21 Jul The Heart Disease Symptoms Doctors Keep Calling “Atypical” with Dr. Jayne Morgan
Why Isn’t Anyone Screening Us For Heart Disease?
Have you ever noticed that you see your gynecologist every single year, but you have never once sat down with a cardiologist? I used to think that was just how midlife healthcare worked. My entire picture of women’s health revolved around hot flashes, mammograms, and whatever came up at my annual OBGYN visit. Heart health never entered the conversation.
Here is the stat that changed that for me. Before menopause, a woman’s risk of heart disease is roughly half of a man’s. Within a few years of our last period, that risk becomes equal. By our seventies, it is actually higher than a man’s. So why is nobody screening us for this?
That question is exactly why I wanted to bring a research cardiologist onto the podcast, someone who could translate the science for us so we can actually advocate for ourselves. I have had three cardiologists on this show before, and every one of them changed how I think about my heart. This conversation did too, but from an angle I had not heard before: the idea that menopause itself is a cardiovascular event, not just a hormonal one.
I also want to be upfront about something. This episode leans into Western medicine and conventional cardiology, including a real conversation about statins. I know my community holds a lot of different views on medication, and I respect every one of them. My goal with this guest was to hear the other side of a conversation I have had many times on this show, so you have the full picture and can make your own informed decision with your own doctor.
Menopause Is Not Just a Hormonal Shift. It’s a Cardiovascular Event
For most of the history of modern medicine, women’s health has been reduced almost entirely to reproduction. Breast health, pelvic health, and fertility have absorbed nearly all of the attention, while the organ actually responsible for the most female deaths gets almost none. Heart disease is the number one killer of women. Breast cancer, which understandably gets an enormous amount of airtime and awareness, ranks number seven.
This is not an accident. Healthcare research and training have historically centered the male body as the default. Because estrogen is produced primarily by the ovaries, it has been filed away as a “reproductive hormone.” In reality, estrogen receptors exist throughout the body, including on the heart and the arteries. Estrogen acts as a natural anti-inflammatory agent and a direct protector of cardiovascular tissue. When estrogen declines during perimenopause and menopause, that protection declines with it. Arteries stiffen, cholesterol shifts, blood pressure creeps upward, and visceral fat begins to redistribute around the organs.
That is the cardiovascular event hiding inside the hormonal one.
The Problem With the Word “Atypical”
One of the most important things to understand is how the word “atypical” has shaped the way women’s heart symptoms get treated. Atypical chest pain is an actual formal diagnosis, one that shows up in medical billing codes. It has historically been applied overwhelmingly to women, and it does more than just describe a symptom. It slows down care. It delays testing. It quietly signals to a medical team that this case is lower priority.
Meanwhile, men presenting with chest discomfort are far less likely to receive that label. The result is a system where women’s cardiac symptoms are treated as a mystery to be watched rather than a warning to be acted on immediately.
What Heart Disease Actually Looks Like in Midlife Women
Most of us grew up picturing a heart attack the way it happens in movies: sudden, dramatic, crushing chest pain. That version absolutely can happen to women too. But a woman’s heart is generally smaller, with smaller arteries, and the way plaque builds up can look different from the classic male pattern. Instead of one dramatic blockage, women more often experience a slow stuttering of plaque along the artery walls. Blood can still get through, just less of it, and less oxygen reaches the heart over time.
The result is not always crushing chest pain. It is often just fatigue. Bone tired, can’t get through the day, wake up already exhausted fatigue. And here is the frustrating part: midlife women have a hundred believable reasons to feel tired. A demanding job, aging parents, teenagers, a household to run, sleep that has not been solid in months. Fatigue rarely triggers the thought “I might be having a cardiac event,” and the healthcare system has not exactly trained us to think that way either.
Other under-recognized symptoms include nausea, unexplained back pain, and jaw pain. Jaw pain in particular can be referred pain from the heart, which is why women experiencing ongoing jaw discomfort after a normal dental exam should be referred for cardiac evaluation rather than sent home reassured that their teeth are fine.
The takeaway here is not to panic over every tired afternoon. It is to stop automatically ranking heart disease at the bottom of your mental list of possible causes when new, persistent, or unusual symptoms show up, and to bring them to your doctor directly and specifically.
