Dr. Herman Weiss
Oct 7, 2026
Most conversations about menopause assume it arrives on its own schedule. For many women it does not. Surgery that removes the ovaries, or cancer treatment, can end ovarian function overnight, sometimes in a woman's thirties or forties. Doctors call this iatrogenic menopause - menopause caused by medical treatment. A new study in JAMA Network Open asks the question these women have been waiting on: what does it do to the heart, and does the age it happens at matter?
The research. Armeni, Erkan, and Kempegowda searched seven medical databases from January 2004 through March 2026 - 14,409 records - for studies comparing heart outcomes in women with iatrogenic menopause against women with natural menopause or women of the same age. Thirty-six studies qualified, covering 2,617,942 women, followed for a median of 16 years.
What they found. Overall, iatrogenic menopause was linked to higher risks: cardiovascular events 25% higher (pooled hazard ratio 1.25), coronary heart disease 48% higher (1.48), stroke 22% higher (1.22), and death from any cause 8% higher (1.08). Here is the part I want you to hold on to. The excess risk of dying - from heart disease and from any cause - showed up only when menopause came before age 45. Before 45, cardiovascular mortality was 20% higher (1.20) and all-cause mortality 15% higher (1.15). At or after 45, the numbers were essentially flat (0.95 and 0.99). In a further analysis, each 5 years later that menopause happened was linked to about an 11% lower risk of heart events and heart death combined (0.89). The authors read this as a period of elevated risk before 45, not a single cliff edge at one age.
What you gain from this. If you are facing a surgery or treatment that will end your ovarian function, this gives you a better question for your care team: not just "will this cause menopause," but "how early will it be, and what is our plan for my heart and my bones if it is before 45?" It also tells you that your risk is not fixed. Blood pressure, cholesterol, blood sugar, not smoking, and regular exercise matter at every age, and the earlier your menopause, the more reason to look at them closely and early. If you have already gone through an early iatrogenic menopause, this is a reason to make sure your cardiovascular risk is being checked, not a reason for alarm.
The honest caveats. This is a pooling of observational studies, not a trial, so it can show association, not proof that the menopause caused the extra risk. The women with iatrogenic menopause were on average about ten years older than the comparison groups in the studies pooled (55.5 versus 45.6 years), a gap that adjustment can only partly close. Women who need these treatments are also often ill to begin with, which can skew the picture. The 5-year-increment finding was a post hoc analysis, meaning it was not the planned main question. And the abstract does not tell us whether hormone therapy use after surgery changes any of this, so I cannot tell you that here.
For my PMOS readers: this paper does not study PMOS, so I will not pretend it does. But the lesson travels. If you have PMOS, you may already carry metabolic and cardiovascular risk factors, and if a medical treatment ever brings menopause on early, those two things would stack. That is my reading, not a finding of the study - but it is a good reason to know your numbers now, years before perimenopause arrives, and to tell any surgeon or oncologist about your full history.
That's the cycle. Bring your doctor the papers, not just the headlines.
Dr. Herman Weiss
(Armeni E, Erkan IBO, Kempegowda P. Age at Iatrogenic Menopause and Cardiovascular Morbidity and Mortality: A Systematic Review and Meta-Analysis. JAMA Network Open, 2026. doi:10.1001/jamanetworkopen.2026.37545)
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