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Menopause and blood pressure

Menopause blood pressure tends to rise through midlife, and for some women menopause itself speeds the climb. In SWAN, some groups showed an accelerated rise starting about 1 year after menopause, and women with hot flashes had higher blood pressure over time. High blood pressure rarely causes symptoms, so the only way to know is to measure it. Get checked at least every 5 years from 40, and more often during the transition.

Blood pressure tends to rise through midlife, and for some women menopause speeds it up. Why it happens, how often to check it, and what lowers it.

Find your stage · 2 min 7 sources

Menopause and blood pressure: expectation vs reality

What people often expect

“Blood pressure only rises with age, not with menopause”

What the evidence shows

SWAN followed 3,302 women over 17 visits. In the low trajectory groups, 35% of women for systolic pressure, 53% for pulse pressure and 28% for mean arterial pressure, the rise sped up about a year after menopause, pointing to a menopause effect on top of aging. Women with hot flashes had higher blood pressure over time. The researchers concluded blood pressure should be monitored often during the transition.

Why blood pressure rises around menopause

Menopause can speed up the rise in blood pressure

Blood pressure climbs with age for everyone. In SWAN, some women's systolic, pulse and mean arterial pressure rose slowly before menopause, then accelerated about 1 year after, which is consistent with a menopause contribution. For other women, blood pressure rose steadily up to menopause and then continued the same way or levelled off. So menopause matters, but not in the same way for every woman.

Hot flashes and blood pressure

Hot flashes and night sweats predicted higher systolic, pulse and mean arterial pressure over time in SWAN. That doesn't prove flashes raise blood pressure, but it suggests women with frequent flashes may benefit from closer monitoring. A younger age at menopause predicted the groups whose pressure accelerated after the final period. Surprisingly, estradiol levels did not predict blood pressure trajectory or level.

Menopause is a time of rising heart disease risk

An American Heart Association scientific statement describes the menopause transition as a time of accelerating cardiovascular risk, with adverse changes in body composition, cholesterol and blood vessel health. Heart disease is the leading cause of death in women, and risk rises notably after menopause. That makes midlife a critical window for checking and treating blood pressure, rather than waiting for problems to appear.

High blood pressure usually has no symptoms

High blood pressure rarely causes symptoms, and many people have it without realizing. Rarely, it can cause headaches, blurred vision or chest pain. The only reliable way to know is to measure it. It's usually diagnosed at 140/90 or higher when checked by a professional, or 135/85 or higher when checked at home, often confirmed with home or 24-hour monitoring.

Who is more likely to have high blood pressure

Beyond age, the NHS lists close relatives with high blood pressure, a Black African, Black Caribbean or South Asian background, a diet high in salt, being overweight, smoking, drinking too much alcohol and long-term stress as things that raise your chances. Several of these are more common in midlife, and they add to any effect of menopause itself. If several apply to you, regular checks through the menopause transition matter even more.

Menopause blood pressure by the numbers

From the studies on this page

after menopause is when the accelerated rise started in the affected groups
1 year
Bar scaled to a 12-year reference span

3,302

women were followed over 17 visits in the SWAN blood pressure analysis

140/90

or higher at a clinic, or 135/85 at home, usually means high blood pressure

The SWAN groups describe patterns of change, not how many women have high blood pressure. Rates of hypertension rise steadily with age in women, whatever their menopause pattern.

Other reasons for a high blood pressure reading

A single high reading doesn't always mean high blood pressure. These are the common reasons readings run high, and how to check.

