When we think about menstrual health, we often focus on fertility, cramps, or irregular cycles. But what if your period could tell you something even more profound, like how your heart might be doing in the decades ahead? For many women, especially those in their 30s and 40s, the menstrual cycle can act as an early indicator of cardiovascular risk. And for those using hormonal birth control, it's worth understanding how these medications might play a role in heart and vascular health.

Menstrual Patterns as a Cardiovascular Clue

Irregular or absent periods aren’t just frustrating—they may be red flags. Women with conditions like polycystic ovary syndrome (PCOS) or premature ovarian insufficiency are at a higher risk for:

• High blood pressure
• Elevated cholesterol
• Stroke
• Coronary artery disease

This connection isn’t just a coincidence. Hormones that regulate your cycle, especially estrogen, also influence the elasticity of your blood vessels, your body’s response to inflammation, and how your body manages cholesterol and glucose. Your cardiovascular system can feel the effects when those hormones are out of balance.

Hormonal Contraceptives: What’s the Risk?

For many women, birth control pills are a cornerstone of reproductive health. But it's important to recognize that not all hormonal contraceptives are the same, especially when it comes to cardiovascular health.

Combined hormonal contraceptives (CHCs), which include both estrogen and progestin, have been linked to a small but significant increase in the risk of blood clots (venous thromboembolism), stroke, and, in rare cases, heart attacks. According to a 2024 systematic review published in Cureus, the estrogen component in CHCs appears to be the primary contributor to this increased risk.

That said, the absolute risk is still low for most healthy women, especially those under 35 who don't smoke and don’t have a personal or family history of clotting disorders. However, these considerations become more important if you fall into certain risk categories.

Who Should Be Cautious?

You may want to speak with your healthcare provider about non-estrogen options if you have:

• A history of high blood pressure, especially if untreated
• A family or personal history of blood clots or stroke
• Migraine with aura
• Diabetes with vascular complications
• Smoking habits, particularly over the age of 35
• Obesity (BMI ≥30)

These factors can increase the likelihood of cardiovascular events when combined with CHCs.

Alternatives to Estrogen-Based Birth Control

If you’re looking for reliable contraception but want to minimize cardiovascular risk, consider these alternatives:

• Progestin-only pills (also called the "mini-pill")
• Hormonal IUDs (levonorgestrel-based)
• Copper IUDs (non-hormonal)
• Birth control implants (etonogestrel)
• Depo-Provera injections (although this option has its own set of pros and cons)
• Barrier methods like condoms or diaphragms

These options typically do not carry the same thrombotic risk as CHCs and may be better suited for women with cardiovascular concerns.

Talking to Your Provider: What to Ask

If you’re using or considering hormonal contraception and have concerns about your heart health, here are some discussion points to bring to your next appointment:

• Is my current method affecting my cardiovascular risk?
• Should I be screened for high blood pressure or cholesterol more often?
• Are there safer alternatives for me based on my personal risk factors?
• Could my cycle history indicate a need for earlier cardiovascular screening?

Menstrual Health as a Vital Sign

Think of your cycle as more than a monthly occurrence—it’s a vital sign that can offer insight into your broader health, including your heart and blood vessels. Paying attention to your period patterns and having open conversations about birth control options can support long-term wellness and help you make informed decisions that align with your personal health profile.

Source:
 Asubiaro J. The Impact of Hormonal Contraceptives on the Incidence and Progression of Cardiovascular Diseases in Women: A Systematic Review. Cureus. 2024 Jul 25;16(7):e65366. doi: 10.7759/cureus.65366. PMID: 39184751; PMCID: PMC11344578.