Beyond Hot Flashes: Why Your Menopause Symptoms Are a Heart Health Issue

A conversation with Dr. Jayne Morgan on what Black women need to know about menopause and cardiovascular disease

Let’s talk about something that doesn’t get nearly enough attention: the connection between menopause and heart disease. Not just as separate chapters in our health journey, but as deeply intertwined experiences that Black women need to understand—especially during Heart Health Month.

Dr. Jayne Morgan, cardiologist and Vice President of Medical Affairs at Hello Heart, has been sounding the alarm on this for years. And recent findings from the Black Women’s Health Imperative’s menopause survey—the largest ever conducted with Black women—make it clear why this conversation is long overdue.

The Protection We Lose

Here’s what many of us don’t know: during our reproductive years, our risk of heart disease is half that of men. But once we transition through menopause, that risk becomes equal. By our seventies, it actually surpasses men’s risk.

Why? Estrogen.

“We know now that estrogen is cardioprotective,” Dr. Morgan explains. “It decreases your cholesterol, and it’s anti-inflammatory.” But as we enter perimenopause—which can start as early as our thirties—those estrogen levels begin to drop. And with them, that cardiovascular protection starts to fade.

This isn’t abstract medical theory. This is about understanding why that constellation of symptoms you’re experiencing—the ones you’ve maybe been told to just “deal with”—are actually your body signaling something important.

When Symptoms Become Risk Factors

Let’s be real: when most of us think about menopause, we think hot flashes. Maybe night sweats. But BWHI’s survey of over 1,500 Black women revealed something striking: 54% said they didn’t have enough information to manage their symptoms effectively. And many were shocked to learn about symptoms beyond hot flashes—the brain fog, the joint pain, the weight gain, the depression.

What Dr. Morgan wants us to understand is that these aren’t just uncomfortable inconveniences. Many of these symptoms are independent risk factors for heart disease.

Take hot flashes. “The severity and intensity of hot flashes is also correlated with heart disease,” Dr. Morgan notes. “We know that Black women tend to have hot flashes of longer duration, greater intensity, and over longer periods of time. So there’s a further increase in heart disease.”

Or consider sleep disruption—something 55% of survey respondents struggled with alongside weight gain, and 42% battled depression. Dr. Morgan points out that insomnia has a direct correlation with heart disease, both in duration and quality of sleep. “And we know during menopause, sleep is frequently interrupted. So now we have women whose estrogen levels are dropping, their risk of heart disease is increasing and, they’ve got an independent risk factor also as one of the symptoms of menopause going on.”

As one survey participant put it: “I literally only heard of one symptom which was hot flashes. The brain fog and low energy is the absolute worst thing. I truly thought that I was going into early Alzheimer’s.”

The Information Gap That’s Putting Us at Risk

Dr. Morgan’s response to BWHI’s survey findings pulls no punches: “This is a fundamentally critical research imperative that dispels the myth that Black women may not experience the full spectrum of menopausal symptoms. It does in fact support our knowledge that not only are all symptoms experienced, but often for longer periods of time and with greater duration than white populations.”

And here’s what should concern all of us: even among the highly educated, insured, professionally active Black women who participated in the survey—women with strong earning power and access to care—there was still a massive information gap. Fifty-two percent reported they didn’t know which recommendations to follow.

“Culturally, it is often misunderstood, and rarely spoken about openly, and certainly any connection to heart disease is not made,” Dr. Morgan says. “This is a great contribution to our knowledge of the health of this population of well educated, high earners, who still lack resources and accurate information.”

What We Need to Know Now

So what should you be tracking? Dr. Morgan recommends paying attention to your pregnancy history as a first indicator. If you’ve ever been diagnosed with preeclampsia, eclampsia, pregnancy-induced hypertension, or gestational diabetes, you’ve already declared a twofold increased risk of heart disease.

“Pregnancy serves as your first stress test,” she explains. “And a cardiologist would view that patient as a volume overloaded patient with a failed stress test.” Ideally, there should be a handoff from your OB-GYN to a cardiologist. “That happens rarely, and it almost never happens in populations of color.”

As you approach perimenopause and menopause, you should be getting cardiac workups and having conversations with your healthcare provider about whether menopausal hormone therapy might be appropriate—not just for symptom management, but as a potential heart health strategy when started at the right time. 

Moving This From the Back Burner

The women who participated in BWHI’s survey made their needs clear: 66% expressed a need for greater culturally grounded education beginning in their 30s. They’re seeking affordable treatment options, access to trusted providers, and safe spaces to share experiences and reduce stigma.  View our survey results and get more resources on  perimenopause and menopause here.

As one participant shared: “I wish more was said in my 30s about perimenopause. I wish I had better access to healthcare I could trust.”

Dr. Morgan’s message is direct: “This must move from the back burner to a full frontal view in order to live, and experience, our most healthy lives, and our most productive years yet.”

This Heart Health Month, let’s start having the conversations that need to happen—about our symptoms, our risks, and the care we deserve. Because understanding the connection between menopause and heart health isn’t just about managing symptoms. It’s about protecting our lives.