Dr. Aaron Block explains what every woman should know about her heart, including how symptoms, risks, and heart disease can be influenced by hormones and life stage.
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For decades, much of the public conversation around heart health has centered on men, leaving many women unaware that their symptoms, risk factors, and life-stage changes can look different.
Because those differences aren’t always highlighted, it can be harder to know what’s typical, what’s worth monitoring, and when it makes sense to check in with a clinician, especially during transitions like perimenopause and menopause.
According to Dr. Aaron R. Block, a Family Medicine Physician and Menopause Society Certified Menopause Practitioner, women can benefit from a clearer, more individualized understanding of how heart disease shows up in their bodies.
With the right knowledge and proactive care, heart health becomes less about fear and more about informed, confident decision making. Here’s what Dr. Block wants women to know.
Many people still picture a heart attack as sudden, crushing chest pain that radiates down the left arm. While that can certainly happen, it isn’t the only way heart disease shows up, especially for women.
“Men more commonly present with what many people think of as the ‘classic’ heart attack symptoms: pressure or pain in the center or left side of the chest that may radiate to the neck, jaw, or down the left arm,” Dr. Block explains.
Women, however, are more likely to experience less typical symptoms. These can include:
- shortness of breath
- nausea, unusual fatigue
- lightheadedness
- back pain
- discomfort in the jaw
Even chest discomfort itself may feel more like pressure, tightness, or fullness rather than sharp pain.
It’s important to keep in mind, however, that these trends aren’t universal. “There is significant overlap and ‘no one’s body reads the textbook,'” explains Dr. Block. Women can have classic symptoms, and men can have subtler ones.
The key is not to self-dismiss new or unusual symptoms. If something feels different, especially chest discomfort, shortness of breath, or unexplained fatigue, Dr. Block advises you to seek medical evaluation.
Symptoms aren’t the only thing that can differ. Dr. Block explains that some types of heart disease are more common in women, and they may show up in different ways compared to men.
For example, in obstructive coronary artery disease, the disease most closely linked to heart attacks, men are more likely to have a single, concentrated buildup of plaque in one part of a heart artery. This plaque can rupture and suddenly block blood flow.
Women, on the other hand, are more likely to have plaque that spreads more evenly along the arteries rather than forming one large blockage.
They are also more likely to have problems in the smaller blood vessels of the heart, called coronary microvascular dysfunction, which may not be detected by standard heart imaging tests.
Dr. Block explains that because current heart imaging tests are better at spotting single, larger blockages (i.e., the kind men are more likely to have), women’s more spread-out plaque or small-vessel disease can sometimes be missed.
“This difference in presentation is one reason heart disease in women is sometimes under-recognized or diagnosed later than it should be,” he says.
Because of this, it’s especially important for women to speak up if they notice symptoms that don’t feel fully explained.
Asking questions and clearly describing what you’re experiencing helps your clinician evaluate your heart more thoroughly and determine if additional testing is needed.
One of the in women’s heart health involves hormones. Dr. Block explains that “hormonal changes across the life span, especially during perimenopause and menopause, do affect cardiovascular risk.”
Estrogen plays an important protective role for the heart during a woman’s reproductive years, Dr. Block explains. It helps keep blood vessels healthy, supports proper blood flow, improves cholesterol by lowering “bad” LDL and raising “good” HDL, and may reduce inflammation in the arteries.
Altogether, these effects help slow the buildup of plaque in the heart and blood vessels.
During perimenopause and menopause, however, estrogen levels drop. Dr. Block notes that this can lead to changes in cholesterol, blood pressure, body fat, and how the body handles sugar, all of which can increase heart disease risk over time.
After menopause, a woman’s overall cardiovascular risk rises and eventually approaches that of men of the same age. “For this reason, midlife is a critical window for reassessing cardiovascular risk and being proactive,” Dr. Block says.
Rather than viewing menopause solely through the lens of symptoms like hot flashes or sleep disruption, it can also be seen as an opportunity to reassess heart health.
Updating cholesterol panels, checking blood pressure trends, reviewing metabolic markers, and refining lifestyle habits can have a meaningful long-term impact.
Preventive care plays a powerful role in reducing heart disease risk.
Dr. Block explains, “It begins with going back to the basics: nutrition, regular physical activity, restorative sleep, stress management, and attention to mental health. When these are consistently addressed, they meaningfully lower cardiovascular risk.”
These foundational habits improve:
- blood pressure
- lipid levels
- glucose metabolism
- inflammatory markers
- body composition.
“That said, lifestyle alone does not eliminate all risk,” Dr. Block emphasizes.
Genetics, family history, autoimmune disease, and pregnancy-related conditions, such as preeclampsia or gestational diabetes, can significantly influence long-term cardiovascular risk, even in women who otherwise appear healthy.
That’s why preventive care also includes routine screening. Dr. Block prioritizes:
- maintaining healthy blood pressure
- monitoring lipid levels
- assessing blood glucose or A1C
- weight management
- evaluating kidney function
When symptoms are present or risk is elevated, additional evaluation, such as stress testing or advanced cardiac imaging, may be appropriate.
Much of this guidance overlaps between men and women. “The major distinction is timing and identifying risk,” Dr Block explains. Because women often develop noticeable heart disease later than men, their risk can sometimes be underestimated during midlife.
“Careful, individualized risk assessment is essential, particularly during midlife and after menopause, when cardiovascular risk begins to rise more rapidly,” he says.
If you’re wondering where to start, Dr. Block offers reassurance: “It is never too early to focus on heart health. The earlier heart healthy habits begin, the greater their long-term impact. But meaningful change to reduce cardiovascular risk can happen at any age.”
- For younger women: The emphasis is often on building lifelong habits and understanding family history.
- During the reproductive years: It’s important to recognize that pregnancy-related conditions such as preeclampsia or gestational diabetes are not isolated events. They can serve as markers of future cardiovascular risk and should be shared with a primary care clinician.
- In perimenopause and menopause: It becomes especially important to reassess blood pressure, cholesterol levels, body composition, and metabolic health, since risk tends to rise more quickly during this transition.
Partnering with a trusted primary care clinician can help translate numbers into meaningful next steps.
“These habits may not be glamorous,” Dr. Block notes, “but they do make serious impacts.”
Women’s heart health is unique, influenced by biology, hormone levels, and life stage. Symptoms can show up differently than in men, and cardiovascular risk can change over time as hormones fluctuate throughout a woman’s life.
By keeping up with personalized screenings, practicing consistent preventive habits, and maintaining open conversations with a clinician, women can actively protect their heart health.
As Dr. Block emphasizes, “prevention is powerful,” and it’s something women can pursue at any stage of life.