Top Medical Groups Unveil First Women's Heart Health Plan Spanning Puberty to Menopause as Risks Climb

DALLAS — Four leading U.S. medical organizations have released the first shared framework for preventing heart disease in girls and women, urging doctors to track cardiovascular risk from puberty through menopause and beyond.

The American Heart Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine published the joint guidance on Oct. 26. It appears as a three-part publication in the journal Circulation.

The groups say heart disease risk in women changes across their lives and often begins showing signs much earlier than doctors typically look for it.

Four 'Female Life Stages'

The guidance introduces a "Female Life Stage" framework that ties cardiovascular prevention to hormonal changes over a woman's life.

The four stages are perimenarche, roughly ages 8 to 15; regular ovarian cycling, about ages 15 to 44; perimenopause, about ages 45 to 51; and postmenopause, age 51 and older. Pregnancy, which can occur during any stage, is also addressed.

The framework encourages doctors to recognize that heart risks can first appear at pediatric visits, in menstrual patterns, mental health and early changes in metabolism.

Menstrual cycles as a vital sign

One notable recommendation is treating menstrual patterns as a female-specific vital sign. Irregular cycles and other changes can signal underlying health problems that may affect heart health.

The guidance also highlights the links between heart health, hormonal changes and psychosocial factors such as stress and depression.

Pregnancy as a warning sign

The groups put special focus on pregnancy. Complications such as high blood pressure during pregnancy and preeclampsia are now treated as factors that raise a woman's long-term risk of heart disease.

The guidance recommends follow-up for women with high blood pressure after giving birth within six months.

Cardiovascular disease is now the leading cause of medical-related deaths during pregnancy, and maternal mortality has risen in the United States.

The 2026 American Heart Association and American College of Cardiology cholesterol guideline also now includes pregnancy-related factors in assessing a woman's heart disease risk.

Fragmented care

The authors said women's health care is often split among different specialists across their lives, from pediatricians to gynecologists to cardiologists, which contributes to poorer care. The new guidance is designed to give doctors across specialties a shared approach.

Dr. Mariell Jessup, chief science and medical officer of the American Heart Association, said women's heart health "must be a part of everyday care across medicine."

Rising risks

The guidance comes amid concerning trends. Heart disease is the leading cause of death for women, yet only about 41% of women recognize it as their greatest health threat.

In February, the American Heart Association projected that six in 10 U.S. women would have at least one type of cardiovascular disease by 2050 if current trends continue.

The forecast also projected that nearly one-third of women ages 20 to 44 would have cardiovascular disease by 2050, compared with fewer than one in four today.

Postmenopausal women are at the highest risk of heart attack, stroke and heart failure, partly because levels of estrogen, a hormone that helps protect the heart, decline during menopause.

What it means for patients

For patients, the guidance means doctors may begin asking about heart-related risks earlier and more often, including during pediatric checkups, routine gynecological visits and after pregnancy.

The framework also calls for the development of comprehensive centers of excellence focused on women's cardiovascular care.

More research needed

Experts say the guidance is an important step but that more research is needed on women's heart health, which has historically been understudied. Women have often been underrepresented in clinical trials of heart disease treatments.

The medical groups hope the shared approach will help doctors identify risk earlier, personalize prevention and act before heart attacks, strokes or heart failure occur.