Cardiovascular disease remains the leading cause of death among women, and the midlife years in which risk accelerates are the years in which women are most likely to be seeing a gynaecologist rather than a physician. This Clinical Expert Series makes the case for using that contact.
The argument rests on longitudinal data showing that lipids, blood pressure, glucose metabolism, body composition and vascular structure all change across the menopause transition in ways that are not explained by chronological ageing alone. Menopause-specific characteristics carry risk information too - the timing and type of menopause, and the symptoms themselves, with vasomotor symptoms, sleep disturbance and depression each associated with cardiovascular risk. The proposal is to fold these into routine cardiovascular risk assessment rather than treating them as a separate symptom conversation.
This is a synthesis rather than new data, and its value is organisational. Nothing here requires a new test: it requires that the visit for vasomotor symptoms also produces a blood pressure, a lipid profile, a glucose and a documented risk estimate, and a named person to act on them. Early or surgical menopause is the flag most often missed, because the woman is young enough that risk calculators return a reassuring number that does not account for it.
- Take a blood pressure, lipid profile and glucose at the menopause consultation - it is often the only midlife contact.
- Record age at menopause and whether it was surgical; early menopause is a risk factor that standard calculators handle poorly.
- Treat vasomotor symptoms, sleep disturbance and depression as risk information, not only as symptoms to relieve.
- Name who owns the follow-up - the gynaecologist, the general practitioner or a cardiologist - before the woman leaves.
- This is an expert synthesis of observational and longitudinal data, not a trial of screening; it changes what you look for, not what you prescribe.
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