Four US medical societies want doctors to start tracking a woman’s heart risk around her first period, decades before most heart attacks. On October 26 they published a joint framework for women’s heart health in three papers in the American Heart Association (AHA) journal Circulation.
The authors come from the AHA, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine. Their plan splits a woman’s life into four “Female Life Stages”, each marked by a hormonal shift. Pregnancy sits across all of them. The societies call it the first coordinated, multi-society framework of its kind.
Why four societies wrote one plan
Heart disease is the leading cause of death for women in the US, according to the CDC. It killed 304,970 women in 2023, about 1 in every 5 female deaths.
The AHA uses a bigger number in its news release: more than 400,000 deaths a year. The two figures don’t conflict. The AHA counts cardiovascular disease, which adds stroke to heart disease, while the CDC figure covers heart disease alone. By the AHA’s count, it kills more women than breast cancer, lung cancer and chronic lung disease combined.
Progress has stalled for two decades, the AHA says. Its 2026 forecast projects high blood pressure among US women 20 and older rising from about 49% in 2020 to 59% by 2050 if trends hold.
The authors’ main complaint is fragmented care. A girl sees a pediatrician and a young woman sees an OB-GYN. A cardiologist may enter the picture only after a heart attack.
“Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected,” said Dr. Sadiya Khan. She is a cardiologist at Northwestern University’s Feinberg School of Medicine and chaired the writing group. In Northwestern’s release, she said the specialties have been “playing different sports” and now need “a singular playbook”.
The four stages, from about age 8 to 51 and older
The AHA release defines each stage by hormones, with approximate ages:
- Perimenarche (about 8 to 15): the transition around the first menstrual period.
- Ovarian cycling (about 15 to 44): cycles become regular and ovulatory, and pregnancy typically happens.
- Perimenopause (about 45 to 51): cycle lengths vary, periods get skipped and hormones change.
- Postmenopause (about 51 and older): the years starting 12 months after the final menstrual period.
Hormonal changes, not birthdays, mark each stage, so the ages are only a guide.
Periods become a heart-health signal
In the first stage, the publications treat menstrual cycle patterns as a “female-specific vital sign”. Heavy or irregular bleeding can be an early marker of cardiovascular risk, according to the AHA. One example is polyendocrine metabolic ovarian syndrome (PMOS), the condition formerly called polycystic ovary syndrome, or PCOS.
Dr. Amanda Marma Perak is a pediatric cardiologist at Lurie Children’s Hospital of Chicago and a vice chair of the writing group. In Lurie Children’s release, she said irregular cycles can signal PMOS, which carries “real cardiovascular risk.” Heavy bleeding “is the most common cause of iron deficiency in young women,” she added.
Mental health counts too. Women are more likely to experience anxiety, depression and eating disorders, the AHA says. Each can contribute to poor heart health.
Why pregnancy is called a “stress test”
The framework does not make pregnancy its own stage. It treats pregnancy as an event that can happen in any stage. The societies describe the time before, during and after it as a biological “stress test” that can expose heart risks nobody had spotted.
Six complications now count as female-specific “risk enhancers”, the AHA says. They are high blood pressure in pregnancy, preeclampsia, gestational diabetes, preterm birth, a small-for-gestational-age baby and stillbirth. The 2026 AHA/American College of Cardiology cholesterol guideline already counts pregnancy history in women’s risk assessment.
“An adverse pregnancy outcome can unmask increased cardiovascular risk and that information should guide care well beyond pregnancy,” said Dr. William Grobman. He is a writing-group vice chair at Brown University and a former Society for Maternal-Fetal Medicine president.
The follow-up gap is wide. Only about 60% of US women with blood-pressure complications in pregnancy get blood-pressure follow-up within six months of delivery, the AHA says. The societies call for “immediate action” on that gap. Cardiovascular conditions account for more than a third of US maternal deaths, according to the AHA.
Midlife is the turning point
The AHA release calls perimenopause a “cardiovascular inflection point”. Changes in cholesterol and metabolic health during these years can be early signs of risk.
Postmenopause gets the most weight. Those years can make up as much as 40% of a woman’s life. Most heart attacks, strokes and heart-failure events happen then, and the AHA says they are more than 80% preventable with early action.
Khan pointed to the AHA’s PREVENT calculator. Doctors can use its sex-specific equations to estimate a woman’s 10- and 30-year risk. “We need to recognize that women’s heart health is deeply interconnected with hormonal and emotional health,” she said in the AHA release.
What to bring to your next appointment
The papers address clinicians, and none of them tells any one woman what to do on her own. The AHA notes that its scientific statements “do not make treatment recommendations”; formal guidelines do that. Talk to your doctor before changing anything.
What the framework does is name the history that matters. Based on the markers the societies list, these are worth raising at a checkup:
- Heavy or irregular periods, now or in your teens, and any PCOS or PMOS diagnosis.
- Any pregnancy complication, such as preeclampsia, gestational diabetes, preterm birth or stillbirth, even years ago.
- Whether anyone rechecked your blood pressure after a pregnancy with high blood pressure.
- Cholesterol or metabolic changes as cycles start to shift in your 40s.
- Anxiety, depression or an eating disorder, past or present.
Missed signals in women are a recurring problem on this beat. Our report on multiple sclerosis misdiagnosis found women about twice as likely as men to get the wrong diagnosis. And as with the Johns Hopkins study on naps and dementia, a population-level risk finding is a reason to talk to your doctor, not a diagnosis.
The third paper looks further ahead. It calls for a national network of “Comprehensive Centers of Excellence for Women’s Cardiovascular Care”. Each would combine clinical care, training, research and community outreach. The AHA release does not say where those centers would be or who would pay for them.
