Women in their premenopausal years experience fewer cases of cardiovascular disease than men, hinting at estrogen’s powerful cardioprotective effects. The drop in estrogen levels during menopause starts to level things out and raises the risk of heart disease — which kills 1 in 5 American women each year.
Being familiar with estrogen’s role in heart health and exploring whether hormone replacement therapy (HRT) offers protective benefits can provide valuable insights into managing these risks.
The Link Between Estrogen and Heart Health
Estrogen plays a critical role in maintaining women's health, especially when it comes to the heart. Research indicates that estrogen may help reduce cardiovascular risk by supporting the following:(1)(2)
Blood vessels
Cholesterol levels
Overall heart function
However, changes in estrogen levels — such as those that happen during menopause — can increase cardiovascular risk.
Estrogen’s Role in the Cardiovascular System
Estrogen plays a vital role in maintaining cardiovascular health through multiple mechanisms:(1)(2)(3)
Blood Pressure Control
Estrogen promotes vasodilation by helping blood vessels expand, improving circulation, and reducing strain on the heart. It also influences nitric oxide production, which aids in vessel relaxation and blood pressure regulation. Lower estrogen levels during menopause may contribute to an increased risk of hypertension.
Cholesterol and Lipid Regulation
Estrogen helps maintain a balanced lipid profile by increasing high-density lipoprotein (HDL) cholesterol and lowering low-density lipoprotein (LDL) cholesterol and triglycerides. As estrogen declines, these changes can lead to an increased risk of cardiovascular issues.
Anti-Inflammatory Effects
Estrogen has protective anti-inflammatory properties that help reduce arterial plaque buildup. However, declining estrogen levels may contribute to increased inflammation, further impacting cardiovascular health.
By supporting vascular function, cholesterol balance, and blood pressure control, estrogen plays a key role in protecting the cardiovascular system.
The Connection Between Estrogen and Heart Palpitations
Palpitations are a commonly reported menopausal symptom. Hormonal fluctuations, particularly declining estrogen levels, can contribute to heart palpitations. These sensations, often described as fluttering or racing heartbeats, can cause added stress, anxiety, and changes in heart rate regulation. While palpitations are often benign, a healthcare provider should carefully evaluate persistent symptoms.
Estrogen’s Effect on Heart Health After Menopause
Postmenopausal women experience a significant drop in estrogen levels, which can contribute to the following:(1)(2)
Increased risk of hypertension
Cholesterol imbalances
Chronic inflammation
Heart disease
Estrogen therapy (ET) may help mitigate some of these risks when used appropriately and under expert medical supervision. A European study found that estrogen replacement therapy could reduce the risk of cardiovascular disease by about 50% in those receiving treatment. However, it’s important to note that progesterone is a recommended addition to ET for patients with a uterus to prevent endometrial hyperplasia.(3)
Estrogen and Heart Disease: A Protective or Risk Factor?
Estrogen’s effects on heart disease are twofold. In premenopausal women, naturally higher estrogen levels are associated with a lower risk of heart disease due to their positive impact on blood vessels and inflammation control. However, after menopause, the decline in estrogen can lead to an increase in adverse effects.(3)Because of the risk associated with declining estrogen levels, some women may find cardiovascular benefits from receiving bioidentical estrogen therapy. However, estrogen’s benefits can vary depending on factors such as age, overall health, and how it’s administered.(2)
Estrogen Therapy to Reduce Cardiovascular Risk
HRT is continuously being studied for its potential to support heart health. Some studies suggest that HRT, more specifically ET, may help maintain cardiovascular function in postmenopausal women when initiated within 10 years of menopause onset.(2)
However, in women with existing heart conditions, the effects of estrogen therapy can be complex and may depend on factors such as dosage, delivery method, and overall health status. Research indicates that transdermal estrogen may carry lower cardiovascular risks than oral estrogen, particularly in postmenopausal women.(1)(2)
The decision to use HRT should always be based on individual risk factors vs. benefits — including personal and family history of heart disease.(3)
ETs Impact on Blood Pressure, Cholesterol, and Triglycerides
Estrogen Therapy and Hypertension
Since estrogen helps regulate blood pressure, balancing hormone levels during menopause may help reduce the risk of hypertension.
Estrogen Therapy and Cholesterol
Improving postmenopausal estrogen levels can lead to favorable changes in lipid profiles, including a decrease in “bad” LDL cholesterol.
Estrogen Therapy and Triglycerides
Estrogen helps regulate triglyceride levels in the bloodstream, supporting overall cardiovascular health.
Preventing Heart Disease After Menopause
Estrogen and heart health are deeply connected, shaping cardiovascular function in ways that influence long-term well-being. While estrogen provides protective benefits by supporting blood vessel function, cholesterol regulation, and inflammation control, its decline can increase the risk of heart disease.
Staying proactive with heart-healthy habits, discussing individualized care options with a healthcare provider, and considering evidence-based approaches, like HRT when appropriate, can help support women's long-term health. A healthy heart starts with informed choices — knowledge, action, and the right support can help keep it strong for years to come.
Can estrogen prevent heart attacks and strokes?
HRT has been studied for its potential to lower cardiovascular risk, especially when initiated during early menopause. However, its role in preventing heart attacks and stroke remains complex.(4)
Some evidence suggests that transdermal estrogen may be more favorable for cardiovascular health than oral estrogen. However, HRT is not universally recommended for heart disease prevention, and its benefits and risks depend on individual health factors.
Women with existing cardiovascular conditions should consult their healthcare provider to determine the best approach for managing heart health.
