<p>This study aims to investigate the associations between the trajectories of menstrual symptoms over 18 years and measured blood pressure in midlife. Data were sourced from the Australian Longitudinal Study on Women’s Health. Participants provided self-reported data on their health and wellbeing, including menstrual symptoms, through regular surveys conducted from ages 18–23 (in 1996) to ages 40–45 (in 2018). Between 2019 and 2021, a subset participated in the Menarche-to-PreMenopause study, which collected physical measurements, including blood pressure and anthropometric data. Distinct trajectories of heavy menstrual bleeding, irregular periods, and dysmenorrhea were identified among 458 women by group-based trajectory modelling. Associations between menstrual symptom trajectories and blood pressure were examined by linear regression models. After adjusting for covariates, women in the increasing heavy menstrual bleeding group had higher diastolic blood pressure (DBP) (mean difference = 3.3 mmHg, 95% CI:1.1–5.6) compared to those in the reference group. Women in chronic irregular periods group also had higher DBP (mean difference = 2.5 mmHg, 95% CI:−0.1–5.0) than those in the reference group. No differences in blood pressure were observed across the different trajectories of dysmenorrhea. In conclusion, women who experienced an increasing heavy menstrual bleeding pattern over time and chronic irregular periods during their reproductive lifespan had higher DBP in their mid-40s. This suggests that attention should be paid to the cardiovascular health of women who report menstrual symptoms.</p>