Major Groups Release First Life Stage Framework for Women's Heart Health From Puberty Through Menopause

Four leading medical organizations on Monday published a coordinated framework that ties the prevention and management of cardiovascular disease in girls and women to distinct hormonal life stages, from the years around the first menstrual period 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 jointly released three manuscripts in the journal Circulation. The documents introduce a "Female Life Stage" framework intended to address longstanding fragmentation in care and to identify opportunities for earlier risk detection and intervention. Cardiovascular disease remains the leading cause of death among women in the United States and globally, and projections indicate the burden will rise substantially by 2050 if current trends continue.

"Heart disease and other forms of cardiovascular disease don't suddenly become relevant when we become older women," said Dr. Stacey E. Rosen, a cardiologist and former volunteer president of the American Heart Association who contributed to the papers. She described the approach as "a paradigm shift in how we look at women's cardiovascular and brain health."

The framework organizes care around four hormonally defined stages. Stage 1, perimenarche, covers the transition around the first menstrual period, roughly ages 8 to 15. Stage 2, ovarian cycling, spans the years of regular ovulatory cycles, approximately ages 15 to 44, when pregnancy most often occurs. Stage 3, perimenopause, marks the transition to variable cycle length and hormonal changes, typically ages 45 to 51. Stage 4, postmenopause, begins after the final menstrual period, generally age 51 and older. Pregnancy is treated as a modifying life event that can occur across stages and function as a biological stress test capable of revealing previously unrecognized cardiovascular risk.

Within each stage the guidance considers cardiovascular, hormonal, and psychosocial health together rather than as separate domains. Authors note that menstrual irregularity, heavy bleeding, conditions such as polycystic ovary syndrome (now sometimes referred to as polyendocrine metabolic ovarian syndrome), adverse pregnancy outcomes, early menopause, and perimenopausal shifts in cholesterol, weight, and blood pressure can serve as early signals. Fewer than one in four adolescent females currently have high cardiovascular health, according to materials accompanying the publications.

Dr. Amanda M. Perak, a pediatric cardiologist at Ann & Robert H. Lurie Children's Hospital of Chicago and vice chair of the collaborative writing group, said heart health for women does not start at menopause. "Puberty is a big turning point," she said. Details about menstrual cycles offer a window into future risk, she added. Dr. Sadiya S. Khan, chair of the science advisory group and a professor at Northwestern University Feinberg School of Medicine, has emphasized that care has often been siloed across specialties, contributing to missed opportunities.

The publications also call for a national network of Comprehensive Centers of Excellence for Women's Cardiovascular Care built on interdisciplinary clinical care, professional education, research, and community engagement. They crosswalk existing society guidelines and identify research and training priorities. Authors note that inconsistent alignment across specialties has limited the ability to act on female-specific risk factors.

Pregnancy-related conditions such as hypertensive disorders, gestational diabetes, and preterm birth are linked to higher later-life cardiovascular risk. The guidance stresses the value of optimizing cardiovascular health before pregnancy and of continued attention in the postpartum period. In the perimenopausal years, rising LDL cholesterol, weight gain, and blood pressure changes are common and warrant monitoring, according to Dr. Natalie A. Cameron, an internal medicine specialist at Northwestern who contributed to the work.

Rosen and co-authors have pointed out that hormones including estrogen and progesterone affect blood vessels, heart muscle, inflammation, clotting, and stress responses throughout the body, not only reproductive organs. Ignoring those effects, they argue, has limited both research and clinical practice. The framework seeks to embed those considerations into routine care from adolescence onward.

Cardiovascular disease, including heart disease and stroke, kills more than 400,000 women in the United States each year, more than breast cancer, lung cancer, and chronic lung disease combined, according to the American Heart Association. The association has projected that the share of women ages 20 and older living with high blood pressure could rise from about 49 percent in 2020 to 59 percent by 2050 under current trends.

Implementation will require changes in training, electronic health records, and coordination among pediatricians, primary care physicians, obstetrician-gynecologists, cardiologists, and other clinicians. The documents identify gaps in evidence for certain female-specific phenotypes and call for additional research. They also note the importance of addressing social and structural factors that influence risk and access to care.

The framework does not introduce new diagnostic criteria or drug recommendations. Instead, it reorganizes existing evidence and guidelines around life stages so that clinicians can act earlier and more consistently. Authors describe the goal as connecting what has previously been treated as separate conversations—menstrual health, pregnancy outcomes, menopausal transition, and cardiovascular prevention—into a single continuum.

Whether health systems and individual practices adopt the model will determine its impact. The publications provide toolkits, case examples, and slide sets to support education. Professional organizations have begun circulating the materials, and the American Heart Association has highlighted the framework in its communications.

For patients, the approach means that questions about periods, pregnancy history, and menopausal symptoms can be treated as relevant to heart risk rather than confined to a single specialty. Clinicians are encouraged to document these details and to ensure they follow patients across transitions in care. The authors argue that such continuity can reduce the underdiagnosis and delayed treatment that have contributed to poorer outcomes for women.

The release marks the first time the four societies have jointly defined a life-course model for female cardiovascular health. Further work is expected on implementation research, clinician training modules, and evaluation of outcomes in settings that adopt the framework. In the meantime, the documents offer a shared language and set of opportunities for earlier prevention at each stage from puberty through the postmenopausal years.