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Written by Dr Serena Jones, GP
Dr Serena graduated from Manchester University in 2008 (MBChB).
She also holds the MRCGP, DRCOG and DFSRH.
Perimenopause is the time leading up to menopause, when your periods gradually stop for good. For most women, this transition begins in their 40s, although it can start earlier. While symptoms like hot flushes, night sweats, and mood swings are well-known, the effect of perimenopause on blood pressure often gets overlooked. Studies suggest that blood pressure is more likely to rise during this time, making it an important issue to watch out for [1].
How Does the Perimenopause Affect Blood Pressure?
- Hormone fluctuations:
Hormonal ups and downs during perimenopause can cause blood pressure to spike, especially during times of stress or poor sleep—both of which are common challenges in this phase. Oestrogen, a hormone that helps maintain flexible blood vessels and healthy cholesterol levels, starts to decrease. As oestrogen levels drop, blood vessels may stiffen, and your body’s ability to regulate blood pressure can weaken. This hormonal shift makes high blood pressure more likely, which can lead to heart disease or stroke.
- Weight changes:
Many women experience weight gain during perimenopause, particularly around your middle. Hormonal changes can increase your sensitivity to insulin and salt, both of which affect blood pressure. Combined with the extra weight, these changes can lead to rising blood pressure levels [2]. - Stress and sleep disruption:
Perimenopause often comes with sleep disruptions—thanks to night sweats or insomnia—and poor sleep can raise cortisol levels, your body’s stress hormone. Higher cortisol can make blood pressure harder to control, creating another layer of stress. - Physiological changes:
- Sympathetic Nervous System (SNS) Activation: The fight-or-flight system in your body tends to be more active during perimenopause. This can make your heart rate faster and your blood vessels tighter, both of which increase blood pressure.
- Endothelial Dysfunction: Oestrogen helps blood vessels relax and widen, but with less of it around, this function can be impaired. This makes blood vessels less flexible and increases blood pressure.
- RAAS Disruption: The renin-angiotensin-aldosterone system (RAAS), which manages blood pressure and fluid balance, also gets thrown off during perimenopause. This can lead to your body retaining more sodium and narrowing blood vessels, both of which contribute to higher blood pressure
How Menopause Affects Blood Pressure
When menopause fully arrives and oestrogen production stops entirely, the cardiovascular risks can ramp up even more. Blood pressure often stays elevated, unlike the fluctuations seen during perimenopause. Blood vessels lose their natural elasticity, which can cause arterial stiffness, making it harder for blood to flow smoothly.
This phase is also linked to an increased risk of developing metabolic syndrome—a combination of conditions like high blood pressure, insulin resistance, and central obesity. Together, these changes create a perfect storm for heart disease and stroke, making it especially important to monitor and manage your health during menopause.
Managing Blood Pressure During Perimenopause
Although rising blood pressure during perimenopause can be worrying, there are ways to stay on top of it:
- Regular monitoring
Regularly checking your blood pressure is key. Spotting changes early allows you to make adjustments before it becomes a bigger issue.
You can find our range of clinically validated blood pressure monitors here.
- Lifestyle adjustments
A heart-healthy diet, such as the DASH diet (see our blog here), rich in fruits, vegetables, whole grains, and lean proteins, can help manage blood pressure. Even moderate exercise, like brisk walking, helps keep your heart and blood vessels in good shape.
Stress management
Techniques such as mindfulness, yoga, or meditation can help reduce stress and its impact on blood pressure. And don’t forget—getting enough sleep is just as important as eating well
Conclusion: Perimenopause’s Effect on Blood Pressure
Perimenopause is a natural part of life, but its effect on blood pressure often gets overlooked. Understanding how hormonal shifts impact your heart health can help you take charge of this transition. By monitoring your blood pressure, making healthy choices, and seeking advice when needed, you can navigate perimenopause with confidence. If you’re noticing changes in your blood pressure, it’s a good idea to check in with your doctor for personalised advice and support.
Resources:
- AHEM Maas, HR Franke, Women’s health in menopause with a focus on hypertension. Neth Heart J. 2009 Feb;17(2):68–72. doi: 1007/BF03086220
- Clarkson TB. Estrogen effects on arteries vary with stage of reproductive life and extent of subclinical atherosclerosis progression. Menopause 2007;14:373-84
