Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Cardiovascular disease is the leading cause of death in women in the UK, yet it remains consistently under-diagnosed, under-treated and under-researched compared to men.
While crushing central chest pain is the classic angina symptom, women are significantly more likely to experience atypical presentations: jaw or throat discomfort, unusual fatigue, nausea, breathlessness without chest pain, and back or upper abdominal discomfort. These are more often attributed to anxiety, musculoskeletal problems or the menopause, leading to diagnostic delays. Women are also more likely to develop microvascular disease, which may not be visible on standard angiography.
The menopause transition is a critical window for cardiovascular risk. Oestrogen protects blood vessel health, and its decline during perimenopause drives simultaneous increases in blood pressure, LDL cholesterol, Lp(a), visceral fat and inflammatory markers. Early menopause (under 45) or premature ovarian insufficiency carries a significantly elevated risk. Risk should be reassessed at the menopause transition, not after a cardiac event.
Palpitations are among the most common cardiac symptoms in perimenopausal and postmenopausal women. They may reflect atrial ectopics or atrial fibrillation triggered by hormonal fluctuation, anxiety, or both — see /conditions/atrial-fibrillation. A 7-day Holter monitor is far more likely to capture intermittent episodes than a single ECG — see /conditions/holter-monitor.
Pregnancy is a significant cardiovascular stress test. Pre-eclampsia, peripartum cardiomyopathy and gestational hypertension are not simply obstetric concerns — they carry lasting cardiovascular implications warranting long-term cardiac follow-up, with elevated lifetime risk of hypertension, heart failure and coronary disease. See /female-cardiologist-london.
Heart disease research has historically enrolled predominantly male subjects, and diagnostic criteria were developed largely from male data. Women's symptoms are more frequently atypical, and are more likely to be attributed to non-cardiac causes before cardiac investigation is pursued.
Yes. The fall in oestrogen during the menopause transition is associated with rises in blood pressure, LDL cholesterol, Lp(a) and visceral fat — all cardiovascular risk factors. Perimenopause is the right time to assess and address these changes, not wait for symptoms.
Not always. While hormonal fluctuation commonly triggers palpitations during perimenopause, atrial fibrillation and other arrhythmias also become more common in this age group. A proper cardiac assessment, including prolonged Holter monitoring, is needed to distinguish between them.
Yes. Dr Nabila Laskar welcomes self-referrals for all consultations and diagnostic tests. No GP letter is required to book.