Cardiovascular diseases account for nearly 25% of all deaths in India, yet women's menstrual health is rarely considered during routine cardiovascular assessments. Fluctuations in oestrogen and progesterone levels throughout the menstrual cycle can influence heart rate, blood pressure, vascular function, and inflammation. While these physiological changes are well recognised, they are not routinely considered during traditional cardiovascular evaluations. As heart disease is increasingly recognised in younger women, incorporating menstrual history into cardiovascular assessment may improve the understanding of symptom patterns and contribute to more personalised care.

This raises an important question: should menstrual history become part of routine cardiovascular assessment or remain confined to reproductive healthcare?

The Heart Changes Across The Menstrual Cycle

The cardiovascular system responds differently during various phases of the menstrual cycle because of changing hormone levels. During the follicular phase, rising oestrogen levels improve endothelial function, promoting relaxation of blood vessels and reducing vascular resistance. In the luteal phase, when progesterone predominates, many women experience mild fluid retention, and resting heart rate may increase slightly. Blood pressure changes during this phase are generally modest and may vary between individuals.

These physiological fluctuations usually remain within the normal range. However, they may influence the interpretation of cardiovascular observations, particularly in women with hypertension, arrhythmias, diabetes, or obesity, or when symptoms vary across the menstrual cycle. Recording the menstrual phase may therefore provide clinicians with useful clinical context rather than relying on a single measurement alone.

Why This Matters In The Indian Context

India is witnessing a growing burden of conditions that increase cardiovascular risk in women, including diabetes, obesity, polyendocrine metabolic ovarian syndrome (PMOS), and thyroid disorders. These conditions may interact with cyclical hormonal changes, making cardiovascular signs and symptoms more variable and, at times, more difficult to interpret.

Recording menstrual history during cardiovascular evaluation may provide additional clinical context and help identify women who could benefit from closer cardiovascular assessment, particularly when menstrual irregularities coexist with metabolic disorders. A 2024 Indian study involving 226 women found that those with short or long menstrual cycles had higher triglyceride and total cholesterol levels and lower HDL cholesterol compared with women who had regular cycles. Although observational, the study suggests that menstrual irregularities may reflect underlying cardiometabolic health, even in women without PCOS or other gynaecological disorders.

Research also shows that women are more likely than men to present with atypical symptoms of cardiac events, including fatigue, shortness of breath, nausea, and upper back pain. These presentations may contribute to delays in diagnosis or under-recognition of cardiovascular disease. Considering menstrual history alongside presenting symptoms may help clinicians identify recurring patterns, guide decisions regarding repeat evaluation, and reduce both missed diagnoses and unnecessary investigations.

A Practical Addition, Not A Complex Investigation

Including menstrual history in cardiovascular assessment does not require specialised equipment or expensive testing. Simple questions such as the date of the last menstrual period, menstrual regularity, menopausal status, and use of hormonal medications can provide valuable additional clinical information. As increasing numbers of women use wearable devices and menstrual tracking applications, longitudinal data on resting heart rate and symptom patterns throughout the menstrual cycle are becoming more readily available, although these data are not yet routinely incorporated into clinical practice.

This approach aligns with the principles of personalised medicine, where biological differences among individuals are considered while making healthcare decisions. Menstrual history is not intended to replace established cardiovascular risk assessment but rather to complement it by providing additional context for interpreting cardiovascular findings.

Women's cardiovascular health cannot be fully understood without acknowledging the hormonal changes that occur throughout the menstrual cycle. Although further Indian research is needed before standardised recommendations can be developed, current evidence suggests that menstrual history may influence the interpretation of cardiovascular physiology, symptom presentation, and long-term cardiometabolic risk. Incorporating this often-overlooked aspect of women's health into routine clinical assessment represents a simple, low-cost step towards more personalised care.

(By Dr. Raina Chawla, Associate Director, Gynaecology, Sarvodaya Hospital, Sector-8, Faridabad)

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