Heart disease is still the leading killer of women, yet it’s routinely missed, and perimenopause may be one of the most important windows to catch it. Preventative cardiologist Dr. Suzanne Steinbaum and I talk about the warning signs hiding in plain sight, the labs a standard cholesterol panel can miss, and why estrogen alone isn’t the same as protecting your heart.
Most women go into perimenopause bracing for hot flashes, weight gain, poor sleep, and brain fog. Almost nobody tells them this may also be one of the most important cardiovascular windows of their lives. And that’s a problem.
Heart disease remains the number one killer of women, yet women are still being underdiagnosed, dismissed, and evaluated with systems largely built around male cardiovascular disease. To unpack what menopause and heart disease really have to do with each other, I sat down with preventative cardiologist Dr. Suzanne Steinbaum.
We cover the surprising signs that may say more about your heart than you realize, why looking healthy doesn’t necessarily mean your arteries are healthy, and why your standard cholesterol panel may not give you the full picture. We also get into estrogen, HRT, inflammation, blood sugar, hot flashes, family history, and pregnancy history, and why putting on an estrogen patch is not the same thing as protecting your heart.
If you’ve ever thought, “I’m healthy, I exercise, my heart is probably fine,” this is the episode I want you to hear. Things may be happening beneath the surface long before obvious cardiovascular disease shows up.
Heart disease in women is often missed because much of how we evaluate cardiovascular risk was built around how the disease shows up in men. In the episode, Dr. Steinbaum explains that women can present differently, get dismissed more readily, and be assessed with tools that may not catch what’s actually happening in their arteries.
That gap matters most in midlife. A woman can walk out of a “normal” check-up with real, developing risk that nobody measured or named.
Perimenopause may be the moment to start paying much closer attention to your heart, because this is when cardiovascular changes can begin. Dr. Steinbaum discusses what starts changing in the arteries during this transition and how declining estrogen may affect cardiovascular health.
Hot flashes may be more than an uncomfortable symptom. Dr. Steinbaum discusses a surprising connection between hot flashes and cardiovascular risk, which is why she doesn’t think they should be dismissed as “just menopause.An association isn’t proof that hot flashes cause heart disease. Still, it’s a good reason to bring your symptoms into the cardiovascular conversation with your provider.
You can be fit, lean, and active and still be at cardiovascular risk. Dr. Steinbaum explains why outward health doesn’t tell you what’s happening inside your arteries. Family history, genetics, metabolic markers, and your reproductive history all add pieces to the picture.
Your pregnancy history may hold early clues about your future heart health. Dr. Steinbaum explains why this belongs in every woman’s cardiovascular risk assessment, even decades later.
Palpitations, shortness of breath, and subtle chest symptoms deserve attention rather than a shrug. Dr. Steinbaum discusses why women shouldn’t automatically write these off as anxiety, stress, or hormones.
If you have chest pain or pressure, severe shortness of breath, or other possible heart attack symptoms, call 911 or your local emergency number right away.
A standard lipid panel gives you useful information, but Dr. Steinbaum explains that your LDL number alone may not tell the whole story. She wants women asking about additional blood markers that can reveal risk a basic panel can miss, including markers related to inflammation and blood sugar.
There’s a genetic cholesterol marker that many women have never had tested. Dr. Steinbaum explains why knowing this number can change how you think about your risk.
The conversation around LDL, ApoB, and statins is controversial, and we get into it. Dr. Steinbaum’s position is that she doesn’t treat numbers in isolation. She looks at the whole person, including history, symptoms, imaging, and other risk factors, before making treatment decisions. Any decision about starting, stopping, or changing cholesterol medication should be made with your own clinician.
HRT is important, but Dr. Steinbaum is clear that it isn’t a free pass for your heart. Assuming estrogen alone protects you from heart disease is a mistake. Putting on an estrogen patch doesn’t replace paying attention to cholesterol, inflammation, blood sugar, blood pressure, and the rest of your risk profile.
This is a message I wholeheartedly agree with. Hormone therapy can be a valuable part of midlife care, but it works best alongside real cardiovascular screening, not instead of it.
Some commonly used cardiovascular tests may miss disease in women. In the episode, Dr. Steinbaum walks through which tests she believes women should know about and a type of plaque that can be especially important in female heart disease. Her bigger point is that cardiovascular prevention needs to become far more personalized. A woman’s risk can’t be fully captured by one test, one number, or one appointment.
If this episode has you rethinking your heart health, these questions can help you start a more complete conversation with your provider:
Cardiovascular risk may rise as women move through perimenopause and menopause, particularly as estrogen declines. In the episode, Dr. Steinbaum discusses how the arteries can begin changing during perimenopause, which is why she sees this stage as an important window for prevention. That doesn’t mean every woman will develop heart disease. It does mean midlife is a smart time for a more thorough look at your cardiovascular health.
Heart disease in women is often missed because many diagnostic systems were largely built around how the disease appears in men. Dr. Steinbaum explains that women may be dismissed, may present with subtler symptoms, and may be evaluated with tests that don’t always catch female patterns of disease. Women who look healthy can be especially easy to overlook.
HRT should not be treated as automatic heart protection. Dr. Steinbaum explains that while HRT is important, assuming estrogen alone protects you from heart disease is a mistake. Your cholesterol, inflammation, blood sugar, family history, and other risk factors still need attention. Talk with your clinician about how hormone therapy fits into your overall cardiovascular plan.
A standard cholesterol panel may not tell the whole story. Dr. Steinbaum explains that LDL alone can miss important information. She wants women to know about a genetic cholesterol marker many have never had tested, along with additional blood markers that can give a fuller picture. Ask your provider which tests make sense for your history.
Hot flashes may be associated with cardiovascular risk, according to Dr. Steinbaum’s discussion in the episode. An association doesn’t prove that hot flashes cause heart disease, but it may be a reason to look more closely at your cardiovascular health rather than treating hot flashes as purely a comfort issue.
Yes, you can exercise regularly and look healthy while still having cardiovascular risk. Dr. Steinbaum explains that factors like genetics, family history, and pregnancy history can affect your arteries regardless of how fit you appear. Exercise is valuable, but it doesn’t replace appropriate testing.
Palpitations, shortness of breath, and subtle chest symptoms deserve attention. Dr. Steinbaum discusses why these shouldn’t automatically be written off as stress, anxiety, or hormones. Mention new or changing symptoms to your provider. If you have chest pain or pressure, severe shortness of breath, or other possible heart attack symptoms, call emergency services right away.
Dr. Suzanne Steinbaum is a preventative cardiologist focused on cardiovascular health in women.
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