Pregnancy complications and early menopause increase women’s future risk of heart disease, suggests a new study. Women who have an early natural (i.e. not surgical) menopause before the age of 40 are also more likely to develop cardiovascular disease – each year is associated with a 3 per cent raised risk. Autoimmune inflammatory conditions such as rheumatoid arthritis and lupus are more common in women compared to men and increase cardiovascular risk around menopause. The study also provided guidance on how to manage heart health during menopause, after pregnancy complications, and during other conditions such as breast cancer and polycystic ovarian syndrome (PCOS). The important role of a healthy lifestyle and diet is recognised – an example for optimal management of menopausal health and in women with PCOS, who have elevated risks of high blood pressure during pregnancy and type 2 diabetes. While menopausal hormone therapy is indicated to alleviate symptoms such as night sweats and hot flushes in women over 45, the authors recommend assessment of cardiovascular risk factors before initiation. Therapy is not recommended in women at high cardiovascular risk or after a stroke, heart attack, or blood clot. The study highlighted that transgender women “should always be encouraged to reduce modifiable lifestyle risks” while acknowledging that “the psychosocial benefits of hormone therapy with an improved body image may result in healthier lifestyle choices”.