• Women's Health
• Heart Disease
• Hormone Replacement Therapy

Estrogen and Heart Disease: How Estrogen Supports Heart Health

Published: September 14, 2025
Updated: September 15, 2025
4 mins

Estrogen is best known for its role in regulating the reproductive system, but its influence extends far beyond fertility and menstrual cycles. This hormone also plays a key role in supporting the cardiovascular system, helping blood vessels stay flexible, promoting healthy cholesterol levels, and maintaining circulation. 

When estrogen levels decline – especially during menopause – these protective effects weaken, raising important questions about women’s long-term heart health. 

How Estrogen Supports Heart Health

Estrogen provides several protective effects for the cardiovascular systems, which help explain why heart health can shift after menopause. 

One key role is vasodilation, where estrogen helps blood vessels relax and widen. This improves circulation and reduces strain on the heart. It also plays a part in cholesterol regulation by raising levels of HDL (“good” cholesterol) while lowering LDL (“bad” cholesterol), supporting healthier arteries. 

Estrogen has anti-inflammatory effects that keep the inner lining of blood vessels strong and flexible, which lowers the risk of damage that can lead to cardiovascular disease. In addition, research suggests estrogen may contribute to heart rhythm stability. This is why hormonal changes during menopause are sometimes linked to new or more noticeable palpitations.

Menopause and its Impact on the Heart

During perimenopause and menopause, declining estrogen levels reduce the protective cardiovascular effects women once relied on. As a result, the risk of high blood pressure, unfavorable cholesterol shifts, and stiffening of the arteries begins to rise. 

Many women also notice heart palpitations around this time. These are often connected to hormonal fluctuations rather than structural heart problems, but they can still be disruptive and concerning.

On top of these changes, symptoms such as stress, poor sleep, and frequent hot flashes place additional strain on the heart, which makes this stage of life a critical window for prioritizing cardiovascular health. 

Protecting Your Heart in Menopause

Even as estrogen levels decline, there are effective ways to support cardiovascular health during menopause.

Lifestyles strategies play a central role. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins help maintain healthy cholesterol and blood pressure. Regular physical activity, including both aerobic exercise and strength training, supports circulation and keeps the heart strong. Maintaining a healthy weight, avoiding smoking, and prioritizing stress management and quality sleep are also essential steps in reducing cardiovascular risk. 

Alongside lifestyle changes, medical monitoring becomes increasingly important. Regular blood pressure, cholesterol and blood sugar checks help catch changes early. If new symptoms such as heart palpitations arise, it’s important to discuss them with a healthcare provider to determine whether they’re related to menopause or another underlying condition.

Is HRT an Option for Heart Palpitations in Menopause?

Hormone replacement therapy (HRT) is often prescribed to ease disruptive menopause symptoms such as hot flashes, night sweats, and in some cases, heart palpitations. HRT can help stabilize the body’s temperature regulation and, for some women, reduce the frequency of palpitations linked to hormonal shifts.

That said, the connection between HRT and heart health is nuanced. HRT is not recommended as a primary treatment to prevent heart disease, but when started early in menopause, it may provide indirect cardiovascular benefits by improving overall wellbeing and symptom control.

Some women notice an improvement in palpitations once their estrogen levels are stabilized with therapy. However, effectiveness varies, and HRT may not eliminate palpitations for everyone.

It’s also important to consider timing and safety. Research shows HRT tends to be safest and most beneficial when initiated around the onset of menopause, rather than many years later. Every decision should be made in consultation with a healthcare provider, taking into account individual risk factors such as personal or family history of heart disease, stroke, or blood clots.

Where Can I Learn More About Hormone Balance?

Every woman’s symptoms are different, so individualized medical guidance is essential when considering any form of HRT.

That’s why the LifeMD Women’s HRT Program offers personalized care to address your hormonal imbalances and find a treatment plan that truly works for you. That means tailoring the program to your medical history and symptoms – whether it’s adjusting your dose, picking the right treatment that fits your lifestyle, or using labs to fine-tune your care.

Join the waitlist to learn more.