Her Heart Risk Just Doubled — What Every Partner Should Know

Estrogen has a protective effect on the cardiovascular system. It helps keep blood vessels flexible, maintains healthy cholesterol ratios (higher HDL, lower LDL), and has anti-inflammatory properties. When estrogen drops during menopause, all of these protections diminish. LDL cholesterol rises. Blood pressure tends to increase. Blood vessels become stiffer. The risk of developing coronary artery disease roughly doubles in the decade after menopause. By age 65, a woman's heart disease risk is comparable to a man's. This is the leading cause of death for women — not breast cancer, not ovarian cancer. Heart disease. One in three women will die from it. And yet most women (and their partners) dramatically underestimate this risk. The menopause transition is a critical window for cardiovascular prevention. What she does now — diet, exercise, managing blood pressure and cholesterol, potentially HRT — shapes her heart health for decades.

This is where your knowledge could literally save her life. Women's heart attack symptoms often look nothing like the classic male presentation of crushing chest pain and left arm numbness. Women are more likely to experience: jaw pain or toothache, unusual fatigue or sudden exhaustion, nausea or vomiting, shortness of breath without exertion, pain between the shoulder blades, dizziness or lightheadedness, and a general sense of 'something is wrong' that's hard to articulate. Some women do experience chest pressure, but they describe it more as tightness, squeezing, or fullness rather than sharp pain. Because these symptoms are vague and atypical, women delay seeking help — and so do the people around them. The average woman waits 54 minutes longer than the average man to call 911 during a heart attack. Every minute of delay means more heart muscle dies. If she has several of these symptoms simultaneously, especially if they're unusual for her, call 911. Don't drive to the hospital. Don't wait to see if it passes.

A comprehensive cardiovascular assessment should include: blood pressure (ideally below 120/80), a full lipid panel (total cholesterol, LDL, HDL, triglycerides), fasting blood glucose and HbA1c (diabetes screening), and a discussion about family history and lifestyle factors. Some doctors may recommend a coronary calcium score — a CT scan that detects calcified plaque in the arteries. It's a powerful predictor of future heart events and is especially useful for women whose risk is borderline based on traditional factors. The challenge is that many primary care doctors still under-screen women for heart disease. If her doctor isn't proactively discussing cardiovascular risk at menopause, she may need to ask — or you may need to encourage her to ask. A cardiologist referral isn't just for people who already have heart disease. Preventive cardiology is one of the most valuable investments in her long-term health.

This is one of the most misunderstood topics in women's health. The relationship between HRT and heart disease depends critically on timing. The 'timing hypothesis' — now well-supported by evidence — shows that HRT started within 10 years of menopause or before age 60 may actually reduce cardiovascular risk. HRT started later may increase it. The 2002 WHI study created widespread panic about HRT, but subsequent analysis revealed that the risks were primarily in older women who started HRT many years after menopause. For women in their 50s starting HRT at the time of menopause, the cardiovascular picture is generally favorable. This doesn't mean HRT is right for every woman, and the decision involves weighing multiple factors including breast cancer risk, blood clot history, and personal preferences. But cardiac fear alone shouldn't be the reason she avoids HRT if she's otherwise a good candidate. Help her have a nuanced conversation with her doctor rather than making decisions based on outdated headlines.

The most impactful lifestyle changes for cardiovascular health are the ones you make together. Mediterranean-style eating — rich in olive oil, fish, nuts, vegetables, and whole grains — has the strongest evidence for heart protection. If you cook, shift the household in that direction. If she cooks, eat what she makes with enthusiasm. Regular physical activity — even 30 minutes of brisk walking most days — reduces heart disease risk by 30-40%. Walk together after dinner. Take the stairs. Find a physical activity you both enjoy. Stress management matters more than people realize. Chronic stress elevates cortisol, increases inflammation, and raises blood pressure. If your household runs on stress — financial worries, relationship tension, caregiving burdens — addressing that is cardiovascular medicine. Sleep is the hidden factor. Poor sleep (common during menopause) independently increases heart disease risk. Supporting her sleep means adjusting the thermostat, being patient with night sweats, and not taking it personally when she needs separate blankets or even a separate room temporarily.