Improving Cardiovascular Clinical Competencies for the Menopausal Transition: A Focus on Cardiometabolic Health in Midlife.

Cardiovascular disease (CVD) is the leading cause of death in women with an increase in risk after menopause. Over the past 20 years, longitudinal studies have helped differentiate the influence of chronological aging from ovarian aging on cardiovascular health. In addition to the pronounced sex hormone changes of the menopause transition (MT), the MT is also often accompanied by vasomotor symptoms, sleep problems, and mental health changes that impact women's cardiovascular health. The purpose of this invited review is to highlight the key changes that can alter CVD risk. Given the gaps in medical training, we also describe the need for specialized postgraduate curriculum in managing the MT with an aim to improve MT screening and management of CVD during this universal life stage. Finally, we propose a multidisciplinary approach led by experts in women's cardiovascular health and present an approach utilizing validated screening tools and CVD risk scores to discuss the candidacy of systemic menopause hormone therapy.