Unique aspects of heart disease in women
Women often experience different symptoms of heart disease and different types of heart disease to men.
As we discussed in the section Women’s heart health in social context, women’s hearts have in the past been researched less than men’s. What we know about heart health, and the guidelines and treatments that are followed, have been learnt by studying males. This means that heart disease in women is still underdiagnosed and undertreated, particularly when it doesn’t appear the same as heart disease in men.
We know now that this has led to women with heart disease having worse outcomes than men. This has led to more research being done, particularly from women’s heart clinics which have been established across the US, Canada and now Australia.
Women develop heart disease on average 10 years later than men, although it’s important to know that heart disease can affect young women. This is why it’s important for all women to be vigilant about their risk factors and the signs of heart disease.
A woman’s risk of heart disease traditionally rises at the time of menopause, as the oestrogen levels made by the body fall. These hormonal changes impact cholesterol levels, body composition, fat distribution and the way our vessels function. Blood pressure also rises with age, which is why it’s important to have regular checks. High blood pressure and cholesterol usually don’t cause any symptoms so unless they’re checked, they may go undiagnosed.
The US-based National Heart, Lung and Blood Institute outlines other important factors that can affect women’s experience of heart disease. These include:
- Anaemia (especially during pregnancy)
- Early menopause (<45 years)
- Endometriosis
- Polycystic Ovarian Syndrome
- High blood pressure
- History of pregnancy complications (gestational diabetes, pre-eclampsia, giving birth to a premature baby or small for gestational age baby)
- Hormonal therapy (oral contraceptive pill or Menopause Hormone Therapy)
The role of hormones in heart disease
For women who experience early menopause (that is, going through menopause before the age of 50), there’s a heightened risk of heart disease. This risk is tied to the shifts in our body’s hormones during menopause. When these hormonal changes happen, they lead to changes in our blood fats, body shape, and the function of our blood vessels.
It’s also important to know that if your periods started very early (before age 10) or late (after age 15), this can increase your risk of heart disease.
These age factors, combined with the hormone changes, play a role in our heart health. It’s always a good idea to discuss these concerns with your doctor.
Pregnancy complications and other factors
Most of us aren’t aware that if we faced complications or challenges during pregnancy we are at higher risk of heart issues later on in life. Think of pregnancy, which involves lots of changes to our cardiovascular system, as a stress test for our hearts.
If you’ve ever had high blood pressure during pregnancy, sugar problems (gestational diabetes), delivered a baby prematurely, or had a baby who was born smaller than average size, you might be at a higher risk for heart issues.
Other health problems, like rheumatoid arthritis and lupus, can also affect our hearts. It’s essential to chat with your doctor about your past pregnancies and any health conditions you’ve had. This can help them understand how best to care for your heart.
Unique symptoms of heart disease in women
Women are also more likely than men to experience non-traditional symptoms of heart disease. Chest pain is the most common symptom of a heart attack or heart disease in both men and women, but women may experience symptoms differently, for instance as:
- Pressure, squeezing or tightness in the chest (rather than chest pain)
- Discomfort in the jaw, neck, arm or back (as well as/instead of in the chest)
Women are also more likely than men to have associated symptoms such as:
- Overwhelming fatigue
- Dizziness
- Shortness of breath
- Nausea
These symptoms can be distracting to investigating doctors. It’s important that you tell your doctor about any chest, neck, arm or jaw symptoms you have, even if there’s something else going on.
Stress is also more likely to trigger angina in women than men. Angina is not a disease, but a symptom of heart problems such as heart disease. It is felt as a type of chest pain or discomfort, but it can be experienced differently by different people. You can read more about how to recognise angina at the Heart Foundation.