Got a question about your hormonal health? 

What are the Symptoms of Heart Disease in Women? 

 

Some common symptoms of heart disease in women that differ from those experienced by men include [5, 12]: 

1. Pain or discomfort: women may not always experience the classic chest pain that men often do. Instead, they might have discomfort in the neck, jaw, throat, abdomen, or back. This discomfort can vary in intensity and may come and go. 

2. Shortness of breath:  can occur with or without chest discomfort and may happen during physical activity or while resting. 

3. Nausea or vomiting: some women may experience these symptoms, which can be mistaken for other conditions like the flu or indigestion. 

4. Sweating: some women may break out in a cold sweat, which can occur unrelated to physical activity or temperature. 

5. Fatigue: Feeling unusually tired, even after a good night's sleep or with minimal exertion, can indicate heart disease in women. 

6. Dizziness or light-headedness: this sensation can occur with or without chest discomfort. 

7. Sleep disturbances: heart-related symptoms may cause difficulty sleeping in some women.   

 

What role do Female Reproductive Hormones have on Heart Health?  

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Women's hormones play a significant role in heart health throughout their lives [13]. Estrogen has a protective effect on the cardiovascular system, helping to maintain healthy blood vessels, lower the levels of bad cholesterol, or hypertension.  

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As women age and reach menopause, their estrogen levels decline. This change can impact the cardiovascular system, increasing the risk factors for heart disease. Additionally, hormonal shifts during the menstrual cycle can affect blood vessel function and lead to fluctuations in heart rate and blood pressure. It’s important to recognize how hormonal levels can raise the risk of heart disease for women, and so adopting some preventive measures is advisable. 

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Regarding the use of hormonal contraceptives such as progestins and progestin-estradiol combination therapies, the clinical science literature does not provide strong evidence about the use of hormonal contraceptives and the risk of developing cardiovascular disease (CVD) as an adverse health outcome [14, 15]. Rather, the clinical evidence suggests that there is an increased risk of blood clot in women who are already diagnosed with congenital heart disease [16]. Therefore, previously published reports of significant cardiovascular health risks being associated with the use of hormonal contraceptives may not be as conclusive as once thought.  

 

Menopausal Hormone Therapy and Heart Health 

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Menopausal Hormone Therapy (MHT) can have various effects on menopausal women with heart disease. While MHT was once widely prescribed to manage the symptoms experienced by women during perimenopause and potentially reduce their risk of heart disease, recent research has shown conflicting results regarding its impact on heart health [17]. For some women with heart disease, particularly those experiencing severe vasomotor symptoms like hot flushes and night sweats, MHT can provide relief and significantly improve their quality of life. However, the decision to use MHT should be carefully weighed against potential health risks and personal medical history in consultation with a family medicine practitioner or gynecologist, especially for women with pre-existing heart conditions or who have other significant risk factors of heart disease (such as diabetes). To determine if MHT is right for you, please consult with your healthcare provider to make an informed decision that is personalized to your needs and medical history. 

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Impact of Heart Health and other Chronic Hormonal Health Conditions 

 

Endometriosis

A recent systematic clinical review examined the potential connection between endometriosis, which is a chronic pelvic inflammatory condition affecting approximately 200 million women worldwide, and cardiovascular disease or CVD [18]. The goal of the clinical review was to evaluate the incidence of cardiovascular events, including coronary heart disease, stroke, and hypertension, in women who are diagnosed with endometriosis, and determine whether the presence of endometriosis might be considered a risk factor for developing CVD.

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The study revealed that there was a significant association between endometriosis and an increased risk of various cardiovascular diseases. Women with endometriosis were found to have an elevated risk of experiencing coronary heart disease and stroke compared to women who do not have endometriosis. The proposed underlying mechanisms for this association include chronic inflammation, hormonal imbalances, and the presence of endometriosis lesions that can contribute to vascular changes, and an increased cardiovascular risk profile.

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Based on the findings of this systematic clinical review, it was recommended to have more cardiovascular risk assessments conducted for women diagnosed with endometriosis and more proactive management of their condition. Given the chronic nature of endometriosis and its tendency to exacerbate cardiovascular health issues, the authors advocate for an integrated healthcare approach covering both gynecological and cardiovascular monitoring and treatment. An integrated approach would involve regular cardiovascular screenings, lifestyle changes, and targeted medical therapies to reduce the risk of CVD.

