Guide

Longevity for women

Women’s longevity biology has substantial sex-specific considerations — particularly around oestrogen decline at menopause and its effects on cardiovascular, bone, and cognitive trajectories. Much longevity science is reported in mixed-sex cohorts; the women-specific applications deserve their own synthesis.

Perimenopause and menopause

Average menopause is age ~51; perimenopause begins 4–10 years earlier. Symptoms (vasomotor, sleep, mood, cognitive) reduce quality of life and overlap with cardiometabolic effects of oestrogen withdrawal. See menopausal hormone therapy.

The timing window for MHT/HRT

Modern reanalysis of the Women’s Health Initiative supports the timing hypothesis: hormone therapy started within ~10 years of menopause reduces cardiovascular events and protects bone; started a decade later, the risk-benefit shifts. The conversation with a knowledgeable clinician should happen in the perimenopausal-to-early-postmenopausal years, not delayed.

Cardiovascular timing

Women’s cardiovascular risk rises after menopause as oestrogen protection lifts. Apo-B lowering, BP control, and exercise become more urgent. See cardiovascular disease and apoB.

Bone health

Oestrogen withdrawal accelerates bone loss. Baseline DEXA in perimenopause if family history; otherwise around 65. Resistance + impact training, adequate calcium and vitamin D, and (when needed) bisphosphonates or other therapies. See osteoporosis.

Reproductive history matters

• Premature ovarian insufficiency carries elevated CV/dementia risk; consider earlier MHT.
• Pre-eclampsia history is an independent CV risk factor; treat lipids and BP earlier.
• Gestational diabetes raises T2D risk substantially.
• PCOS adds cardiometabolic risk that persists.
• Hysterectomy with/without oophorectomy affects MHT decisions.

Often-missed considerations

• Sleep apnea is common in postmenopausal women and substantially under-diagnosed.
• Iron status (ferritin) shifts with menstrual cessation.
• Thyroid issues are 5–8× more common than in men.
• Genitourinary syndrome of menopause is treatable and often quality-of-life-defining.