Women who go through natural menopause before age 40 may face a lifetime risk of coronary heart disease roughly 40% higher than women who reach menopause later.
That is the central finding of a Northwestern Medicine analysis published March 18, 2026, in JAMA Cardiology.
The research team pooled individual data from six long-running U.S. cohorts, including the Framingham Heart Study, the Atherosclerosis Risk in Communities Study, and the Women's Health Initiative.
In total, 10,036 postmenopausal women aged 55 to 69 were followed for 163,600 person-years between 1964 and 2018.
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The elevated risk showed up in both groups the study examined.
Black women with premature menopause had a hazard ratio of 1.41 for coronary heart disease, and white women had a hazard ratio of 1.39, according to the JAMA Cardiology paper.
The gap persisted after the analysis accounted for smoking, obesity, high blood pressure, and diabetes.
Why losing estrogen early matters
Coronary heart disease is caused by narrowing of the arteries that supply the heart muscle, and estrogen has long been understood to help keep those arteries flexible. When ovarian function fades, that protection fades with it.
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Lead author Dr. Priya Freaney, an assistant professor of cardiology at the Northwestern University Feinberg School of Medicine, described the cascade in the Northwestern Medicine announcement.
"As the natural estrogen declines, no matter what age it happens in, cholesterol and blood pressure go up, body fat distribution shifts to the abdomen, muscle mass gets lower, blood sugars can become dysregulated and arteries stiffen," Freaney said.
When menopause arrives before 40, those changes have decades more time to work on the vascular system.
Some evidence suggests that timing of hormone therapy in relation to menopause onset may itself influence heart risk, as covered in our earlier report on hormone therapy started early in menopause.
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A sharper disparity for Black women
The study also highlighted a significant racial gap, showing that premature menopause was roughly three times more common in
Black women than in white women (15.5% compared to 4.8%).
Lead researcher Freaney pointed out that this difference aligns with broader disparities in heart disease risk factors and outcomes between Black and white women.
What women with early menopause can ask about
The practical takeaway from the paper is that reproductive history belongs in the cardiovascular conversation.
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Freaney has urged both patients and clinicians to raise it directly.
Women who reached menopause before 40 can tell their primary care doctor or cardiologist and ask about a full lipid panel, blood pressure tracking, and whether their overall risk profile warrants earlier preventive treatment.
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This article is made and published by Ida-Marie Palm Varbæk, who may have used AI in the preparation.