Estrogen keeps your artery walls flexible and keeps your liver clearing LDL out of the blood ¹. When the ovaries stop making it, that stops at once. Arteries stiffen within a year ², LDL and ApoB jump in a tight window around the final period rather than drifting up slowly ³, and fat shifts from hips to belly by roughly 10% a year at stable weight ⁴.

The advantage women hold over same-age men erodes after the final period and is mostly gone by the late sixties ⁵. Proof it's menopause and not just age: women who lose their ovaries early, or reach menopause before 45, get the same trajectory in a younger decade, with more coronary disease, stroke, and heart failure ⁶. And frequent hot flushes track with more cardiovascular events, independent of the usual risk factors ⁷.

Get a proper cardiovascular baseline at the transition, then again a year or two after your last period. Most of it is routine primary care, and where numbers cross a threshold the ordinary drugs apply, just started in your early fifties instead of your late sixties.

The hormone-therapy question turns on timing. Started within 10 years of your final period, before 60, it is broadly safe and probably mildly protective; started first in your late sixties, it harms ¹⁰. The scary 2002 headline came from a much older cohort; the re-analysis put the harm in the late starters ¹¹. In the window and having symptoms, the heart conversation is on your side ¹².

Why acting now beats acting later. The window is leveraged because the artery wall is still flexible and the plaque hasn't had years to organise ⁵.

• Months: a baseline you can act on, and a clear yes-or-no on hormone therapy.
• A year or two: the trajectory bends; training here holds off the belly-fat shift ⁹.
• A decade on: the slope toward stroke and heart failure was bent in your early fifties, when it was cheapest to bend.

Push earlier and harder if menopause came before 45 or your ovaries were removed ⁶; if your pregnancies included preeclampsia, gestational diabetes, or preterm birth ¹²; or if you're Black, where blood pressure climbs steeper ¹⁴.