Cardiovascular diseases (CVD) is an important cause of mortality in women. The cardiovascular events occur approximately 10 years earlier than men. Premenopausal women have a lower incidence of coronary artery disease (CAD) then men due to protection given by estrogens. Changes in body fat distribution, lipid profile, impaired glucose tolerance, hypertension, and increased inflammatory markers start from menopause transition (MT) are linked with estrogen deficiency. These cause endothelial dysfunction causing higher CVD risks. This causes nonobstructive coronary artery disease in women. There is increase in Total cholesterol (TC) levels, Low density lipoproteins (LDL-C), and decreased High density lipoproteins (HDL) during menopause transition. Hypertension, Impaired glucose tolerance, increases over menopause stages and are risk factors for CVD. Oral or Transdermal MHT does not increase the risk of heart disease if given within 10 years of menopause or before the age of 60 years in low risk women for CVD. MHT can alleviate the majority of CVD risk factors to varying degrees, including visceral obesity, dyslipidemia, and glucose homeostasis. MHT is not recommended for the primary prevention of cardiac diseases. WHO ISH risk prediction charts, Framingham’s risk score calculator, PREVENT: Predicting Risk of Cardiovascular Disease events’s are various scores to assess cardiovascular risks. Lifestyle management, exercise, adequate sleep, healthy diet, and managing stress are important. Visceral adiposity, Diabetes, Hypertension Dyslipidemias should be addressed early and prevention should be the aim.