Many people may not realize that heart disease is the number one killer of women. (Yes, really.)
As Dr. Anu Lala, heart failure and transplant specialist explains, “we think of a typical person who suffers from a heart attack as a man in his 50s after shoveling snow clutching his chest, but [cardiovascular disease] is the same number one killer for women.”
So how can we keep our hearts healthy during and after the menopausal transition, and what screenings should we be getting during these years? We’re digging in below…
Menopause and heart health: what’s the connection?
Women tend to develop atherosclerotic cardiovascular disease (called “ASCVD” for short) — involving the buildup of cholesterol plaques in arteries, narrowing of arteries, and increased risk for myocardial infarction (aka heart attack), peripheral arterial disease, and stroke — later than men.
The reason? Studies show that during our reproductive years, estrogen plays a cardioprotective role with a positive effect on
- Cholesterol production and levels
- Blood vessels and their elasticity
As estrogen levels fluctuate and eventually decline post-menopause, we lose much of that protection. Combine that with the fact that menopause is associated with an increase in blood pressure, body mass index (BMI), and body fat distribution (“meno belly” is a REAL thing), and what you get is a perfect storm of risk factors for cardiovascular diseases. Fortunately, there’s a whole lot we can do about it…more on that below.
What about heart palpitations?
You know that feeling when your heart is racing — like you just finished a marathon or got off a roller coaster…except you didn’t? That’s a heart palpitation, the causes of which are closely associated with hormonal fluctuations associated with hot flashes. Other risk factors that can cause or exacerbate the feeling of your heart racing include stress/anxiety, intense exercise, stimulants (e.g., coffee), nicotine, alcohol, fever, severe anemia, low blood sugar/blood pressure, heart arrhythmias, hyperthyroidism, and certain medications (Albuterol, asthma inhalers, certain cough/cold meds, thyroid meds, etc). So yes, there’s a LONG list of potential culprits behind heart palpitations, with menopause being one of them.
10 types of heart tests & screenings
As always, the decision of which screening/test to get when is a personal one that should be made alongside your healthcare provider with consideration for risk factors such as:
- High blood pressure
- High cholesterol
- Sedentary vs active lifestyle
- Family history
Certain tests may be used for screening (i.e. tests done when one does not have symptoms) versus tests done as part of a heart function evaluation (diagnostic tests).
1. Blood pressure & cholesterol (lipid) tests
While there are no clear guidelines for cholesterol testing for younger adults, the United States Preventive Services Task Force, American Academy of Family Physicians, American College of Cardiology, and American Heart Association have generally settled on recommending these tests every five years between the ages of 20-45 for women, then annually with frequencies adjusted based on risk factors.
2. Body mass index (BMI) measurement
Our BMI (based on body weight, waist circumference, and height) alone isn’t a predictor of heart disease risk. But it is an important consideration alongside blood pressure and lipid tests. This is fairly routine for doctors to measure at annual physicals, but if you’re curious, here’s a helpful BMI calculator to give you a sense for where you stand.
Remember, though, that not all body fat is made equal. On the one hand, there’s something called subcutaneous fat (aka fat under our skin), which is much less of a health issue than visceral fat (aka deeper abdominal fat). This is why, when it comes to healthy weight management during perimenopause/menopause, BMI isn’t the holy grail because it does not distinguish between the two, nor does it account for muscle mass. However, because it is simple to test and there are clear cut-offs for “normal” vs “overweight” vs “obese,” it’s used as a proxy for risk.
3. Hemoglobin A1C tests
This measures the amount of glucose (a type of blood sugar) that has been attached to hemoglobin (a protein in red blood cells that delivers oxygen to tissues) over the previous 2-3 months. While considered a metabolic test rather than a cardiovascular test, it is used as a screening for diabetes and prediabetes, both of which are major cardiovascular risk factors.
4. Electrocardiogram (EKG)
EKGs record the heart’s electrical activity — specifically heart rate and heart rhythm — using a machine called an ECG. This test is recommended for those experiencing symptoms such as palpitations/rapid heart rate, chest pain, shortness of breath, lightheadedness, confusion, and/or fatigue.
While an electrocardiogram uses small electrodes that stick to your chest, an echocardiogram is essentially an ultrasound. This is not a screening test for adults. Rather, it’s done to evaluate heart function to see how well a heart pumps (to evaluate for heart failure), look for congenital heart defects, and see if the heart valves are working as they should.
6. Exercise stress test
Here, electrodes are applied to your test and connected to an ECG machine (just like they are during an electrocardiogram). Except you’re not lying down — instead, you’re on a treadmill or stationary bike to assess how your heart responds to physical demands of exercise.
7. Nuclear stress test
During a nuclear stress test, a small amount of radioactive substance is injected into the bloodstream. From there, it travels to the heart. Images are taken before and after exercise, and level of heart function can be determined through this comparison.
8. Coronary artery calcium scan (CAC)
There are two primary types of computerized tomography (CT) scans, including a coronary artery calcium scan (CAC). CAC is a quick, 10-minute screening test conducted in certain circumstances to look at the amount of calcified plaque in your coronary arteries, known as a calcium score. No chemical dye is required here, and while it predicts coronary artery disease risk, it does not directly identify blockages or assess heart function.
9. Coronary CT angiogram
This test requires contrast dye to be injected to make it possible to actually map out blood vessels around the heart and possibly identify blockages in them.
10. Coronary angiogram
With this test, a small flexible tube called a catheter is inserted (either in the groin or arm) through an artery to your heart (this is called “cardiac catheterization”). Contrast dye is injected and X-ray pictures of your heart are taken to assess if coronary arteries are narrowed or blocked. While an angiogram is the most invasive of these tests, it also provides an opportunity for treatment at the same time. For example, if there’s a significant blockage found during an angiogram, the blood vessel can be opened (called a “balloon angioplasty”) or a stent placed.
When to see your doctor
Heart attacks often present differently in women than men, meaning many times, women don’t feel the classic pain in the chest and left arm. Instead, the common symptoms women experience may include shortness of breath, nausea/vomiting, and back or jaw pain.
If you experience any of these symptoms, it’s best to call 911 and see a healthcare provider right away:
- Chest pain — or feelings of pressure, fullness, or squeezing — that lasts more than a few minutes, or goes away and comes back
- Pain/discomfort in one or both arms, the back, neck, jaw or stomach
- Shortness of breath with or without chest discomfort
- Breaking out in a cold sweat, nausea/vomiting or lightheadedness
For more information on women’s heart health, visit the American Heart Association.
How to keep our hearts healthy through menopause & beyond
Get this: 80% of heart attacks and strokes related to heart disease are preventable.
Refer to our full guide to menopausal heart health for more on:
- Lifestyle changes
- Nutrition and supplement recommendations
- Relaxation techniques
- Medication treatment options — including whether hormone therapy (HT) can help