Female Life Stages for Cardiovascular Disease Prevention and Management in Girls and Women: A Case-Based Approach

Cardiovascular disease remains the leading cause of death among women in the United States and worldwide, yet current approaches to prevention and management do not fully account for female-specific biology. To address this need, the American Heart Association, in collaboration with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, published a Presidential Advisory defining the Female Life Stage construct, which defines four distinct stages across the life course: Perimenarche (Stage 1), Ovarian Cycling (Stage 2), Perimenopause (Stage 3), and Postmenopause (Stage 4), with pregnancy including the time before and after (Peripregnancy period) recognized as a distinct life period when cardiovascular risk may be modified.1 To provide examples of how this framework and the accompanying consensus guidance published in an accompanying Scientific Statement can be translated into a personalized care approach, this special report presents six hypothetical cases spanning the Female Life Stages, including adolescence and young adulthood, the peripartum period, midlife, perimenopause, and postmenopause.2 These cases illustrate how a female-specific life course framework that reflects hormonally-mediated physiologic transitions can promote earlier recognition of cardiovascular risk, guide cardiovascular screening and inform cardiovascular management. The cases underscore how hormonal health (e.g., menstrual cycle assessment, pregnancy planning and prevention, assessing and managing perimenopausal and postmenopausal symptoms) and psychosocial health (e.g., anxiety, depression, disordered eating) have cardiovascular implications. Moreover, this approach integrates well-established female-specific cardiovascular risk factors (e.g., premature menopause and adverse pregnancy outcomes), in addition to less well-recognized risk factors (e.g., early menarche, polyendocrine metabolic ovarian syndrome). We also review key evidence to inform a patient-centered approach to exogenous hormone therapy and associated cardiovascular risks for a variety of indications, including management of abnormal uterine bleeding, ovarian suppression, pregnancy prevention, and menopausal symptoms. By contextualizing the Female Life Stage framework within practical case scenarios, this article provides clinicians with a structured, evidence-based approach to improve cardiovascular prevention and management for girls and women.