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This story was written by Emily Park, digital editor for IN Kansas City magazine, and was originally published in IN Kansas City's February 2023 edition. For more stories from IN Kansas City magazine, visit https://www.inkansascity.com/.
Estrogen and progesterone are two of the most important hormones affecting women. From defining physical characteristics to carrying pregnancies and strengthening bones, these hormones have major impacts on us throughout our lives.
But estrogen and progesterone can also contribute to some not-so-great symptoms that might coincide with serious health complications such as heart disease, says Michelle Dew, MD, a cardiologist with AdventHealth Medical Group Cardiology & Cardiovascular Surgery.
“While these hormones are not considered, currently, to have a direct effect on women’s cardiac health at younger ages, we know that there can be fluctuations in how we feel with our monthly cycles, sometimes manifesting with palpitations, dizziness, and swelling,” Dew says. “These symptoms can be related to the normal hormonal swings that a woman will experience monthly and not represent cardiac issues. But it is well known that women experience increased rates of hypertension and worsening cholesterol profiles after menopause, which is a significant hormonal shift for our bodies.”
Research suggests changes in heart muscle function after menopause may be related to hormonal changes, Dew adds.
Heart Disease and Hormones Across All Ages
Heart disease is the leading cause of death worldwide in women of all races. This is due to factors such as diabetes, smoking, hypertension, hyperlipidemia, obesity, family history of premature heart disease, poor diet, and lack of exercise. Hormones have both a direct and an indirect impact on heart health, causing both symptoms and changes in heart muscle cells in different stages of life.
Puberty: Hormones affect the development of physical and mental changes and can contribute to palpitations, dizziness, fainting, and bloating.
Pregnancy: Hormones that help maintain pregnancy can contribute to palpitations, swelling, and fainting.
Menopause: It’s common for women to experience palpitations, weight changes, body shape changes, increasing blood pressure, and less desirable cholesterol profiles, which are all known to be related to hormonal changes to some degree.
“With menopause, we see increases in blood pressure and cholesterol,” Dew says. “These have been directly implicated in higher rates of heart disease. About ten years after menopause, a woman’s risk of heart attack approaches that of a man’s risk.”
Dew says patients who experience any of those symptoms should talk to their doctor.
“I can’t tell you how many women I have seen as patients with various complaints who never had anyone ask them if their symptoms had any relationship to their periods,” she adds. “If a woman has irregular heartbeats, swelling in the legs, or other new things in the body, she should keep a record of when the symptoms occur. Sometimes, the symptoms can be related to her cycle and she should talk to her medical provider about this. For many patients, we can use different medications or supplements on an as-needed basis with very good effect.”
There are other conditions—Spontaneous Coronary Artery Dissection and Stress Cardiomyopathy, or ‘Broken Heart Syndrome’—that disproportionately affect women, and research into the potential correlation with hormones is ongoing.
Supporting Women’s Cardiac Health
From screenings to heart-health education and treatment for heart disease, AdventHealth offers many resources for cardiovascular health. The HEARTaware risk assessment is a brief survey that can help identify the risk of heart disease and stroke. This free assessment, as well as information about a set of low-cost screenings, can be found at heartcarekc.com.
In the community, AdventHealth partners with the American Heart Association to increase access to resources and education about heart health. AdventHealth is the Presenting Medical Sponsor for the American Heart Association Go Red for Women initiative in Kansas City, and for the 2023 luncheon this spring, Dew will serve as the medical co-chair alongside fellow AdventHealth cardiologist Heath Wilt, DO, FACC.
“As a supporter of the Go Red for Women movement, we work alongside the American Heart Association to educate women on the importance of living a healthy lifestyle and maximizing heart health,” Dew says. “We need to change the perception women have about heart disease and stroke. Making a healthful difference in a woman’s life can have ripple effects. If she is the primary caregiver for her family, she can help raise awareness and improve health for the whole family.”