Cardiologist Dr. Jayne Morgan has a message that cuts through the noise: menopause is not a gynecological footnote. It's a cardiovascular inflection point — and most women don't find out until it's too late.
In this episode, Dr. Morgan and Stacy cover the full arc of women's cardiovascular health: why complicated pregnancies are early warning signs, what happens to blood pressure at age 51, how every perimenopausal symptom signals estrogen loss and rising cardiac risk, and why perimenopause is actually your best window to intervene. They also discuss the racial disparity in symptom severity, the limits and promises of AI in women's health, and why the case for estrogen doesn't require the studies we don't have.
The Risk Factor Nobody's Talking About — Menopause, Estrogen, and the Heart Disease Epidemic in Women
Guest: Dr. Jayne Morgan
Stacy London: Doctor Morgan, welcome to Hello Menopause. I'm so happy you could join me here.
Dr. Jayne Morgan: Stacy, it's great to see you again. I have missed you.
Stacy London: I missed you too. You have said that menopause is an inflection point for cardiovascular health. I'd love to start there and talk about what you mean by that and how this conversation has become part of the forefront of the entire menopause conversation.
Dr. Jayne Morgan: ChatGPT said about me: Dr. Jayne Morgan is repositioning menopause as a cardiovascular inflection point, and not a gynecologic footnote. I always hold on to that quote.
Stacy London: You talk about it as an inflection point rather than a gynecological footnote — which has been the issue for years and years. Our generation, Gen X, has really taken menopause by the neck and said, wait, hang on a second. We need to explain this. We need to understand more about female physiology, what is happening to us at this stage — particularly with our heart. Can you tell us what we should be thinking about in terms of cardiovascular health leading up to menopause, and then how that changes postmenopause?
Dr. Jayne Morgan: A woman's cardiovascular health really starts with so many life phases. Let's start with pregnancy. Pregnancy complications are not benign. The way we were taught to manage them — you have a high-risk OB come in, but by and large it's still managed from an obstetrical and gynecologic lens. All other physicians work in our specialty silos. The treatment for pregnancy complications like pre-eclampsia, high blood pressure, eclampsia, or gestational diabetes was actually to deliver the baby, because once the baby was delivered, the mother's parameters gradually came back down to normal. So we were saying: get the high-risk OB in, keep mom and baby safe, get her as close to term, deliver the baby — and that's a win. But we now know that is not true. That pregnancy was a marker for heart disease. This woman's risk of heart disease is now going to be twice that of someone else's.
I want to be clear about something. I've heard people say, "I'm going to avoid pregnancy complications and heart disease — I'm just not going to get pregnant." It's not the pregnancy that causes the heart disease. The pregnancy actually did you a favor by declaring it for you. It identified which women are more susceptible. Even without the pregnancy, you still would have been in this high-risk group. You just wouldn't have known it.
Stacy London: Is this similar to people who don't experience symptoms during perimenopause — no hot flashes, no brain fog, no joint pain? That doesn't mean they're not at risk for cardiovascular disease, osteoporosis, all the things that become markers for us postmenopause?
Dr. Jayne Morgan: That's right. And I'm talking about pregnancies that have complications — which is a high percentage of pregnancies in the United States. We have the highest maternal mortality rate in the world. Women are still dying, and most of those deaths look like cardiovascular deaths. I'm talking about the women who survive it, where it's a "phew, the system saved you, everything's fine." But no — your risk of heart disease is still elevated.
The reason pregnancy helps to declare it is because pregnancy is a stress test for the system. Here's why it's important for doctors to come out of our silos: an OB-GYN sees a pregnant patient with complications and says, "36-year-old female in her 32nd week of gestation with pre-eclampsia." A cardiologist looks at the same woman and says, "36-year-old female in a volume-overloaded state who just failed her stress test." Same patient, two separate lenses. Diversity of thought, diversity of experience, diversity of perspectives — that brings the whole picture in for that patient.
And it's also true if you've ever had a low birth weight baby. Small babies mean there was some compromise in the vascular supply — the blood and oxygen supply to that woman. The baby's perfectly normal, perfectly well formed, but didn't grow as large as expected because of that blood supply. So low birth weight babies are also indicators of women who are at higher risk of heart disease. Pregnancy is the first stress test.
Stacy London: There should be cardio-obstetrics teams. People shouldn't work in silos and then have the cardiologist come in only when there's a problem.
Dr. Jayne Morgan: That's it exactly. There should be cardio-obstetrics teams. Oftentimes that problem is a code — the mother may be coding, the baby may be coding. That's not the time to have a cardiologist involved. As a whole, medicine hasn't understood the lens I'm bringing as a cardiologist. They're looking through a gynecological lens. And once you deliver the baby, a lot of those indices return to normal and everybody forgets about it.
Stacy London: It also puts the focus on the mother. There's a conversation happening about how every fetus is a life, and yet nobody seems to care about the woman carrying that fetus. This puts an emphasis on her health.
