Key takeaways

Women’s risk of heart disease increases sharply after menopause due to hormonal changes affecting cardiovascular health.
Pregnancy complications such as preeclampsia, gestational diabetes, and endometriosis significantly raise a woman’s risk for heart problems later in life.
Heart attack symptoms in women often differ from men’s, including fatigue, shortness of breath, nausea, and pain in the neck, back, or jaw, making them harder to diagnose.
Women are often undertreated for heart conditions due to common misperceptions in healthcare, necessitating persistence in seeking proper evaluation and treatment.

A few years ago, I had a cardiac ablation to fix a heart condition called supraventricular tachycardia, or SVT. And although the outpatient procedure didn’t take too long on its own, it had been a 10-year journey to get to that point. When I first reported my symptoms to my doctor—a sudden, drastic increase in heart rate, lightheadedness, and chest pressure—I was told that I just paid too much attention to my body. Then, I was sent on my way. About a decade, five heart monitors, and three cardiologists later, my SVT was finally diagnosed and fixed. Part of the reason my treatment took so long is because I ignored one of the cardinal rules of women’s heart health: Don’t let your healthcare provider brush you off.

“It’s important for women to really advocate for being evaluated properly or treated properly when they have cardiovascular disease or risk factors because we know women are oftentimes undertreated,” explains Kathryn Lindley, MD, chair of the American College of Cardiology’s Cardiovascular Disease in Women Council.

5 things to know about women’s heart health

Don’t end up in the same situation I was in. These five things you should know about heart disease in women will keep you informed for every visit with your healthcare provider.

1. Your risk increases after menopause

Women are generally less likely to have cardiac issues than men—until menopause. “Cardiovascular risk continues to increase with age over the course of a woman’s life, although that risk tends to increase most sharply around the time of menopause,” Dr. Lindley says. “A lot of it is related to hormone changes. Our native sex hormones are likely protective for women and as those sex hormones start to change and wane as we go through menopause, a lot of those cardiovascular risk factors start to increase.”

So although you should always be vigilant about your heart as you get older, it’s extra important to get annual checkups after hitting menopause. The average age for a first heart attack is 66 for men, but isn’t until 70 for women.

2. Pregnancy complications can lead to heart complications

If you’ve had a baby, one of the most important things to know post-pregnancy is that certain complications make you more susceptible to heart problems later in life. That extra risk kicks in about 20 or 30 years postpartum, estimates John Osborne, MD, Ph.D., director of cardiology at LowT Center/HerKare. If you experienced premature birth, preeclampsia, gestational diabetes, or repeat miscarriages, it could impact your cardiovascular health. Endometriosis also raises your risk of coronary artery disease up to 400% for women younger than 40.

“It’s important to know that if you had any of those conditions,” Dr. Lindley says, “you are at increased risk and you should talk to your doctor about it and be screened a little more carefully and treated a little more aggressively for your risk factors.”

3. Heart attack symptoms in women may be different

The standard symptoms of a heart attack are well-known: chest pressure, radiating pain in your left arm, and shortness of breath. But, Dr. Osborne says, those hallmark indicators typically only occur in a third of women experiencing a heart attack.

“For women, the more typical symptoms are fatigue or shortness of breath,” he says. “But the problem is lots of things cause those. The symptoms in women can be less in your face.”

Dr. Lindley agrees, noting some other symptoms for women to look out for are nausea and sweating, in addition to the more standard chest discomfort. Pain in the neck, back, or jaw are also signs of a heart attack in women.

4. Heart problems in women are harder to diagnose

Angiograms are the main way to find narrowings or blockages in heart arteries. However, they are less effective for women. Women’s hearts are smaller, and they tend to develop blockages in smaller arteries that aren’t as easily detected on the scan. Meaning, you could be given an “all-clear,” on the test, but still have an issue going on. The early signs of a heart blockage include slow or irregular heartbeat, shortness of breath, lightheadedness, chest pain, and difficulty exercising.

Although in some cases there can be no signs of heart problems in women, the symptoms of heart disease in women that require medical attention, according to the CDC, include:

Angina (dull, heavy, or sharp chest pain)
Pain in the neck, jaw, or throat
Upper abdominal pain
Back pain
Nausea and vomiting
Fatigue
Shortness of breath
Swelling of the feet, ankles, legs, abdomen, or neck veins
Arrhythmia (heart palpitations)

5. You might not be taken as seriously

The sad reality is that most women, like me, might have to go through several healthcare providers before finding one that really investigates their heart concerns. It’s not out of malice, though—it’s due to a common misperception in the healthcare world.

“[Women] tend to be less aggressively treated with medications and have a somewhat higher mortality rate [as a result],” explains Dr. Osborne. “We see men at risk for heart disease and women not so much, but actually that’s not the case.” Be persistent if you’re worried about your heart health. It may take a few tries to get to the right healthcare provider because they can sometimes unintentionally struggle evaluating and diagnosing women properly with cardiac concerns.

“Find a doctor you can feel confident is going to take your concerns seriously and will appropriately do a risk assessment of your cardiovascular health,” Dr. Lindley says. “We want to make sure women are appropriately screened and counseled and that when they have problems they’re appropriately evaluated.”

So find a healthcare provider who works with you like a health partner, rather than just any healthcare provider. Someone who will listen to your concerns and take them seriously, someone you connect with, and someone that fosters a mutual sense of respect. Your health may depend on it.