Women who experience menopause before the age of 40 face a 27 to 30 per cent higher risk of major cardiovascular events, according to a prospective cohort study that followed 111,619 postmenopausal women across 26 countries for a median of 14.6 years. The analysis, drawn from the PURE study, also found that menopause between 40 and 45 increases the risk by approximately 14 per cent. The association persisted after adjusting for classic risk factors such as hypertension, diabetes, smoking, and sedentary habits, marking early ovarian cessation as an independent cardiovascular red flag.

The underlying mechanism points to the premature loss of endogenous oestrogens, which during reproductive life help regulate cholesterol, triglycerides, and vascular relaxation, thereby slowing atherosclerosis. Once this hormonal shield disappears early, arterial plaque formation accelerates and cardiometabolic profiles worsen. The data also reveal a sharp income-driven gap: in low-income nations including Pakistan, Tanzania, and Bangladesh, up to 43 per cent of postmenopausal women had undergone early or premature menopause, compared with roughly 23 per cent in Canada and Sweden. Researchers caution that in settings with widespread undernutrition, hypothalamic amenorrhea may partially confound the figures, but the independent signal remains strong.

Against this backdrop, clinicians in Brazil and Argentina emphasise that regular physical activity is not merely supportive but forms a core non-pharmacological treatment during the menopausal transition. Cardiologists at the Hospital Sírio-Libanês in São Paulo recommend 150 minutes of moderate aerobic exercise or 75 minutes of vigorous activity weekly, combined with strength training, to lower cardiac risk and reduce vasomotor symptoms such as hot flushes. Yoga, long overlooked in favour of higher-intensity gym routines, has emerged in separate studies as an effective tool for improving endothelial function and lowering resting heart rate, while Pilates sequences adapted for older adults aid venous return and mobility without joint strain.

Eye health adds another dimension to the ageing picture: optometrists in Jakarta note that many ocular diseases — including glaucoma and cataracts — develop asymptomatically after age 40, making complete eye exams every one to two years essential for early detection, particularly for those with diabetes or hypertension. Australia has recently joined the effort to mainstream menopause awareness, launching its first federal education campaign in May 2025 to help women — and their doctors — recognise perimenopausal symptoms that are frequently misdiagnosed as depression or stress. The next practical milestone for cardiovascular prevention will be whether national health systems begin incorporating menopausal status into standard risk-stratification tools, a step that could redirect screening resources towards a long-neglected population.