Dr. Jayne Morgan: It does. Because heart disease is the number one killer of women. It's not breast cancer, which is what many people think. I'm the vice president of medical affairs at Hello Heart, the digital-first AI cardiovascular company with a Bluetooth-enabled blood pressure monitor and app. Blood pressure is the single biggest driver of heart disease. We see elevated blood pressure in pregnancy complications, and we certainly see it in perimenopause and menopause. We are trying to pull women back from the starting line of heart disease.
Stacy London: Is there a specific window — perimenopause or postmenopause — where cardiovascular risk is greatest, or where the changes are most dramatic?
Dr. Jayne Morgan: The risk changes are most dramatic at age 51. When you get to 51 — the average age of menopause in the US — you see a dramatic increase in blood pressure. Prior to that, when we look at blood pressure lines for men and women, men have higher blood pressures throughout the entire lifespan, from age 10 all the way up to 50. The men's line is up here, the women's line is down here. Then suddenly at 51, even though men go up slightly, women take a sharp increase. Now our line is on top of the men's line. That is the inflection point — the loss of estrogen, the loss of vascular pliability and flexibility, the rigidity now of the arteries.
Stacy London: Are those two things directly related — loss of estrogen and higher blood pressure?
Dr. Jayne Morgan: Direct correlation. Estrogen is what by and large protects the hearts of women and protects our vasculature — our arteries and our veins. When we look at that graph, it's stark to see how those lines suddenly switch. That is directly related to menopause. You are at your greatest risk when you are in full menopause, especially if you haven't done anything during perimenopause by way of preventive care. Perimenopause is your greatest interventional opportunity window. There's your window to jump in with both feet and take care of it.
Stacy London: How do we do that? We know blood pressure tends to go up after 51. What can we do, and how do we pay attention to it?
Dr. Jayne Morgan: It grows up significantly. It's not a gradual rise. It is a metabolic cliff that we fall off of. And so if we can back up to all those years prior and pull ourselves back from that cliff — that's what we're talking about when we discuss estrogen and hormone replacement therapy: improving your vascular biology. Improving your vascular biology means lowering your blood pressure and making the endothelium, the lining inside your vessels, healthier. It decreases your risk of heart disease.
I hear people say there's no data on primary or secondary prevention of heart disease from estrogen or hormone replacement therapy. There are a lot of reasons for that — women haven't been included in trials, and on and on about the patriarchy of medicine. But let's pull away from that and look at risk factors for heart disease. Hypertension is the most significant risk factor. There is no argument that estrogen positively impacts the endothelial lining of arteries and makes them more pliable to bring blood pressure down. So even though we don't have studies on the primary and secondary prevention of heart disease, we have studies on the prevention of high blood pressure — which is the risk factor for heart disease.
Stacy London: You don't necessarily need the direct test to prove the point.
Dr. Jayne Morgan: We always like to have endpoints in research that we're actually measuring. If we're going to say estrogen reduces heart disease, we want a trial where the endpoint was heart disease reduction — decrease in heart attacks, decrease in stroke. We don't have that. What we do have is the positive impact on the single biggest risk factor for heart disease. So we can make that implication: if estrogen is improving the biggest risk factor for heart disease, it must be improving heart disease.
Here's why I'll say that: for every 10 millimeters of mercury that your blood pressure goes up, your risk of heart disease goes up by 20%. So if your blood pressure goes up by 20 — systolic, that top number — your risk of heart disease goes up by 40%. So no, we don't have studies, and yet we do have studies.
Stacy London: Are there particular symptoms that women in perimenopause or postmenopause might chalk up to menopause that could actually point to a more serious cardiovascular issue?
Dr. Jayne Morgan: All of them make me think of cardiovascular issue — including painful sex, including urinary tract infections, a metallic taste in your mouth, itchy ears. They are all markers of decreasing estrogen, and that means we are losing the protection of estrogen on our heart. Every single symptom is an indicator that I need to take care of this woman's heart and begin really aggressive preventive measures. For the first time, maybe sexual history is part of your cardiovascular history. Maybe talking about painful sex needs to be a discussion with the cardiologist — so the cardiologist knows to check blood pressure, cholesterol, sleep, weight, visceral fat. That's how we need to reframe it.
Stacy London: When you see something like that, what is the standard response? When you say preventive measures, does that mean HRT? A statin? How do you decide on the best course of action?
Dr. Jayne Morgan: When I say preventive measures, I'm not talking about HRT. I'm talking about the results of estrogen loss. Blood pressure has gone up — get on medications, bring it back down. Cholesterol has gone up — get on statins, bring it back down. Sleep has been disrupted — what can we do to restore it? Because when we talk about brain fog, that has a lot to do with sleep debt over time and the inability to process executive functions when you're sleep deprived. You may have one or two years of sleep debt, but you're supposed to be functioning at a high level. Brain fog has a lot to do with the fact that women don't sleep for three years and then wonder, "Why can't I think? Why can't I process information?" You haven't been asleep since 2023.
Stacy London: What are the tent poles for good heart health throughout our lives?
