Cardiovascular disease (CVD) is the leading cause of death among women, and early (<45) and premature (<40) menopause are associated with greater CVD risk. Here, we summarize the literature informing the current understanding of the relationship between early and premature menopause and CVD risk in women, including both natural and surgical menopause. Overall, the literature suggests that there is an association with both natural and surgical early and premature menopause and elevated CVD risk in women, with risk potentially preferentially elevated in surgical menopause. Multiple mechanisms may link menopause timing with CVD risk, including postmenopausal estrogen deficiency; shared upstream risk factors such as cardiovascular risk factors, smoking, diet and exercise, reproductive factors, cardiometabolic changes that accompany the menopausal transition, and glycemia; inflammatory and adiposity-related pathways; and contributions from genetics, including epigenetics, telomere length, and clonal hematopoiesis. However, analyses using human genetics for causal inference suggest that earlier age of menopause may predominantly represent a risk marker rather than a causal risk factor. We conclude by outlining the main unanswered questions in the field, highlighting a need for further research illuminating our mechanistic understanding of the relationship between early and premature menopause and CVD risk and further work around targeted management strategies to mitigate elevated CVD risk. Further study to understand disease mechanisms is required to establish targeted, evidence-based management approaches to prevent CVD and other chronic diseases in affected women.