Menopause cardiovascular health and the role of hormone therapy.

BACKGROUND: The menopause transition marks a period of accelerated cardiovascular risk in women, highlighting the importance of opportunistic screening and intervention in midlife primary care. OBJECTIVE: This article summarises current evidence linking menopause with cardiovascular disease (CVD) and appropriate interventions, including lifestyle optimisation and menopausal hormone therapy (MHT). DISCUSSION: The midlife acceleration of CVD risk is driven by distinct cardiometabolic and vascular changes, with ovarian ageing independently associated with adverse lipid profiles, fat redistribution, vascular dysfunction and metabolic syndrome. Early, premature, surgical and symptomatic menopause further amplifies risk. Lifestyle optimisation and lipid-lowering therapy remain powerful strategies to mitigate these changes. MHT, although not recommended solely for primary or secondary CVD prevention, may be offered for symptom management and bone protection in appropriately selected women, and in cases of premature, early or surgical menopause. Midlife consultations provide a unique window for general practitioners to opportunistically risk stratify, initiate preventive measures and support informed MHT decision making, thereby shaping long-term cardiovascular trajectories.