Your Reproductive History Is Part of Your Cardiovascular Story — Here's What the New Guidelines Say
I want to share something that represents a real and meaningful evolution in cardiovascular medicine — one that I believe every woman should understand, because it directly affects how proactive her care should be.
For a long time, a woman's pregnancy complications, her age at menopause, and conditions like endometriosis or PCOS were treated as separate, contained chapters of her medical history — relevant to reproductive health, perhaps, but not formally connected to her future cardiovascular risk. That framework has changed. Major cardiovascular guideline bodies have now formally incorporated specific elements of a woman's reproductive history into cardiovascular and stroke risk assessment. This is not a fringe opinion. It reflects a substantial body of research, and it is now reflected in the guidance issued by some of the largest cardiovascular professional organizations in the country.
In plain terms: your gynecologic and obstetric history is cardiovascular data, and it deserves to be treated that way.
Your gynecologic and obstetric history is cardiovascular data.
What Pregnancy Complications Can Reveal About Future Risk
Pregnancy puts the cardiovascular system through a significant physiological stress test, and how a woman's body responds can reveal information that extends well beyond the nine months of gestation.
Gestational diabetes, for instance, is associated with a substantially elevated future risk of developing type 2 diabetes, along with an increased risk of future cardiovascular disease. Preeclampsia, a hypertensive disorder affecting a meaningful percentage of pregnancies, is now recognized as an independent cardiovascular risk factor in its own right, associated with a significantly higher future risk of stroke. Other pregnancy events — recurrent pregnancy loss, preterm birth, placental abruption, and stillbirth — have similarly been linked to elevated future vascular risk.
What this means practically is straightforward: if your pregnancy history included any of these complications, that history is not simply a closed chapter. It is relevant clinical information that belongs in every cardiovascular risk conversation you have moving forward, and it should inform the frequency and intensity of your cardiovascular screening.
Why the Timing of Menopause Matters for Your Heart
The age at which a woman goes through menopause — whether naturally, surgically, or as a result of medical treatment like chemotherapy — carries meaningful cardiovascular implications. Menopause before age 40 is classified as premature; before age 45, it's considered early. Women who experience menopause earlier than the average age face a measurably elevated risk of stroke, and the risk tends to increase the earlier menopause occurs.
Here is the piece of this story I find most important, because it points directly to action: across the research, the elevated stroke risk associated with early menopause was concentrated almost entirely in women who did not receive any hormone therapy. Appropriate estrogen replacement, continued until at least the average age of natural menopause, meaningfully mitigates much of this excess risk. This is precisely why current guidance recommends hormone therapy for women with premature or early menopause, absent a clear contraindication — not simply for symptom relief, but as a genuine risk-reduction strategy for long-term cardiovascular and bone health.
If you experienced menopause before age 45, whether naturally or through surgery, and you are not currently on hormone therapy, this is a conversation worth having with a provider who understands the full picture.
Endometriosis and PCOS: Reframed as Vascular Conditions
Two conditions that have long been framed almost exclusively around fertility and pain are now also understood to carry independent cardiovascular implications.
Endometriosis has been associated with an elevated risk of stroke across multiple large international studies. The proposed mechanisms are multifactorial: chronic systemic inflammation from endometrial lesions outside the uterus appears to contribute to dysfunction in the blood vessel lining, certain hormonal treatments used to manage the condition can themselves influence vascular risk, and surgical procedures performed for severe endometriosis sometimes result in earlier surgical menopause, which independently elevates cardiovascular risk.
PCOS tells a similar story. While not yet formally listed as an independent risk factor in every major stroke guideline, the research base is substantial, with large-scale analyses showing meaningfully elevated stroke risk in women with PCOS. Current international PCOS guidelines now explicitly recommend cardiovascular risk assessment as a standard part of care for these patients — not an optional add-on.
If you carry a diagnosis of endometriosis or PCOS, cardiovascular risk assessment should be a routine part of your long-term care plan, not something that only enters the conversation if a problem arises.
What This Means for Your Next Appointment
Translating this shift into action starts with documentation. I encourage every woman to create a concise, one-page personal health summary that includes every pregnancy outcome (including complications, losses, and preterm deliveries), her age and method of menopause, any diagnosis of endometriosis or PCOS, and her current and past use of hormonal contraception or hormone therapy. Bring this summary to cardiovascular appointments. Most clinicians simply do not have the time to excavate a complete reproductive history from a full medical chart — handing them a clear summary makes this information impossible to miss.
From there, appropriate screening typically includes regular blood pressure monitoring, a complete lipid panel (increasingly including newer markers like lipoprotein(a) and apolipoprotein B for women with these risk factors, since standard panels alone may understate risk in this population), and glucose or hemoglobin A1c testing, particularly for women with a history of gestational diabetes.
This is not about generating fear. It is about ensuring that your care reflects the most current evidence available, and that the full picture of your health — including the reproductive chapters too often treated as separate — informs how proactively your cardiovascular health is monitored and protected.
Defy Menopause - Own the Change
Many women tell me: "One day I feel amazing. The next, I can barely get out of bed. Is this normal?"
Yes, it is. And no, you don’t have to suffer through it alone.
Hormonal fluctuations during perimenopause can make you feel like you’ve lost control of your body. But knowledge is powerful. And there are clear, science-backed ways to support your hormones, ease symptoms, and reclaim your energy.
That’s exactly why I created Defy Menopause: Own the Change — a 30-day program designed to give you the tools, knowledge, and support you need to move through these changes with clarity and confidence.
Inside, you’ll find:
Access to Dr. Tracy Verrico at one (1) live, group session
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Because you deserve more than just "putting up with it."
You deserve to thrive.
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Medical Disclaimer: The information provided in this blog is for general educational and informational purposes only and is not intended as, nor should it be considered, medical advice. This content does not establish a physician-patient relationship and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this newsletter. If you think you may have a medical emergency, call your doctor or emergency services immediately.
References
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2. Wu P, Haththotuwa R, Kwok CS, et al. Preeclampsia and future cardiovascular health: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2017;10(2):e003497.
3. Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia. 2019;62(6):905-914.
4. Zhu D, Chung HF, Dobson AJ, et al. Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies. Hum Reprod. 2020;35(8):1933-1943.
5. Havers-Borgersen E, Hartwell D, Ekelund C, et al. Endometriosis and long-term cardiovascular risk: a nationwide Danish study. Eur Heart J. 2024;45(44):4734-4743.
6. Okoli U, Charoenngam N, Ponvilawan B, et al. Endometriosis and risk of cardiovascular disease: systematic review and meta-analysis. J Womens Health (Larchmt). 2023;32(12):1328-1339.
7. ESHRE, ASRM, CREWHIRL and IMS Guideline Group on POI, Panay N, Anderson RA, et al. Evidence-based guideline: premature ovarian insufficiency. Fertil Steril. 2025;123(2):221-236.
8. Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA Guideline on the Management of Dyslipidemia. Circulation. 2026.
