First multisociety guidance targets women’s heart health at every life stage

Clinical takeaway: Incorporate menstrual history, pregnancy history, and menopause status into routine cardiovascular risk assessment. Female-specific risk enhancers such as adverse pregnancy outcomes, irregular menses, polyendocrine metabolic ovarian syndrome (PMOS), and early menopause may warrant earlier screening and more aggressive prevention efforts.

For the first time, the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine have issued unified guidance for preventing and managing cardiovascular disease in girls and women across the lifespan. The statement introduces a “Female Life Stage” framework that integrates hormonal, psychosocial, and cardiovascular health and aims to reduce missed opportunities for earlier intervention.

The framework organizes care around four biologic stages: perimenarche, ovarian cycling years, perimenopause, and postmenopause. Pregnancy is treated as a separate cardiovascular "stress test" that can reveal previously unrecognized risk and influence long-term prevention strategies.

“Women experience their healthcare across clinical specialties, but it often is fragmented or disconnected,” said writing group chair Sadiya S. Khan. “This new approach gives clinicians across specialties shared guidance to recognize risk earlier, personalize prevention, and act before a heart attack, stroke or heart failure event.”

A central theme of the guidance is that female cardiovascular health cannot be evaluated in isolation from hormonal and psychosocial health. The authors encourage clinicians to assess cardiovascular health through the lens of Life’s Essential 8 while also routinely evaluating menstrual health, mental health, and reproductive history.

The statement elevates menstrual cycle patterns to the status of a cardiovascular vital sign. Heavy or irregular bleeding, PMOS (formerly known as PCOS), premature ovarian insufficiency, and iron deficiency may signal an unfavorable cardiometabolic trajectory and should prompt closer surveillance and risk-factor management.

Pregnancy history also takes on greater importance. Hypertensive disorders of pregnancy, gestational diabetes, preterm birth, stillbirth, and delivery of a small-for-gestational-age infant are identified as female-specific cardiovascular risk enhancers that should be documented and incorporated into long-term risk assessment.

The authors note that the postpartum period remains a major missed opportunity for prevention, with many women failing to receive appropriate follow-up after pregnancy-related complications. The guidance calls for structured transitions from obstetric care to ongoing primary and cardiovascular care.

Menopause receives substantial attention as a cardiovascular inflection point. The statement recommends screening for perimenopause-related symptoms beginning at age 40 and performing comprehensive cardiovascular risk assessment during the menopause transition, when adverse changes in lipids, metabolic health, and vascular function often accelerate.

Several medication-related recommendations are highlighted. Women taking anticoagulants or dual antiplatelet therapy should receive anticipatory counseling about heavy menstrual bleeding and iron deficiency, both of which can contribute to reduced quality of life and premature discontinuation of evidence-based treatment.

The guidance also stresses individualized decision-making for hormonal therapies. When prescribing contraceptives, fertility-related treatments, ovarian suppression, or menopausal hormone therapy, clinicians should consider the indication, cardiovascular and thrombotic risk, contraindications, and patient preferences. Pregnancy intentions should be discussed routinely, with review of medication safety and discontinuation of potentially teratogenic therapies when appropriate.

The statement concludes with a call for a national network of Comprehensive Centers of Excellence for Women’s Cardiovascular Care to improve interdisciplinary care, research, education, and community engagement.

Key Recommendations

• Treat menstrual health as a cardiovascular vital sign by routinely assessing and documenting menstrual history, cycle regularity, bleeding patterns, and related symptoms.
• Screen for depression, anxiety, eating disorders, and other psychosocial factors that can influence cardiovascular health and health behaviors across the life course.
• Incorporate female-specific risk enhancers, including adverse pregnancy outcomes, early menopause, PMOS, and menstrual abnormalities, into cardiovascular risk assessment and prevention decisions.
• Begin screening for perimenopause and menopause-related symptoms by age 40 and perform comprehensive cardiovascular risk assessment during the menopause transition.
• Discuss pregnancy intentions at routine visits and review medication safety before conception, particularly when prescribing cardiovascular therapies with potential fetal toxicity.
• Recognize adverse pregnancy outcomes as long-term cardiovascular risk enhancers and ensure structured postpartum follow-up and transition to longitudinal care.

Source: Khan SS, et al. (2026 Oct 26) Circulation. Consensus guidance for the female-specific prevention and management of cardiovascular disease: A scientific statement from the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine