Blood Pressure During Perimenopause: A Complete Guide
Blood pressure often rises during perimenopause as estrogen declines. This guide explains why it happens, what the risks are, and how to manage it effectively.
How Perimenopause Affects Blood Pressure
Estrogen has a protective effect on the cardiovascular system. It helps keep blood vessels flexible, supports healthy endothelial function (the lining of blood vessels), and has a mild blood pressure-lowering effect. As estrogen declines during perimenopause, these protections are reduced. Blood vessels become stiffer, the renin-angiotensin-aldosterone system (which regulates blood pressure via fluid balance) becomes more active, and sympathetic nervous system activity increases. The result is that blood pressure tends to rise during perimenopause. Studies show that the prevalence of hypertension in women increases sharply after the menopause transition, making this a critical window for monitoring and action.
Symptoms and Silent Risks
High blood pressure is often called a silent condition because most people do not feel any different when their readings are elevated. Occasional symptoms such as headaches, a sensation of pressure in the head, dizziness, or nosebleeds can occur at very high levels, but these are unreliable indicators. The real concern is the cumulative damage that sustained high blood pressure does to the heart, brain, kidneys, and eyes over time. Perimenopause is the right moment to start taking blood pressure seriously, especially if you have a family history of heart disease or stroke, carry weight centrally, smoke, or have a high-stress lifestyle.
Dietary Approaches
The DASH diet (Dietary Approaches to Stop Hypertension) is the most evidence-based dietary pattern for blood pressure management. It emphasises vegetables, fruits, low-fat dairy, wholegrains, lean protein, and nuts, while reducing sodium, red meat, saturated fat, and added sugar. Potassium is particularly beneficial, as it helps counteract the blood pressure-raising effects of sodium. Aim for 3,500mg of potassium daily from foods like bananas, potatoes, leafy greens, and beans. Reducing sodium to below 2,000mg daily, limiting alcohol to no more than one drink per day, and cutting back on caffeine if you are sensitive to it can all contribute meaningfully.
Exercise and Lifestyle
Regular aerobic exercise is one of the most effective non-medication interventions for blood pressure. Aim for at least 150 minutes of moderate-intensity activity per week, such as brisk walking, cycling, or swimming. Strength training two to three times weekly also supports cardiovascular health and helps manage the central weight gain common in perimenopause. Stress is a significant driver of blood pressure, particularly through its effect on cortisol and the sympathetic nervous system. Practices like slow breathing (five to six breaths per minute), meditation, and yoga have measurable blood pressure benefits when practised consistently. Good sleep is also essential, as blood pressure is regulated during sleep.
Medication and HRT
If lifestyle changes alone are insufficient to bring blood pressure within a healthy range (below 130/80 mmHg), medication is appropriate and effective. Common options include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and thiazide diuretics. Your GP will advise on the best choice given your overall health picture. HRT is not a treatment for high blood pressure, but stabilising hormonal fluctuations can reduce some of the vasomotor and nervous system drivers of elevated readings. Transdermal HRT (patches or gels) may be preferable to oral forms for women with blood pressure concerns, as it avoids the liver's first-pass metabolism and its associated effects on clotting and blood pressure regulation.
Monitoring and When to Act
Home blood pressure monitors are inexpensive, accurate, and valuable during perimenopause. Measuring in the morning and evening, sitting quietly for five minutes first, gives a more reliable picture than a single clinic reading. A reading consistently above 140/90 mmHg warrants a GP appointment. Above 180/120 mmHg is a hypertensive crisis requiring immediate medical attention. Track your readings over time and bring them to appointments. Getting an annual blood pressure check is a minimum during perimenopause, more frequently if previous readings have been borderline or if you have other cardiovascular risk factors.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.