Postmenopausal women have an increased risk of ischemic heart disease (IHD)-related mortality and morbidity, which is largely attributed to obstructive coronary artery disease. However, there are conditions that disproportionately affect this population, including ischemia with no obstructive coronary arteries (INOCA) and coronary microvascular dysfunction (CMD), that are increasingly being recognized as important contributors and associated with heart failure with preserved ejection fraction (HFpEF). While these chronic conditions occur in both women and men, they are more prevalent in women, particularly, but not exclusively after menopause. Abnormal epicardial coronary endothelial function and CMD have been identified in a majority of INOCA patients on invasive coronary function testing. Although CMD is associated with major adverse outcomes in both women and men, women have more angina and lower quality of life with this condition. CMD can coexist with obstructive stenosis and with diffuse non-obstructive atherosclerosis. Aging, cardiometabolic risk factors, inflammation, and conditions of estrogen deficiency are associated with impaired endothelial function, which is a hallmark of INOCA, CMD, and HFpEF. Cardiac autonomic dysfunction has also been implicated in enhanced coronary reactivity, pain sensitivity, and persistent symptoms. These heterogeneous mechanisms lead to both structural and functional alternations in the coronary microvasculature, leading to impaired myocardial flow and myocardial dysfunction, but understanding why postmenopausal women are more impacted than men remains poorly characterized. This chapter focuses on unique cardiovascular risk factors and female-predominant conditions in postmenopausal women including INOCA, CMD, and HFpEF.