The Real Reason Women’s Heart Attacks Get Missed—And How to Protect Yourself
You may not know this about me, but for the first 15 years of my career, I had a side gig as an ER doctor. It might sound surprising, but family doctors aren’t paid as much as most physicians. Plus, I loved the adrenaline and challenges of the ER. Walking into an ER shift required me to switch off my "prevention-first" family doctor mindset and focus on one critical question: “What could kill this patient if I miss it?”
One shift stands out. A fit, attractive woman in her early 50s walked into the ER saying, “I just don’t feel right.” That was her only complaint. The female ER nurses, unfortunately, didn’t take her seriously -probably because she looked - and triaged her into a side room to be seen later.
Here’s the thing: I’ve learned to collaborate closely with nurses. Not every nurse (just like every doctor) is equally skilled, so knowing which ones to trust is vital. On this shift, I’m glad I trusted my instincts instead of the nurse’s dismissive attitude.
When I entered the room, it was true—she didn’t look sick. She was calm, interactive, and smiling even as she told me her story. But she kept insisting, “I know my body, and something is off.” Despite her normal appearance and no significant medical history, she was menopausal, in her 50s, and had a family history of heart issues. I ordered an EKG, earning an eye-roll from the nurse.
Minutes later, that same nurse came running to me, panic-stricken, holding the EKG. It showed clear signs of an active myocardial infarction (MI)—a heart attack. Yet this woman had zero classic symptoms like chest pain, shortness of breath, or arm pain. We had her in the cardiac cath lab within 30 minutes. That quick action likely saved her life and spared her heart from severe damage.
The Lesson: Women often don’t present with heart disease like men. Instead of chest or arm pain, women might feel fatigue, nausea, back pain, or even just off. Tragically, women are dismissed more often in ERs, which is why those treated by female ER doctors are 2-3 times less likely to die from a heart attack than those treated by male ER doctors.
This isn’t to scare you but to underscore a vital truth: Cardiovascular disease (CVD) is the leading cause of death in U.S. women, not breast or ovarian cancer. One in five women will die from CVD— 7-10 times the rate of breast cancer. Every 80 seconds, a woman in the U.S. succumbs to this preventable disease. Alarmingly, heart attack hospitalizations in women aged 35-54 are rising.
The Hormone Connection
Perimenopause and menopause aren’t just about hot flashes - they’re pivotal windows for heart, brain, and overall health. Hormonal shifts during these stages can worsen vascular function, impair mitochondria, and quadruple the risk of autoimmune diseases.
Mental health also takes a hit. Women aged 45-55 are three times more likely than men to attempt suicide, often due to perimenopausal mood swings. Estrogen stabilizes mood, supports cardiovascular function, and preserves brain health. Yet, 73% of U.S. women aren’t receiving bioidentical hormone replacement therapy (BHRT). Why?
The Ghost of the Women’s Health Initiative (WHI) Study: Let’s Lay It to Rest
The WHI study from the early 2000s scared women off hormone therapy. But here’s the catch: it studied the wrong women (average age: 63) at the wrong time in life, using the wrong treatment (synthetic hormones, not bioidentical).
Newer research shows BHRT is safe for women under 60 and can:
Slow biological aging
Reduce diabetes progression
Improve bone density
Boost mood and sleep
Enhance cardiovascular health
Lower Alzheimer’s risk
The Brain-Heart Connection
High cortisol levels in women over 40 are linked to memory decline, brain shrinkage, and increased Alzheimer’s risk. Stress and untreated hormone deficiencies accelerate this trajectory.
But there’s hope. Studies, including the Framingham Heart Study, show BHRT during the 5-10 years around menopause can significantly lower risks of heart disease and Alzheimer’s.
Don’t Settle for “Just Getting Older”
Whether you’re a Gen Xer or Millennial, passive aging is out. Proactively addressing perimenopausal symptoms and tracking key metrics like blood sugar can extend your health span. Your biology may be universal, but your health journey is unique. Functional medicine tailors solutions to you—not just your demographic. After all, health isn’t about merely avoiding disease; it’s about thriving at every stage.
Be BioFIT- Be Educated, Not Influenced.
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Grateful to be your physician guide.
Kevin Hoffarth MD, IFCMP
BioFIT Medicine