Women with Premature Menopause Face Greater Cardiovascular Risks, Study Finds

New research is shedding light on a significant association between premature menopause and increased cardiovascular disease risk.1

The data were presented at the 9th Annual Heart in Diabetes Conference by Abena Korwaa Agyekum, MD, an internal medicine resident at SUNY Downstate, and suggest the importance of cardiovascular risk assessment and prevention in this patient population.1

According to the OASH Office on Women’s Health, the average age for menopause in the United States is 52. Early and premature menopause occur when ovaries stop making hormones and periods stop at a younger age than usual, usually attributable to family history, smoking, chemotherapy or pelvic radiation treatments for cancer, surgery to remove the ovaries or uterus, and certain health conditions like rheumatoid arthritis and chronic fatigue syndrome.2

While some women who go through menopause early or prematurely may have symptoms or health problems similar to those of regular menopause, others may also have severe menopause symptoms, sadness or depression and a heightened risk of serious health problems, including osteoporosis and heart disease.2

“Premature menopause affects approximately 1% of women under 40 years of age and may increase cardiovascular risk but specific outcomes remain incompletely characterized,” Agyekum and colleagues wrote.1

To address this gap in research, investigators compared mortality and cardiovascular events between women with premature menopause and age-matched controls using TriNetX Research Network data. The study population included women with premature menopause, identified using ICD-10 codes, and age-matched controls without premature menopause. In total, the propensity-matched cohorts each included 9245 participants.1

The primary outcomes were all-cause mortality, heart failure, arrhythmias, cerebrovascular events, and other cardiovascular complications, which were assessed during a 10-year follow-up period.1

Results showed premature menopause was associated with a significantly increased risk of all-cause mortality compared with controls (1.8% vs 0.6%; risk ratio [RR], 3.08; 95% CI, 2.26-4.19; P <.001). Investigators additionally observed a greater risk of multiple cardiovascular complications in these patients, including cerebrovascular disease (RR, 1.39; 95% CI, 1.07-1.82; P = .014), coronary artery disease (RR, 1.54; 95% CI, 1.01-2.34; P = .044), and peripheral artery disease (RR, 1.43; 95% CI, 1.06-1.95; P = .019).1

Of note, no significant differences were observed between the groups for atrial fibrillation or ventricular tachycardia rates.1

Clinically, investigators assert that these findings demonstrate the importance of early cardiovascular risk stratification for women with premature menopause and the need for aggressive cardiovascular prevention strategies. Additionally, they recommend regular monitoring for cardiovascular complications and individualized treatment approaches in this patient population.1

Agyekum and colleagues acknowledged limitations to this research, including the retrospective study design and the potential for residual confounding. However, they also called attention to their use of large, propensity-matched cohorts, multi-institutional data, comprehensive outcome assessment, and 10-year follow-up period.1

Looking ahead, investigators cite the need for prospective studies to confirm these findings as well as investigation of prevention strategies, long-term cardiovascular outcome studies, and evaluation of the potential impact of hormone replacement therapy.1

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References

1. Agyekum AK, Essien E, Nwaezeapu K, et al. #0085 Premature Menopause and Risk of Cardiovascular Outcomes A Propensity-Matched Analysis Using the TriNetX Research Network. Abstract presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, from June 6 - 8, 2025.

2. OASH Office on Women’s Health. Early or premature menopause. March 11, 2025. Accessed June 6, 2025. https://womenshealth.gov/menopause/early-or-premature-menopause