New Joint Women’s Heart Health Guide Outlines Five Important Life Stages

Women’s health has reached another notable milestone: four major medical organizations have joined forces to publish the first unified framework and clinical guidance for women’s heart health, organized around distinct phases of life from the first menstrual period through postmenopause.

The guidance comes from the American Heart Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. Cardiovascular disease is still the leading cause of death among women, yet research has long focused more heavily on men’s symptoms and biology, which differ from women’s in many ways and have contributed to gaps in care.

The new framework is designed to close that gap. It divides cardiovascular care for women into chronological stages that reflect hormonal and biological changes, while also addressing pregnancy. By giving clinicians a shared approach, the system is intended to help identify risk earlier and prompt action before conditions become more serious.

Sadiya S. Khan, who chaired the collaborative writing group and is a professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine, said in a news release that women often receive care across multiple specialties, but that care can be fragmented. She said the new papers help providers “connect the dots” across health areas so care can begin holistically in adolescence.

Khan also said women’s heart health cannot be understood by looking only at the heart. She emphasized that it is closely tied to hormonal and emotional health.

The Stages

Stage 1: Perimenarche

The first stage covers the transition around the first menstrual period, usually between ages 8 and 15. In an essay for Time, Khan wrote that a first period before age 10 may signal a higher risk of cardiovascular disease.

Amanda Marma Perak, vice chair of the collaborative writing group and a pediatric cardiologist at Lurie Children’s Hospital, said heart health begins well before adulthood. She added that pediatric clinicians can help every girl start on strong footing and ensure that health information follows her as she grows.

Stage 2: Ovarian Cycling

This stage generally spans ages 15 to 44, when ovulation and hormone cycles become established. Pregnancy most often happens during these years.

Khan wrote for Time that premenstrual syndrome can often affect sleep, exercise, and eating habits, all of which matter for cardiovascular health. She noted that these symptoms are common, but common does not mean harmless. Heavy or irregular bleeding can also serve as warning signs. Polyendocrine metabolic ovarian syndrome, formerly known as PCOS, has been linked to a significantly higher risk of heart disease.

Stage 3: Perimenopause

This stage involves the shift from regular cycles to irregular ones, skipped periods, and hormone changes, typically around ages 45 to 51.

Khan wrote that defining perimenopause as its own life stage recognizes that its symptoms can disrupt daily life, last for years, and deserve treatment. Hormonal and nonhormonal therapies can both help, with decisions shaped by symptoms, age, cardiovascular and cancer history, and a woman’s preferences. She added that the same visit is also a chance to evaluate cardiovascular risk and address changes in cholesterol and cardiometabolic health.

Stage 4: Postmenopause

This stage begins after menopause, which is reached 12 months after a woman’s final period, and can last for about 40% of a woman’s life. It generally starts around age 51 and beyond.

The news release says most heart attacks, strokes, and heart failure events happen during this stage, but more than 80% could be prevented if action is taken early.

Pregnancy (in Any Life Stage)

The framework also treats the period before, during, and after pregnancy as a biological “stress test” that can reveal cardiovascular risks that may not have been recognized before. The release describes postpartum care as a missed opportunity for many women.

It says only about 60% of U.S. women who have blood-pressure-related complications during pregnancy get follow-up care for high blood pressure within six months after delivery, and notes that the American Heart Association is calling for immediate action to close that gap.

Khan said all girls and women deserve more healthy years to live their fullest lives, adding that improving women’s health is a shared responsibility.