Heart disease is the #1 killer of women, taking more lives than all of the top five cancers combined. Yet, many women are unaware of their risk—or worse, they dismiss early warning signs as stress, aging, or anxiety.
For decades, women’s heart health has been misunderstood and underdiagnosed. Compounding this issue is the sharp decline in hormone replacement therapy (HRT) use after the controversial Women’s Health Initiative (WHI) study in 2002, which led to unintended health consequences for millions of women.
Dr. Robert Burke, a board-certified cardiologist, highlights the urgency of addressing these issues:
“Women’s heart disease is ridiculously common, yet it’s still misunderstood. Unlike the Hollywood version of a heart attack, where someone clutches their chest and collapses, women’s symptoms can be much more subtle.”
Recognizing the Signs of Heart Disease in Women
One of the biggest misconceptions about heart disease is that it always presents as the “Hollywood heart attack”—a sudden, crushing chest pain that radiates down the left arm. While this may be true for some, women’s heart attack symptoms can be much more subtle.
Common but often ignored symptoms include:
🔴 Shortness of breath with activity
🔴 Chest discomfort that wakes you up at night
🔴 Pain in the jaw, neck, shoulders, or between the shoulder blades
🔴 Heart palpitations (racing, skipping, or pounding heartbeats) for no clear reason
🔴 Unusual fatigue or feeling like you’ve “aged overnight”
According to Dr. Burke:
“The scariest thing we see as cardiologists are women who have what we call ‘silent heart attacks.’ They have an event—maybe while they’re sleeping—and they wake up just feeling off. They might think they have the flu, or they’re just run down. But in reality, they’ve had a heart attack.”
Many women experiencing these symptoms are misdiagnosed with anxiety rather than heart disease. This dismissal can delay critical treatment, increasing the risk of serious complications.
Why Women Must Advocate for Themselves
Self-advocacy is crucial when it comes to heart health. If something doesn’t feel right, push for real diagnostic tests rather than accepting a vague diagnosis of stress or anxiety.
Women experiencing symptoms should request:
✔ An EKG (electrocardiogram) to check heart rhythm
✔ Blood work for cardiac markers
✔ An echocardiogram (heart ultrasound)—a safe, radiation-free test
✔ A coronary artery scan or stress test if symptoms persist
Dr. Burke emphasizes:
“One of the most frustrating things as a cardiologist is when women tell me they’ve been dismissed by other providers. If no tests have been done, there is no real diagnosis. If your symptoms are being waved off as anxiety without any objective data, you need to keep advocating for yourself.”
The Link Between Menopause, Hormones, and Heart Disease
The sharp decline in hormone replacement therapy (HRT) use after the Women’s Health Initiative (WHI) study has had lasting consequences for women’s health. Before 2002, 22% of women over 40 were on HRT. Today, that number has dropped to less than 5% (Manson et al., 2013).
The WHI initially reported that HRT increased the risk of:
📈 Heart disease
📈 Stroke
📈 Venous thromboembolism (VTE)
📈 Breast cancer (Rossouw et al., 2002)
These findings caused panic among physicians and patients alike, leading to a mass discontinuation of HRT. However, further analysis of the WHI data has revealed that the risks were overstated—especially for younger women in their 40s and 50s (Manson et al., 2013).
Dr. Burke explains:
“The WHI caused a massive shift in medical practice, but the problem is, we threw the baby out with the bathwater. We now know that HRT, when started early in menopause, actually reduces the risk of coronary heart disease, lowers breast cancer mortality, and decreases stroke deaths.”
Studies have also shown that the decline in HRT use has increased healthcare costs by $4 billion in the U.S. alone due to the rise in chronic diseases that could have been prevented (Chlebowski et al., 2003).
Who Should and Should NOT Take HRT?
HRT is not suitable for everyone. Women with a history of:
🚫 Blood clots (deep vein thrombosis or pulmonary embolism)
🚫 Certain types of breast cancer
🚫 Untreated high-risk genetic markers
…should consult their healthcare provider to weigh the risks and benefits.
However, for the majority of women in their 40s and 50s, the benefits of HRT often outweigh the risks, especially when started within 10 years of menopause onset.
Dr. Burke adds:
“For younger menopausal women, estrogen therapy reduces cardiac disease, decreases deaths from breast cancer, and even lowers overall mortality. The idea that all women should avoid HRT is outdated.”
The Role of Wearables in Heart Health
The Apple Watch and other wearables have revolutionized how women can monitor their heart health. These devices can detect:
📊 Atrial fibrillation (AFib)—the #1 cause of preventable stroke
📊 Heart rate trends, helping to detect early signs of heart disease
📊 Heart rate variability (HRV)—a marker of stress and overall health
“The Apple Watch is a game-changer,” says Dr. Burke. “It can detect arrhythmias like AFib, track heart rate variability, and even perform an EKG on the spot. This kind of real-time data is invaluable for both patients and doctors.”
For women who experience palpitations, dizziness, or an irregular heartbeat, this data can be life-saving.
Final Thoughts: Take Control of Your Heart Health
Women’s heart disease has been overlooked for far too long. The misinterpretation of the WHI study caused millions of women to suffer unnecessarily by avoiding HRT, which could have protected their heart and overall health.
Key takeaways:
✅ Listen to your body. Trust your gut.
✅ Know your numbers—track your heart rate, blood pressure, and HRV.
✅ Find a provider who takes your concerns seriously and is informed on HRT.
Heart disease is not just a man’s disease—and the sooner women start taking their heart health seriously, the better their long-term outcomes will be.
For more evidence-based information on menopause, hormones, and longevity, check out thePause™ App, where you can receive personalized AI-driven health recommendations.
Author: Susan Sly
References
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- Chlebowski, R. T., Anderson, G. L., Aragaki, A. K., et al. (2020). Association of menopausal hormone therapy with breast cancer incidence and mortality. JAMA, 324(4), 369–380.
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- Chlebowski, R. T., Hendrix, S. L., Langer, R. D., et al. (2003). Influence of estrogen plus progestin on breast cancer and mammography. JAMA, 289(24), 3243–3253.
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- Grodstein, F., Stampfer, M. J., Manson, J. E., et al. (1996). Postmenopausal estrogen and progestin use and cardiovascular disease. New England Journal of Medicine, 335(7), 453–461.
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- Manson, J. E., Chlebowski, R. T., Stefanick, M. L., et al. (2013). Menopausal hormone therapy and health outcomes. JAMA, 310(13), 1353–1368.
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- Rossouw, J. E., Anderson, G. L., Prentice, R. L., et al. (2002). Risks and benefits of estrogen plus progestin. JAMA, 288(3), 321–333.