The following are key points to remember from a consensus document from the European cardiologists, gynecologists, and endocrinologists on cardiovascular health after menopause transition, pregnancy disorders, and other gynecologic conditions:

1. Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease (CVD) risk. This position paper provides an update of gynecological and obstetric conditions that impact CV risk in women.
2. Menopause is associated with central adiposity, insulin resistance, and a pro-atherogenic lipid profile. It is important to assess lipid levels and blood pressure during menopause transition according to prevention guidelines. Adherence to a healthy lifestyle and diet with regular exercise are important factors in the optimal management of menopausal health.
3. Regular control/self-measurement of blood pressure is needed in women after hypertensive pregnancy disorders (HPDs)/pre-eclampsia. Of note, inflammatory comorbidities increase CVD risk in women around menopause.
4. Menopausal hormone therapy (MHT) is indicated to alleviate menopausal symptoms. Before starting MHT, assessment of CV risk factors should be performed. MHT is not recommended in women at high CV risk and after a CVD event. Furthermore, initiation of MHT is generally not advised in asymptomatic women.
5. Early menopause is associated with higher risk of diabetes and CVD. Women with premature ovarian insufficiency (POI) and early menopause (<45 years) should have an assessment of their CV risk factors. In addition, women with POI are recommended to take HRT until the average age of menopause. Of note, a genetic predisposition to POI may also increase risk for cancer.
6. Pregnancy history should be an integral part of CV risk assessment, since women after HPD, especially after pre-eclampsia/hemolysis, elevated liver enzyme levels, and low platelet count, are at increased risk of developing premature hypertension and CVD.
7. Women with gestational diabetes mellitus should have a screening oral glucose tolerance test (OGTT) test at 4–12 weeks post-partum, and this test should be repeated every 1–3 years.
8. Several chronic gynecologic conditions may be associated with an adverse CVD risk. Women with polycystic ovarian syndrome (PCOS) should have a CV risk assessment with measurement of blood pressure, OGTT, fasting lipid profiles, and screening for gestational diabetes mellitus in pregnancy. Dietary and lifestyle modifications should also be extra emphasized in women with PCOS.
9. Combined oral contraceptive pills should be avoided in women with a history of venous thromboembolism, stroke, CVD, or any other peripheral vascular disease. In addition, use of oral contraceptive pills is contraindicated in women above 35 years of age who smoke and in women with severe dyslipidemia or obesity. On the other hand, progestin-only contraceptives administered by oral, subcutaneous, or intrauterine routes can be prescribed in women at elevated CV risk.
10. BRCA1/2 gene mutation carriers and women treated for breast cancer have increased risk of CVD and need their CV risk factors checked. The use of MHT in women after breast cancer should be individualized with expert advice for menopausal treatment. Current guidance suggests to reserve MHT for those with refractory symptoms after other nonhormonal treatments have been unsuccessful.

Clinical Topics: Cardio-Oncology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Lipid Metabolism, Diet, Exercise

Keywords: Adiposity, Blood Pressure, Breast Neoplasms, Cardiotoxicity, Cardiovascular Diseases, Contraceptives, Oral, Combined, Diabetes, Gestational, Diet, Dyslipidemias, Exercise, Gynecology, Hormone Replacement Therapy, Insulin, Lipids, Menopause, Menopause, Premature, Neoplasms, Polycystic Ovary Syndrome, Pre-Eclampsia, Pregnancy, Primary Prevention, Progestins, Risk Factors, Vascular Diseases, Venous Thromboembolism

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