Many women have never discussed heart health with a clinician, and most report multiple symptoms

Heart disease is the leading cause of death in women, and the risk rises during the menopause years. But an international study has revealed that only half of women know this. Many have never talked about their heart with a doctor or a nurse, and the majority are living with multiple symptoms.

This discovery, and many more, came from a survey of 7,470 women aged 40 to 60 in Ireland, Spain, Greece, Croatia, Lithuania and Colombia, whose responses were analyzed as part of the Horizon Europe project, CARAMEL (CArdiovascular Risk Assessment in MEnopausaL women).

Women and clinicians also took part in interviews and co-design workshops in all six countries, and the data were subsequently analyzed by researchers in Trinity’s School of Nursing & Midwifery.

Dr. Sharon O’Donnell, associate professor in critical care nursing and CARAMEL lead at the School of Nursing and Midwifery, said, “Our research found major gaps in what women know about heart health and menopause. More than half of women who participated in the study were unaware of their risk of heart disease or that menopause can increase that risk. Most of these women were university-educated, so the knowledge gaps we identified are probably greater within the wider population. We are also very concerned by what we heard from women with intellectual disabilities, most of whom had received no information about menopause before it began.

“Women need to know about their increased risk of heart disease in the menopause years. If you need more information, have concerns or notice symptoms, please speak to your primary care doctor or another health care professional. As part of the CARAMEL project, we have developed a new CVD Prevention Portal to help women learn about their heart health and support health care professionals to give better advice and care during menopause.”

The study is published in the journal BMC Women’s Health.

Key messages from the research

Only around half of midlife women (48%) know heart disease is their leading cause of death.

Awareness ranged from two in three women in Ireland (67%) to fewer than one in five in Colombia (19%). About one in three women named a cancer instead.

Women know the classic heart risks, such as high blood pressure and being overweight. They are much less sure about risks that belong to women. Fewer than half (45%) knew that an early menopause raises the risk of heart disease.

And knowing the facts did not mean feeling at risk. Half of the women whose own risk factors put them at high risk did not see their risk as high.

“There’s an awful lot of talk about menopause… but I never really got the whole cardiac thing… How come I didn’t know about it?”—Woman, Ireland

Women are waiting to be asked. Nearly half (47%) have not talked about their heart with a professional in the past year. This included three in 10 who had already been diagnosed with high blood pressure. The most common reason women gave was that they expected the professional to raise it.

The silence goes beyond the heart. Almost one in three women (31%) had not talked about menopause with a professional in the past year, and fewer than one in four did so at most visits. Four in 10 used no treatment at all for their symptoms.

When women did talk to a professional, many felt only half heard: almost one in four said the professional dealt with their physical symptoms but not the emotional ones.

“They don’t listen to you, and they don’t think you understand anyway.”—Woman with intellectual disability

Menopause is far more than hot flashes. Seven in 10 women had experienced fatigue, and two in three had sleep problems and mood swings. About half reported brain fog and anxiety, and nearly four in 10 were unhappy with their sleep. Hot flashes, the best-known symptom, were less common than fatigue, sleep problems or mood swings.

Women want help they can trust. Two in three (67%) said they would like menopause information through an app, yet only 5% had ever used one as a source. They told us why: too many apps feel commercial, carry ads or seem to collect their data. What women asked for was practical advice on symptoms, sleep, diet and exercise, written in a warm voice.

Women’s heart attack signs are the least known. Almost every woman (95%) knows that chest pain can signal a heart attack. But far fewer know the subtler signs that are common in women: unusual fatigue (57%), nausea (47%), indigestion (38%) or anxiety (34%).

In women, a heart attack can begin with these less dramatic symptoms. A woman who does not recognize them may not seek help in time, and may be told, or tell herself, that it is nothing.

When the heart sends a warning, many women wait. More than half of women (55%) have had a moment when they thought something might be wrong with their heart. Waiting to see what happened was as common a response as contacting a doctor, and fewer than one in 10 called emergency services.

Others stopped to rest or told a partner or a friend. Among the women with intellectual disability who had such a moment, none called emergency services.

HRT depends on where a woman lives. Two in three Irish women (65%) have used HRT, compared with between 6% and 19% of women at the other six sites. Across all sites, nutritional supplements (36%) were used more often than any medical treatment.

Whether a woman used HRT depended more on whether she had seen a gynecologist or a private menopause clinic than on her education or income, and the site she lived in mattered most of all. Among women with the heaviest symptoms and poor health, one in four used no treatment at all and one in two no medical treatment.

The message is not that every woman needs HRT. It is that every woman deserves clear, balanced information to decide with her doctor.

One in four (27%) have been diagnosed with high blood pressure, a major cause of heart attack and stroke. Yet three in 10 of these women had not talked about their heart health with a professional in the past year.

Asked why not, almost half with high blood pressure (48%) said they expected the professional to raise it if there was a problem. Diagnosed heart disease was much less common (10%), which makes the menopause years a window for prevention.

“Like traffic lights—red, yellow, green. It always has to be simple.”—Woman, Croatia, on how to show personal heart risk

Women with intellectual disability are left furthest behind. Four in five women with intellectual disability (78%) had not been told anything about menopause before it began, compared with 45% of Irish women in general. Only one in three (36%) knew that heart disease is women’s leading cause of death.

Almost all had their blood pressure checked in the past year, but half (53%) had no conversation about heart health. Yet they were just as keen as other women on an app (80%), as long as it is simple, easy-read and has audio. In workshops, women asked for a symptom diary “so that we are believed.”

“Make it simple, think about people with other disabilities like blind people or deaf people.”—Woman with intellectual disability.

Who’s behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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