A Menopause Heart to Heart

Women and Cardiac Disease

Heart attack
Science Photo Library / Getty Images

If you ask a menopausal woman what health problem she fears the most, and you’ll probably get the answer, “breast cancer.” Or maybe, “lung cancer.” But the biggest killer of women over the age of 50 is not cancer, it’s heart disease. For some reason, we have a hard time thinking of ourselves as vulnerable to heart attack or stroke. But if you are a menopausal woman, it is time to pay attention.

Before age 45, women seem to have a definite advantage over men when it comes to heart disease.

But we catch up quickly, and after the age of 65 we have the same risk as men for having a heart attack or stroke, and more risk of dying from either.

The reason women need to be particularly alert to heart disease is that medicine is only beginning to study this disease in women, and it is clear that the differences between women’s and men’s hearts are -– literally –- killing us. Here is why:

Women’s Symptoms Are Different.

Women have different -– and more subtle –- symptoms of cardiac disease, and may easily mistake some of them for normal aging or “feeling under the weather.” Sometimes symptoms are classic, such as crushing chest pain or pain down the left arm, but not always. Women may have no chest pain at all, or minimal discomfort, and are more likely than men to notice the following when there is heart disease:

  • Profound fatigue
  • Difficulty breathing
  • Feeling faint or dizzy
  • Nausea and vomiting
  • Being anxious or having a “feeling of doom”
  • Profuse sweating
  • Neck/shoulder blade/upper back pain or discomfort
  • Burning abdominal pain

Women Are Treated Differently.

Even when a diagnosis of heart disease or heart attack is made, women may not be treated with the same medications as men. Or if they are treated, the medications may not work as effectively because it is later in the process (because women wait so long) or because, for unknown reasons, some of the anticoagulant medications work better for men.

Testing May Not Identify Heart Disease.

The standard diagnostic tests that show cardiovascular damage, such as the treadmill stress test and angiography, are not as helpful at diagnosing women’s heart disease. Blood vessels that look clear on angiography, for example, may actually have plaque lining them but because it has not intruded into the vessel is does not show. These tests can give a false impression of function, even when there is significant disease.

Women “Tough It Out.”

Women tend to minimize the discomfort of cardiac pain, and that means they wait longer to get help -– until after the damage is done. We tend to mistake our symptoms for other conditions like heartburn or low energy, and don’t get checked. We also have a higher tolerance for cardiac pain, and studies have shown that when women and men have the same degree of cardiac disease, men rate it as more serious. This is to our disadvantage, because then the symptoms are not treated as aggressively.

Some Diseases Hit Women Harder.

There are diseases that are hard on anyone’s cardiovascular system, but women are particularly disadvantaged (more than men) by diabetes, high cholesterol, depression, and metabolic syndrome.

Women smokers are also taking a higher risk than their male counterparts.

There Are Things You Can Do to Reduce Your Risk.

You can do many things to lower your risk of heart disease. While you can’t control your family history, your gender or your age, you can control many aspects of your lifestyle, habits and behavior. Here are some important ones:

  • Stay on top of your health. Get yearly checkups, including a blood pressure check and cholesterol screen. If you have chronic conditions like diabetes or high blood pressure, manage them early so your body can cope.
  • Stop smoking! Smoking is hard on everyone, but it has more impact on women than on men. Find resources that help you quit (doctor, quitline, smoking cessation program, hypnosis, whatever) and do it. Women who smoke have a high risk of heart disease much sooner than those who don’t.
  • Diet and exercise. I know, I know. If it were easy, we’d all be thin and fit. But moving more and adopting a low-fat diet are both things you can control, and both can add years to your life.
  • Manage your stress. Stress and depression are hard on your heart, so managing your stress and mood is part of a good heart healthy lifestyle.
  • Take aspirin. If you are over 60, check with your healthcare provider to see whether taking an aspirin everyday is a good addition to your health routine. Especially for preventing stroke, it can be an easy step to reduce your risk.
  • Learn your family history. Knowing whether your family has a history of heart disease can help you plan for yourself, and can help you and your medical provider make good decisions based on your risk factors.
  • Educate yourself, and tell your friends. Find resources on women and heart disease, and spread the word (like we do about mammograms) to your friends. We can learn the facts and help each other stay healthy.
  • Repeat after me: I am irreplaceable!

You are irreplaceable. You play a role in many people’s lives, and you have so much more of life to live. Tending to your heart makes everyday easier to face, and makes you more able to respond to all the tempting choices.


McSweeney JC, Cody M, O'Sullivan P, et al. “Women's early warning symptoms of acute myocardial infarction.” Circulation. Vol.108:2619-2623, Nov. 2003. Retrieved 5 Feb. 2008

Mosca, L, et al, “Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women”Circulation. Vol. 109:672-693, Feb. 2004. Retrieved 5 Feb. 2008.

Bellasi, A, et al, “New insights into Ischemic Heart Disease in Women,” Cleveland clinic Journal of Medicine Vol.74, No.8, Aug. 2007. Retrieved 5 Feb. 2008.

Continue Reading