Survey of 7,470 Midlife Women Shows 47% Never Discussed Heart Health With Clinicians Despite Menopause-Linked CVD Risk

The CARAMEL project survey, published in BMC Women's Health, combined quantitative responses from 7,470 participants with qualitative interviews and co-design workshops. Researchers documented stark awareness gaps: only 45% recognized early menopause as a risk factor, and half of high-risk women underestimated their personal danger. Country-level variation was pronounced, from 67% awareness in Ireland to 19% in Colombia. Most participants were university-educated, implying wider deficits in general populations and among women with intellectual disabilities who reported receiving no pre-menopause information.

Preventive care failures compound these knowledge shortfalls. Nearly one-third of women had not discussed menopause with clinicians at all in the prior year, and four in ten used no symptom treatment. Symptoms extended well beyond vasomotor complaints, with fatigue affecting 70%, sleep disturbance and mood swings each at 67%, and brain fog plus anxiety near 50%. When consultations occurred, one-quarter of women said clinicians addressed physical but not emotional symptoms, revealing a pattern of incomplete assessment that delays diagnosis of cardiovascular disease, the leading killer of women.

These findings align with prior observational data in JAMA Cardiology on sex-specific menopause effects and a 2023 Lancet review documenting under-recognition of female CVD presentations. The silence persists because women wait for clinicians to initiate topics, while guidelines rarely mandate routine heart-risk framing during menopause visits. The project released a CVD Prevention Portal to bridge this gap, yet its reach depends on primary-care uptake.

Next steps require cluster-randomized trials testing whether structured prompts in electronic records increase documented heart-menopause discussions by at least 30% within two years, alongside disaggregated outcome tracking by education and disability status.