HomeHealth TopicWomen's Health

What Are the Unique Heart Disease Risk Factors for Women?

Christina Palmer, MD
Published on May 24, 2021

Key takeaways:

  • Heart disease is the leading cause of death in women.

  • The cycles of a woman’s life — including menstrual cycles, birth control, pregnancies, and the transition into menopause — each have unique effects on heart health. 

  • You can take charge of your heart health at each stage of life.

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Heart disease is the leading cause of death in all Americans, and there are certain risk factors that exclusively affect women. Women face many stages in their life, including fertile years and the use of birth control, one or more pregnancies and periods of breastfeeding, and the transition into menopause. Hormones cycle and fluctuate during these periods. Once a woman enters menopause, estrogen levels significantly and permanently decrease. 

Read on to learn more about heart health in different phases of a woman’s life, and what to do to keep your heart healthy throughout all of your years.

Role of estrogen in heart health

Estrogen is a hormone that plays a crucial role in a woman’s reproductive health and fertility. Estrogen also plays a key role in other functions of the body including heart health, bone health, and brain function.

Estrogen is particularly important for heart health because it helps with the following:

  • Keeps arteries flexible (good for a healthy blood pressure and avoiding strain on the heart)

  • Regulates cholesterol 

  • Regulates blood sugar

Estrogen levels change throughout a woman’s life, and as a woman enters menopause, estrogen levels decrease significantly. This leads to some unique heart health risks throughout a woman’s life.

Can taking birth control pills increase my risk of heart attack? 

While rare, some birth control pills can cause blood clots and increase the risk of heart attack and stroke. This increased risk is due to the estrogen in some birth control pills: The higher the estrogen dose in your pill, the higher the risk. 

For most people, this is a small risk worth taking for the benefit of contraception. For some people, though, the risk is higher, such as if you are over age 35 and smoke or have: 

  • Obesity

  • High blood pressure

  • Diabetes

  • A history of a blood clot or migraine headaches with aura 

In addition to the increased risk of a heart attack or stroke, the pill can also increase risk factors for heart disease such as high blood pressure or increased cholesterol levels.

Progesterone-only pills are a type of birth control pill that do not contain estrogen, so they do not increase your risk of heart disease.

Alternatives to birth control pills

There are many alternative methods of birth control pills that do not contain estrogen and so will not increase your risk for heart disease. These include:

How does pregnancy increase the risk of heart disease?

Pregnancy puts a unique strain on the heart.  Throughout a pregnancy, the heart has to pump  up to 45% more blood with every heartbeat. That’s a lot of extra work, and it is normal for the heart rate to increase in pregnancy, by up to 10 or 20 beats per minute more.

There are some specific complications of pregnancy that can cause heart disease or increase the risk for heart disease both during and immediately after a pregnancy. 

These include:

  • Gestational hypertension: This is when a woman develops high blood pressure during her pregnancy.

  • Preeclampsia and eclampsia: This can lead to dangerously high blood pressure and seizures, as well as affect other organs including the liver, kidneys, and heart. 

  • Gestational diabetes: This is the development of elevated blood glucose during pregnancy, which can damage blood vessels and increase risk of heart disease.

  • Cardiomyopathy: This is a form of heart failure that occurs at the end of pregnancy or after delivery.

  • Heart attack: The risk of a heart attack increases during pregnancy.

There is also evidence that developing these complications increases the risk of heart disease later in life. 

How does breastfeeding affect the heart

While pregnancy carries some heart risks, breastfeeding can provide heart benefits to the nursing mother. In one study, women that breastfed had a 10% lower risk of later cardiovascular disease. Breastfeeding may also help women reduce their risk for high blood pressure, diabetes, and obesity.

Menopause and heart disease

After menopause, we know that the risk of heart disease increases. We also know that women who go through early menopause under age 45 have a higher risk of heart disease and have earlier plaque buildup.

The decrease in estrogen during menopause can increase heart disease risk factors by:

  • Stiffening of blood vessels

  • Increasing blood pressure

  • Increasing LDL “bad” cholesterol levels

  • Increasing triglycerides 

  • Increasing blood sugar levels

Hormone replacement therapy (HRT) may help reduce heart disease risk, as well as provide other benefits, if given at the right time in a woman’s life. Though HRT is not currently recommended just for heart health.

Heart disease warning signs in women

Early heart disease is often silent — which is why it is so dangerous. High blood pressure or high blood sugar can easily go undetected. And in fact, about 20% of heart attacks are silent, meaning you have no known symptoms of a heart attack and don’t know you’ve had one.

That’s why, regardless of the stage of your life you are in, it’s a good idea to check in with your healthcare provider on your individual heart risk and what screening tests might be right for you. 

When it comes to heart attacks, women often experience unique symptoms different to the typical symptoms people often expect to feel. For example, they are more likely to have jaw and throat pain, nausea, and vomiting, and less likely to have chest pain. 

The bottom line 

Heart disease is the leading cause of death in women. Certain stages of life, such as pregnancy or menopause, may increase that risk — especially if you have other risks like smoking, high blood pressure, diabetes, or overweight or obesity. But knowing your risks can help you to take action to lower them. This means staying up to date with regular health screenings and keeping a watchful eye on your vitals and physical activity levels — even if you think you’re healthy. And cut back on or quit smoking. It’s never too late. Your heart will thank you.

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