For the first time, four major US medical societies have released a shared framework designed to make heart health part of care for girls and women from puberty through menopause and beyond.
The American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine published three coordinated papers in Circulation on 26 October. Together, they introduce a “Female Life Stage” framework intended to help clinicians recognize cardiovascular risk earlier and connect care that is often divided between paediatrics, obstetrics, gynaecology and cardiology.
Four stages, one continuous risk picture
The framework divides female cardiovascular health into four stages defined by hormonal transitions: perimenarche, ovarian cycling, perimenopause and postmenopause. Pregnancy is treated as an event that can occur in one or more of these stages and may reveal cardiovascular risks that were not previously recognized.
Stage 1, perimenarche, covers the years around a girl’s first menstrual period, approximately ages 8 to 15. Stage 2, ovarian cycling, covers the reproductive years, approximately ages 15 to 44, when regular hormone cycles are established and pregnancy typically occurs. Stage 3, perimenopause, covers the transition to irregular cycles and hormonal change, approximately ages 45 to 51. Stage 4, postmenopause, begins after menopause or 12 months after the final menstrual period.
The approach is not intended to replace standard cardiovascular risk assessment. Instead, it adds female-specific context, encouraging clinicians to consider heart health alongside hormonal changes, menstrual history, pregnancy history and psychosocial health.
Menstrual health as a heart-health signal
One of the framework’s central ideas is that menstrual cycles can provide clinically useful information. The societies describe menstrual patterns as a female-specific vital sign, noting that heavy or irregular bleeding can be early markers of cardiovascular risk, including conditions such as polycystic ovary syndrome (PCOS)/PMOS.
Perimenopause is described as a cardiovascular inflection point. Changes in cholesterol, blood pressure and metabolic health during this transition may signal increasing risk, creating an opportunity for earlier prevention rather than waiting until disease is established.
Postmenopause is also a major prevention period. The years after menopause can represent up to 40% of a woman’s lifetime, and most heart attacks, strokes and heart-failure events occur during this stage. The societies state that more than 80% of these events are preventable when action is taken early
Pregnancy as a cardiovascular clue
The framework gives particular weight to pregnancy and the postpartum period. Complications such as high blood pressure, preeclampsia, gestational diabetes, preterm birth, small-for-gestational-age infants and stillbirth are recognized as female-specific risk enhancers.
These events do not only matter during pregnancy. They can reveal underlying cardiovascular vulnerability and should inform follow-up care well after delivery. Yet follow-up remains inconsistent: only about 60% of US women with hypertension-related pregnancy complications receive follow-up care for high blood pressure within six months of giving birth.
Cardiovascular conditions account for more than one-third of maternal deaths in the United States, making pregnancy and the postpartum period a critical point for prevention.
Connecting heart, hormones and mental health
The framework also emphasizes that emotional health is part of cardiovascular health. Women are more likely to experience anxiety, depression and eating disorders, all of which can contribute to poorer heart health.
The societies argue that these domains should not be addressed in separate clinical silos. Instead, cardiovascular, hormonal and psychosocial health should be assessed together across each life stage.
For paediatric clinicians, the framework creates an early opportunity to establish healthy habits and track risk as girls grow. For obstetric and gynaecological clinicians, it provides a way to use reproductive history as part of long-term cardiovascular care. For cardiologists, it encourages attention to female-specific risk factors that may have been overlooked in traditional models.
Building a system around women’s care
The third paper proposes a national network of Comprehensive Centers of Excellence for Women’s Cardiovascular Care. These centres would be built around four pillars: interdisciplinary clinical care, professional education and training, research, and community engagement.
The goal is to reduce fragmentation and make it easier for clinicians to act on risk before a heart attack, stroke or heart-failure event occurs. The framework also calls for more research involving women, expanded funding for women’s health and better translation of existing evidence into practice.
The publications include a presidential advisory establishing the life-stage framework, a scientific statement providing consensus clinical guidance, and a science advisory outlining the proposed centres of excellence. They are intended to inform care and future guideline development, rather than to replace existing clinical guidelines.
Source: American Heart Association