Dr. Jayne Morgan: Hypertension, cholesterol, diabetes, obesity, anemia — and one we're probably overlooking: vitamin D deficiency. Insulin resistance is a result of estrogen loss, so we have increased risk of diabetes. Diabetes is a risk factor for heart disease. High cholesterol is a risk factor for heart disease. Hypertension is a risk factor for heart disease. Sleep deprivation is a risk factor for heart disease. Obesity and weight gain are risk factors for heart disease.
Stacy London: And if heart disease runs in our family?
Dr. Jayne Morgan: Genetics are not necessarily your fate. We can impact our genetic expression through behavior choices and food choices. You may not be able to prevent the disease, but you may be able to delay it, get it in a milder form, slow the progression. It's not just genetics — it's how the environment interacts with the genetics. And that's the part we can control.
Stacy London: Heart health is something we can actually affect at every stage of our lives. There's a lot we can do before and after the menopausal experience to take care of our hearts.
Dr. Jayne Morgan: That's right. We can be our own best AI agents. You want to live the life today that you see for yourself ten years from now. Look in the mirror and say, what kind of life do I want for this person ten years from now? Those are the decisions you have to make today.
Stacy London: That's hard for some of us. If you tell me to do something today because it'll benefit me in ten years, I'm eating the cookie. Ten years is a long time.
Dr. Jayne Morgan: Have a cookie. Do not deprive yourself of cookies forever — just don't eat the whole box. Life is about pleasure, and eating is part of that. It doesn't mean you have to become a nun with the most restrictive life ever.
Stacy London: Moderation. But what's the benefit right now? How do we keep it in the here and now?
Dr. Jayne Morgan: The benefit now — especially if you're taking care of your blood pressure, cholesterol, weight, nutrition, and sleep — is better energy, better focus. You are more of a whole person and you're feeling good. We're talking about quality of life. Your quality of life measures increase, and the bonus is it's going to help you ten years from now. It takes work. That's why a lot of people don't do it.
Stacy London: Is there a future where doctors work in teams around a patient — cardiologist, gynecologist, together?
Dr. Jayne Morgan: I hope so. I write about it all the time. I was on the cover of Atlanta Medicine Magazine — the first medical journal issue devoted entirely to menopause. I recruited physicians from different specialties across Georgia to submit articles, and we had an entire issue focused on menopause. One of the articles I wrote was specifically about doctors coming out of their specialties. And if you follow me on social media, I do something called the Stairwell Chronicles — I sit on my stairs with my laptop and write letters out loud to every specialty, telling them how menopause is their responsibility. Cardiologists, primary care physicians, dentists. Go through my social media and you'll find a letter to your doctor.
Stacy London: Where do people find you?
Dr. Jayne Morgan: It's Dr. Jayne Morgan — D-R-J-A-Y-N-E-M-O-R-G-A-N — on Instagram, Threads, and TikTok. On LinkedIn I'm Jayne Morgan D. And if you lose me, find me through Stacy.
Stacy London: It's one thing to talk about this and write to all the specialties, but what do we do about health inequity? Women of color are so disproportionately affected — not enough resources, not enough doctors, not enough hospitals.
Dr. Jayne Morgan: Black women in particular have the longest and most severe perimenopausal symptoms. I think it's because of the cumulative debt load of stress they carry into perimenopause. The greater your stress load over time, the worse your perimenopausal symptoms will be. We see Black women having the longest stretch — sometimes ten years or more.
Stacy London: Maternal mortality rates are roughly three times higher in Black women. It's not just that women are being ignored — there is a class system based entirely on resources.
Dr. Jayne Morgan: What's striking is that Black women who were not born in the United States do not have the same high rates of maternal mortality. It's only Black women born here. So it's inherent to the lived experience in this country. And when we talk about epigenetics, it impacts generations later — the conditions under which a fetus is formed, the situation of the mother. It goes on and on. I think about it a lot.
Stacy London: We try to create some equality through information on this show — you don't have to have money to get answers from smart people who know what they're talking about. Every episode, we ask for three action items listeners can take on their own. What would you recommend?
Dr. Jayne Morgan: Number one: if you're prescribed medications, take them. Don't have bragging rights about not taking any meds — you're just playing with fire. Take your medications and feel privileged to have been in a health system where something was prescribed, because many people aren't getting that.
Number two: engage with AI as it continues to accelerate. Women's health is going to drive AI and digital research because we are the ones who need it. We will be the first to adopt, demand, and make it a standard of care — because we're not going to wait another 25 years for research. AI can be your friend. Embrace it.
Number three: follow good people on social media — people who are giving you real information without trying to sell you something. Follow Dr. Jayne Morgan.
Stacy London: Excellent advice. Thank you so much. You shoot straight from the hip and you care deeply. The fact that cardiovascular health is such a big part of the menopause experience is something most people still don't know — and conversations like this one are changing that. Thank you, Dr. Morgan.
Dr. Jayne Morgan: Thanks so much, Stacy.
Hello Menopause is hosted by Stacy London and produced by Let's Talk Menopause in partnership with Studio Kairos.
This transcript has been lightly edited for clarity.
This podcast is for informational purposes only and does not constitute medical advice. Please consult a qualified healthcare provider for personal medical guidance.
