to untangle the impact of menopause timing alongside side-effect severity, given how damaging years of lost sleep and fever-like sensations can be for women’s health.
The Early Edition7:48Hot and Bothered series: Staying strong through perimenopause and menopause.
CBC’s Amy Bell works out with fitness trainer Lindsay Honey and discovers out how important exercise can be in perimenopause and menopause.
“When you think about what happens in standard menopause, you kind of get a hint of what’s happening, but just on a bigger, longer time frame with early menopause,” she said.
Restful sleep is important to give the brain a chance to renew itself, Sekuler added. She likened it to a dishwasher rinse cycle, flushing out toxins overnight.
“We also know that if you’re not getting enough sleep, then you’re going to have additional cognitive issues and physical issues — so it’s intertwined,” she continued.
“If you just feel crappy, you’re not going to want to go out and exercise, you’re not going to want to take the time to go shopping and make a healthy meal, you’re not going to want to go out and socialize with your friends. And loneliness is … one of the most significant risk factors for dementia.”
Many of those risk factors are within women’s control, all the ups and downs of menopause aside.
Reducing stress, staying cognitively engaged, avoiding alcohol and cigarettes, and getting your hearing and vision checked — and treated, if needed — are all ways to keep your brain sharp and ward off dementia, Sekuler said. Fitness and diet matter as well, both Sekuler and Prior noted, with clear, long-term benefits for both your brain and your heart.
Perimenopause and menopause can bring plenty of physical symptoms, but what about the mental and emotional toll? CBC’s medical columnist Dr. Melissa Lem explains what’s happening in a woman’s body that affects their mental health.
Hormone therapy may be an option
In cases where women are struggling with severe side-effects as they head into menopause, hormone therapy is also an option.
It’s worth speaking to your primary care provider about the best approach, since for decades, research and messaging has flip-flopped regarding who should actually get hormone therapy, and whether it’s worth any potential health risks.
“Women’s health is not as well investigated or understood or cared about, frankly, as men’s health issues,” Sekuler said. “And so we really are in the earlier stages of understanding what’s happening in menopause and what’s the right way to treat it.”
Freaney, from Northwestern University, agreed. “Women have been vastly understudied in cardiovascular science for decades, so we have lots to learn.”
Still, she said findings like hers should give physicians pause — even if they don’t tell the whole story behind what exactly leads women to experience heightened risk.
“If you can understand a woman’s risk for heart disease over the course of her whole life early, then you can … develop a prevention plan earlier,” Freaney said.
