Perimenopause Isn't Just Hot Flashes — It's a Heart Health Turning Point

Why a Former Cardiac Surgery PA Takes Perimenopause Seriously

Before functional medicine, Dr. Gengo spent years as a physician assistant in cardiac surgery, eventually becoming Chief PA at NewYork-Presbyterian/Weill Cornell. She watched women's cardiovascular risk climb steadily through their 40s and 50s — often waved off as “just getting older” or “just hormones” until it wasn't.

That experience changed the question she asks. Instead of treating perimenopause as something to simply endure, she asks “what is this hormonal shift actually doing to your heart, your metabolism, your risk — and how do we get ahead of it.” That's what brought her to functional medicine, and why she doesn't reach for hormone replacement therapy as a first move. Dr. Lisa Gengo, ND, PA-C, FMCP-M sees patients in Stamford, Greenwich, Darien, New Canaan, Fairfield, and Ridgefield, CT — and throughout the Tri-State Area via telehealth.

Why Perimenopause Raises Your Heart Disease Risk

Estrogen isn't just a reproductive hormone — it helps keep your blood vessels flexible, your cholesterol profile favorable, and your blood pressure in check. As estrogen begins its erratic decline during perimenopause, often years before your last period, that protection fades with it. Most women don't realize this shift is already reshaping their cardiovascular risk.

The changes rarely arrive one at a time. LDL cholesterol tends to climb, blood pressure that was stable for years starts creeping up, weight begins shifting to the abdomen instead of the hips, and insulin sensitivity declines — even without a change in diet or exercise. On their own, each change might get chalked up to "getting older." Together, they help explain why a woman's heart disease risk rises to match a man's within about a decade of her final period.

That's the part that catches people off guard. These shifts don't usually come with a dramatic symptom — no chest pain, no emergency. They just quietly raise your risk while everyone around you, including many doctors, files it under "normal menopause." Dr. Gengo's approach is to find it while it's still quiet — through lab testing that looks at hormones, metabolism, and cardiovascular markers together — so it can be addressed instead of dismissed.

Palpitations, Anxiety, Weight Gain: When "Just Hormones" Deserves a Second Look

Here's what surprises most patients: heart palpitations, new-onset anxiety, disrupted sleep, and stubborn weight gain are some of the most common perimenopause complaints — and some of the most common early cardiovascular and metabolic warning signs. The overlap is not a coincidence.

Fluctuating estrogen can trigger palpitations and anxiety directly, and that's real and worth acknowledging. But those same years are also when blood pressure, cholesterol, and insulin sensitivity are shifting for physiological reasons that have nothing to do with mood. When every symptom gets filed under "hormones" without a closer look, early cardiovascular changes can go unmeasured for years.

Dr. Gengo doesn't stop at reassurance. She runs the labs — hormone panels, lipid particle testing, insulin and blood sugar markers — so palpitations, anxiety, and weight gain get evaluated on their own terms, not dismissed as "just perimenopause." Catching a shift here, while it's still reversible through nutrition, movement, and targeted support, is one of the most effective things she does for a patient's long-term heart health.

Real Hormone & Nutrient Testing — Not Just a Prescription Pad

Dr. Gengo doesn't prescribe or manage hormone replacement therapy — that stays with your OB-GYN, and she partners closely with them on it. Her focus is everything else that could be happening at the same time: perimenopause and menopause rarely show up alone, and thyroid imbalances, blood sugar shifts, or nutrient gaps are often part of the picture too, so treating a single symptom in isolation isn't always the fix. That's why Dr. Gengo runs a full picture — sex hormones, thyroid, insulin and blood sugar markers, and key cardiovascular nutrients like magnesium, omega-3s, CoQ10, and B vitamins — most of which are never checked at a standard annual visit.

This is where her approach differs most from a typical visit: rather than reaching for a prescription first, she checks what your body may actually be low on and helps you build it back up — first and foremost through food, then targeted supplementation where labs show it's needed.

Her philosophy, in her words: Nutrition isn't about eating less. It's about eating more of what actually nourishes you. Dr. Gengo doesn't hand patients a restriction list as a first resort. She works from abundance — real, nutrient-dense food that supports hormone balance, calms inflammation, and protects your heart at the same time, because those systems were never meant to be treated separately. It's all connected, and that's exactly the kind of connection a rushed 15-minute appointment doesn't have time to make.