Perimenopause + Heart Health: What does research say?

Perimenopause marks a genuine shift in cardiovascular risk for women, and the research now says it happens earlier than most people expect. A large-scale analysis published in the Journal of the American Heart Association found that perimenopausal women were twice as likely to have lower overall cardiovascular health scores compared to women still having regular menstrual cycles, with differences driven largely by changes in cholesterol and blood sugar. The transition is not just about periods and hot flashes. Your heart is changing too, and perimenopause is the window to pay attention.

Always consult your healthcare provider before starting any new supplement, especially during perimenopause or while managing a medical condition.

"The midlife transition has really been forgotten historically in women's healthcare."

— Jessica Nazzaro, DO, FACOG, NCMP, Board-Certified OB-GYN and National Certified Menopause Practitioner

Why perimenopause changes your cardiovascular risk

For most of your reproductive years, estrogen supports vascular health in several meaningful ways. It helps maintain flexible arteries, supports healthy cholesterol metabolism, and plays a role in the body's management of blood sugar and inflammation. When estrogen begins to fluctuate during perimenopause, those protective effects become less consistent.

Research from the Study of Women's Health Across the Nation (SWAN) describes perimenopause as a period of substantial alterations in cardiometabolic and vascular health parameters - shifts that correlate with future risk for cardiovascular events. This is not a distant concern. It begins during the transition, not after it ends.

A 2025 review published in PMC summarized the mechanisms: fluctuating estrogen, progesterone, and follicle-stimulating hormone levels affect vascular health, metabolism, and mental well-being simultaneously, with research finding that women in perimenopause already show early indicators of changes in blood pressure, oxidative stress, and vascular function.

What the American Heart Association found

The American Heart Association framed this directly in recent reporting: perimenopause may offer a "window of opportunity" for cardiovascular risk assessment and lifestyle intervention. Using the Life's Essential 8 health metrics framework, researchers found that perimenopausal women scored significantly lower on overall cardiovascular health compared to premenopausal peers. The biggest drivers were cholesterol and blood sugar — both of which begin shifting during the transition, not just after menopause.

The takeaway from that research is not alarm. It is action. Perimenopause is not too late. It may be precisely the right time to look closely at what you are doing to support your cardiovascular and cellular health.

The connection between NAD+ and cardiovascular health at midlife

NAD+ (nicotinamide adenine dinucleotide) is a coenzyme present in every cell, required for energy production and cellular repair. NAD+ levels decline with age, and research at the University of Colorado found that this decline may contribute to changes in vascular health in midlife and older adults.

A randomized, double-blind clinical trial published in Nature Partner Journals found that supplementation with the NAD+ precursor nicotinamide riboside (NR) was well-tolerated and effectively elevated NAD+ levels in healthy middle-aged and older adults, with exploratory analyses suggesting potential for supporting vascular function. A subsequent protocol study published in Frontiers in Cardiovascular Medicine investigated whether NR supplementation might support healthy blood pressure and arterial flexibility in midlife adults.

This is emerging science, and it is not a substitute for cardiovascular care. But it is one reason cellular energy support has become a growing focus for midlife women. our NAD+ supplement with 500 mg clinically studied NR is designed specifically for women navigating the natural decline in NAD+ levels that comes with age.†

What else supports cardiovascular health during perimenopause

Supplementation is one piece of a larger picture. The research is consistent on a few foundational habits that support cardiovascular health during the transition:

• Resistance training. Muscle mass declines with age and accelerates during perimenopause. Muscle tissue is metabolically active and plays a role in blood sugar regulation. Resistance training supports both. Dr. Tosin Odunsi, an OB-GYN, has said plainly: "As soon as somebody hits 30, I need you lifting heavy." — Dr. Tosin Odunsi, MD, MPH, FACOG, Obstetrics and Gynecology Physician
• Whole-food nutrient density. The micronutrients that support cardiovascular function, including CoQ10, B-vitamins, iron, and selenium, are most bioavailable from whole-food sources. our grass-fed beef organ complex designed for women's hormonal changes supplies these naturally occurring nutrients through a Clean Label Project Purity Award-certified formula.†
• Stress management. Chronic stress activates physiological pathways that affect cardiovascular health. The 2025 PMC review on perimenopause cardiovascular health explicitly identified stress as a key factor shaping long-term outcomes.
• Sleep. Sleep disruption is common during perimenopause and is associated with cardiovascular risk. Addressing sleep proactively, not reactively, is a meaningful intervention.

Creatine, muscle, and heart health at midlife

Muscle health and cardiovascular health are more connected than most people realize. Sarcopenia (age-related muscle loss) accelerates during perimenopause and is associated with metabolic changes that affect cardiovascular risk. Creatine supports cellular energy production and has been studied for its role in supporting muscle strength and cognitive function in midlife women.† our micronized creatine with just one ingredient is a single-ingredient, vegan, non-GMO formula designed for women. Research published in the Journal of the International Society of Sports Nutrition found creatine supplementation has shown positive effects on muscle strength and exercise performance in women across the lifespan, particularly when combined with resistance training.

How this cluster connects

Heart health is one piece of the perimenopause picture. For a broader look at what perimenopause is and when it begins, see what age does perimenopause start. For a closer look at hot flashes and what is actually happening during one, see what causes hot flashes during perimenopause.

Frequently asked questions

Does perimenopause increase heart disease risk?

Research indicates that cardiovascular health scores decline during perimenopause, with changes in cholesterol and blood sugar as primary drivers. The American Heart Association describes perimenopause as a "window of opportunity" to assess cardiovascular risk and make supportive lifestyle changes.

When does perimenopause affect heart health?

The changes begin during the perimenopause transition itself, not only after menopause is complete. Research from SWAN and other long-term studies shows that cardiometabolic markers begin shifting as early as the early-to-mid 40s for many women.

What does NAD+ have to do with heart health?

NAD+ is a coenzyme required for cellular energy production and repair. Research on the NAD+ precursor nicotinamide riboside has explored its potential role in supporting vascular function in midlife adults, though this is an active area of study and not a substitute for cardiovascular care.†

Is exercise important for heart health during perimenopause?

Yes. Resistance training in particular supports muscle mass, blood sugar metabolism, and cardiovascular function. Most experts recommend beginning or continuing strength training in your 40s as a meaningful investment in long-term health.

Can supplements support heart health during perimenopause?

Certain supplements, including those that support cellular energy and whole-food nutrient density, can be part of a comprehensive approach to health during perimenopause.† They work alongside, not instead of, medical care, nutrition, and exercise. Always consult your healthcare provider before starting any new supplement.

What is the best prenatal vitamin for perimenopause?

Prenatal vitamins are designed for pregnancy and preconception, not perimenopause. If you are navigating perimenopause, look for supplements designed specifically for midlife women, including those that support cellular energy, muscle health, and whole-body nutrient density.

† These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider before starting any new supplement, especially during pregnancy, breastfeeding, or while managing a medical condition. Keep out of reach of children.

1