Why We See a Gynecologist Every Year But Not a Cardiologist
This is one of the most striking gaps in midlife women’s healthcare. Most women have a standing relationship with their OBGYN and rarely, if ever, see a cardiologist proactively. Ideally, conversations about heart health should start with your primary care physician or OBGYN during the perimenopausal years, not after a cardiac event.
A baseline workup at this stage can include an EKG, so your doctor has a record of what your heart looked like when it was healthy, along with basic labs, a family history review, and a conversation about how your blood pressure and cholesterol have trended over time. Women often are not getting this proactive baseline, which means when something does change, there is nothing to compare it to.
The Cholesterol and Statin Conversation
This is where the episode gets into some genuinely nuanced territory, and it is worth sitting with rather than skimming past.
As estrogen declines, several things happen at once. Arteries lose some of the flexibility estrogen used to provide, which contributes to rising blood pressure. Cholesterol metabolism, which shares pathways with estrogen in the liver, shifts as well. LDL, often labeled the “bad” cholesterol, tends to rise. HDL, the “good” cholesterol, tends to drop. Triglycerides often rise too. Because both high blood pressure and high cholesterol are considered silent, meaning you feel completely normal either way, it becomes easy to deprioritize addressing them.
There is also a psychological piece here worth naming honestly. Many people, understandably, associate taking daily medication with being unwell or being “old,” and some quietly treat medication-free numbers as a badge of honor even when those numbers are elevated. The reframe offered in this episode is that the actual goal is not being medication-free, it is having numbers that are genuinely healthy, whatever it takes to get there for your individual body.
For women specifically, research suggests statins are prescribed less often than for men, and are also declined more often by women themselves once prescribed, partly due to concerns about muscle soreness, a side effect that can occur but is often manageable with dose adjustments. Newer options like PCSK9 inhibitors were also discussed as another tool that has been shown to help reduce arterial plaque, alongside statins, and are increasingly being considered for midlife women rather than treated as an afterthought.
None of this replaces a conversation with your own doctor about your own numbers, family history, and personal risk tolerance. But it is worth knowing that the “just avoid statins” narrative you may have heard elsewhere is not the only credible perspective in cardiology, and it is worth hearing both sides before you decide what is right for you.
The Nutrition Approach That Actually Supports a Midlife Heart
Rather than the low fat, calorie-restrictive advice many of us grew up with, the nutrition approach here centers on the Mediterranean style of eating: colorful fruits and vegetables, quality protein from sources like chicken and fish, and healthy fats like olive oil and avocado. The emphasis is not on cutting calories or eliminating fat. It is on giving the body what it needs to maintain muscle mass, since muscle is directly tied to metabolism, and metabolism helps regulate visceral fat.
There is a detail here that reframes the whole conversation: the heart itself is a muscle, one of the only striated muscles in the body alongside your arms and legs. Feeding your muscles well is, quite literally, feeding your heart.
A Midlife Heart Health Checklist to Bring to Your Doctor
If you are heading into a doctor’s visit and want to advocate for yourself, here are the conversation starters and tests worth bringing up:
- An EKG, even if you feel completely fine, so you have a healthy baseline on record
- A full lipid panel, including LDL, HDL, triglycerides, and if available, ApoB and Lp(a)
- Vitamin D levels, along with iron and ferritin, both of which can run low in women and affect cardiac risk
- A thyroid panel, since thyroid issues can mimic menopausal palpitations and heart symptoms
- A conversation about your blood pressure trend over time, and whether a home blood pressure monitor makes sense for you
- Whether a coronary calcium score is appropriate for you as a risk assessment tool if you are not currently experiencing symptoms
If you are currently experiencing new or unusual symptoms, whether that is persistent fatigue, jaw pain, nausea, or anything that feels off, this is not a wait and see situation. It is worth calling your doctor promptly and asking directly to be evaluated for cardiac causes, not just the more familiar explanations.
Women currently outlive men by several years on average, but we also spend a notably larger share of our lives coping with declining health rather than thriving in it. Closing that gap starts with something simple: treating the heart with the same seriousness we have long given to breast and reproductive health, not instead of it, but alongside it.
You are not being dramatic for asking your doctor about your heart. You are asking the question the healthcare system should have been asking you for years.
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
