How to recognise the symptoms of a heart attack during menopause.

Dear MHI Reader,

Cardiovascular diseases are still the leading cause of death worldwide – and yet they are often still perceived as an ‘illness of men’.

Yet heart attacks affect women just as often, only on average ten years later and often with slightly different symptoms than in men, but this does not make them any less dangerous. In particular, during menopause, when the natural protection provided by oestrogen disappears, the risk for women increases considerably. But how exactly do the symptoms differ? Why are heart attacks in women often recognised too late? And what does this mean for your health?

Menopause: A turning point for the heart

Until menopause, women are relatively well protected against cardiovascular disease by the hormone oestrogen. Oestrogen keeps blood vessels flexible, regulates cholesterol levels and has an anti-inflammatory effect. But with menopause, the cardiovascular system changes:

• The blood vessels become stiffer and blood pressure rises.
• The blood lipid levels deteriorate – the ‘bad’ LDL cholesterol increases.
• The metabolism changes, the risk of diabetes increases.
• The risk of vascular constriction (arteriosclerosis) increases.

These factors contribute to women of advanced age having almost the same risk of heart attack as men – with one crucial difference: their symptoms are often atypical, leading to misdiagnosis and delayed treatment.

Heart attack: Differences between women and men

While men usually experience the ‘classic’ heart attack symptom – a strong, pressing pain in the chest – women often show non-specific signs. This means that their heart attack is not immediately recognised or is confused with other complaints.

Symptom	Men	Women
Chest pain	Strong, pressing, localised in the middle	Less intense, more diffuse or burning
Shortness of breath	Possible, but often only noticeable late on	Often one of the first symptoms
Nausea / vomiting	Rare	Frequent, often associated with stomach problems
Tiredness / exhaustion	Uncommon	Very frequent, can increase over weeks
Back pain	Rare	Frequent, often between the shoulder blades
Sweating	Cold, sudden outbreak of sweat	Hot flushes can be mistaken for menopausal symptoms
Anxiety	Possible, but less typical	Very common, often interpreted as a ‘panic attack’

Precisely because some of these symptoms can also occur during menopause, such as hot flushes, exhaustion or sleep problems, the danger is often not recognised. And: many women wait too long before seeking medical help – with serious consequences.

Why are heart attacks in women recognised later?

In addition to the different symptoms, there are other reasons why heart attacks in women are often diagnosed too late or not at all:

1. Lack of awareness: Many women do not take their own risk seriously enough. Heart attacks are often still seen as a ‘man’s problem’, which is why women interpret symptoms differently or do not take them seriously enough.

2. Underestimated symptoms: Because chest pain is not always the main complaint, symptoms such as nausea, exhaustion or shortness of breath are often dismissed as stress related.

3. Misdiagnosis in an emergency: Studies show that women with heart attack symptoms are less likely to receive immediate emergency treatment than men, often because their symptoms are ‘atypical’.

4. Lack of consideration in studies: Women have been neglected in medical research for a long time. Heart attack studies were often based on male patients, which is why diagnostics and therapy were not optimally adapted to women.

A rethink is needed – for better diagnosis and treatment

Gender medicine is committed to ensuring that gender-specific differences in medicine receive more attention. Women and men not only require a differentiated view of their cardiovascular risk, but also individually adapted diagnosis and treatment strategies.

What does that mean in practice?

• Strengthen early detection: regular medical check-ups, especially during and after menopause, are essential. When was your last check-up?

• Raise awareness: Women should take their heart health just as seriously as men – and not hesitate to seek medical attention. In an emergency, every minute counts.

• Targeted diagnostics: Doctors should be made more aware of female heart attack symptoms and use alternative diagnostic methods.

What can women do to actively protect their hearts, especially after menopause? In the next newsletter, you will learn which preventive steps can strengthen your heart and reduce your risk in the long term.

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