 

 

PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age, characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovaries. The association between PCOS and the risk of developing cardiovascular diseases (CVD) such as coronary heart disease (CHD) and stroke, was investigated with the goal of determining whether women diagnosed with PCOS have an elevated risk of CVD and whether obesity, which is often associated with PCOS, influences this risk [19].

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The study’s authors found women diagnosed with PCOS have a higher prevalence of cardiovascular events such as stroke and CHD compared to women without PCOS. The analysis also highlighted that the presence of obesity significantly raises this risk of cardiovascular complications.

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The importance of having comprehensive cardiovascular risk management in women with PCOS, particularly patients who are obese, is paramount to having good health outcomes. The study’s authors advocate for regular cardiovascular screenings, lifestyle interventions that are primarily aimed at weight management, and targeted medical treatments to address both PCOS and related metabolic disruptions. Addressing these health concerns through an integrated healthcare approach will improve the cardiovascular health and general health outcomes for women with PCOS.

 

Lifestyle Changes for Reducing Risk of Heart Disease 

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There are recommended lifestyle modifications that a person can make to maintain a healthy heart as they age – these modifications include [20, 21]: 

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• Exercising regularly: Aim for at least 150 minutes (2.5 hours) per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous exercise. Activities like brisk walking, jogging, swimming, or cycling can improve cardiovascular health.

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• Follow a healthy diet: Try to adopt a nutritionally balanced diet that is rich in fruits, vegetables, whole grains, lean proteins, and healthy, unsaturated fats like avocados and olive oil. Limit saturated and trans fats, prepared or packaged foods with high sodium and added sugars. Consider adopting the Mediterranean diet or DASH diet to lower your risk of heart disease. 

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• Maintaining a healthy weight and BMI, especially around the waist area, will reduce the physiological strain on the heart and lower the risk of developing cardiovascular disease.

 

• Quit smoking: Smoking is a major heart disease risk factor. Quitting smoking can significantly improve heart health and your general well-being. 

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• Limit alcohol intake: Recent research suggests that women are more vulnerable to the adverse effects of alcohol than men. This is partly because women generally have a higher concentration of alcohol in their blood after drinking the same amount as men, due to having less body water. There's also an increased risk of breast cancer associated with alcohol consumption in women. New 2023 guidelines for Canadians recommend 2 drinks or less in per week for women, citing that health risks increase more steeply for females than for males when drinking more than 6 drinks per week [22]. 

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• Manage stress: Chronic stress contributes to heart disease risk. Practice stress-reducing techniques like mindfulness, meditation, yoga, or deep breathing exercises to promote relaxation. 

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• Prioritize sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep increases heart disease and other health risks. 

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• Schedule regular health check-ups: Monitor blood pressure, cholesterol, blood sugar, and other heart disease risk factors with regular check-ups. Discuss any concerns or symptoms promptly with your healthcare provider. 

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The Framingham Risk Score 

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The Framingham Risk Score (FRS) is a sex-specific algorithm used to estimate the cardiovascular risk of an individual over the next 10 years. It was developed from data obtained from the Framingham Heart Study and considers factors like age, cholesterol levels, blood pressure, diabetes, and smoking status. This score is widely used by physicians and cardiologists to guide their clinical decisions on a suitable preventive health plan to reduce the risk of developing heart disease [23, 24]. 

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To learn more and calculate what is your personal Framingham Risk Score, you can use the FRS Calculator which is free to use from the Canadian Cardiovascular Society. Cardiovascular risk level thresholds are as follows: 

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• High Risk – FRS ≥ 20% 

• Intermediate Risk – FRS between 10-19% 

• Low Risk – FRS < 10% 

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Based on your FRS risk level, doctors will typically ask to see additional blood test results to look at other risk modifiers such as different lipoprotein concentrations and any family history of cardiovascular disease. Based on your specific condition, doctors will decide whether to prescribe statin treatment. 

Dr. Shafeena Premji has also recently spoken about the Framingham Risk Score in our latest women Talking™ Wednesday presentation on "Women's Hormones and Heart Health", May 29, 2024. You can catch her suggestion regarding the FRS below or on Healthyher.life’s YouTube channel.