White-coat readings
High at the doctor's office, normal at home.
Test: Home or 24-hour monitoring
Medicines and alcohol
Some painkillers, decongestants and regular drinking raise blood pressure.
Test: Medicine review
Thyroid or kidney problems
Check →
High readings with other symptoms like tiredness, swelling or weight change.
Test: Blood tests
Stress or pain at the time of reading
A single high reading taken when you were rushed, anxious or in pain.
Test: Repeat readings on different days

How to lower blood pressure during menopause

Measure your blood pressure
First step
Get checked at a pharmacy, clinic or doctor's office, and if you're 40 or over and haven't had a check in 5 years, book one now. If a reading is high, you may be asked to use a home monitor over a few days or wear a 24-hour monitor to confirm it. SWAN findings support checking more often during the menopause transition.
Lifestyle changes to lower blood pressure
Strong evidence
Less salt, less alcohol, not smoking, a healthy weight and at least 150 minutes of exercise a week all help lower blood pressure. A healthy, balanced diet matters too. The NHS notes that lowering blood pressure even a small amount reduces the risk of heart attacks, strokes and kidney disease.
Blood pressure medicines
Strong evidence
If lifestyle changes aren't enough, or blood pressure is very high, medicines usually bring it under control. You may need more than one tablet. Untreated high blood pressure raises the risk of heart disease, heart attacks, strokes, heart failure, kidney disease and vascular dementia. Once your blood pressure is controlled, most menopause treatments remain open to you, so treating it early keeps your options wide.
HRT and blood pressure
No good evidence
HRT treats menopause symptoms such as hot flashes and dryness, but hormone therapy is not indicated to prevent heart disease. The Menopause Society notes that HRT risks depend on the type, dose, route and timing, so if you have high blood pressure and want HRT, discuss which type and route suit you with your prescriber.
Related guide →

When blood pressure needs a doctor

Urgent: Chest pain that doesn't go away, or spreads to your arm, neck, jaw or back
Call 911 (999 in the UK). Chest pain with sweating, feeling sick, lightheadedness or shortness of breath can be a heart attack. Don't drive yourself.
Urgent: Frequent headaches or blurred vision, or chest pain that comes and goes
Get urgent medical advice and a blood pressure check.
You're 40 or over and haven't been checked in 5 years
Get a check at a pharmacy or doctor's office. Many pharmacies offer it.
Readings of 135/85 or higher at home
See a doctor to confirm and discuss treatment.

Menopause blood pressure: questions women ask

Does menopause increase blood pressure?

For some women, yes. In SWAN, a group of women had a steeper rise starting about a year after menopause, on top of the usual rise with age. Hot flashes also tracked with higher pressure over time. Others saw no extra jump, which is why measuring your own is the only way to know.

Can perimenopause cause high blood pressure?

Blood pressure tends to rise through the transition, and women with hot flashes had higher pressure over time in SWAN. The biggest acceleration came after the final period. Check your blood pressure regularly from 40, and more often if you have frequent hot flashes.

Can high blood pressure cause hot flashes?

That hasn't been shown. SWAN found an association the other way round: women with hot flashes tended to have higher blood pressure over time. Very high blood pressure can cause flushing and headaches, so get checked if you're unsure.

Can HRT raise blood pressure?

HRT isn't used to prevent heart disease, and its risks depend on the type, dose, route and timing. If you have high blood pressure, get it controlled and talk to your prescriber about which type and route of HRT suit you.

Does estrogen affect blood pressure?

In SWAN, women's own estradiol levels didn't predict their blood pressure pattern, but hot flashes and a younger age at menopause did. If you take HRT and have high blood pressure, discuss the type and route with your prescriber.

Can perimenopause cause low blood pressure?

Perimenopause doesn't typically cause low blood pressure, but hot flashes, sweating and dehydration can make you lightheaded when you stand up quickly. Drink plenty of water and get up slowly. Dizziness that keeps happening needs a blood pressure check lying and standing.

What is a normal blood pressure for women in menopause?

The same as for other adults. High blood pressure is usually 140/90 or higher when checked by a professional, or 135/85 or higher at home. Lowering blood pressure even a small amount reduces the risk of heart attacks and strokes.

How can I lower blood pressure during menopause?

Cut salt and alcohol, stop smoking, keep to a healthy weight and aim for at least 150 minutes of exercise a week. Get your blood pressure measured regularly, and if it stays at 140/90 or higher at the clinic or 135/85 at home, talk to your doctor about medicine. Many women need a combination of lifestyle changes and tablets.

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