A Woman’s Guide To Heart Health: Symptoms, Labs, & Lifestyle
Close Banner
Women's Health
A Woman’s Guide To Heart Health: Symptoms, Labs, & Lifestyle
Author: Ava Durgin
April 25, 2026
Assistant Health Editor
By Ava Durgin
Assistant Health Editor
Ava Durgin is the former Assistant Health Editor at mindbodygreen. She holds a B.A. in Global Health and Psychology from Duke University.
Image by Studio Firma
April 25, 2026
Feeling strong isn't just about how much you can lift; it's about how well your body functions and supports you over time. And at the center of that system? Your heart.
Yet, heart disease is often left out of the women's health conversation. Despite being responsible for 1 in every 5 female deaths in the U.S., cardiovascular health remains underrepresented in discussions about women's health, overshadowed by other health concerns that, while important, are far less deadly.
Women's heart attacks look different
For too long, the default image of someone having a heart attack has been male: crushing chest pain, collapsing to the ground. But women's experiences with heart disease are often very different, and far more subtle. Especially around midlife, as hormone levels shift and protective estrogen wanes, cardiovascular risk spikes. And many women are unaware of how to read the signs.
"There are signs and symptoms that can go unattended and disregarded if not connected to potential heart issues," explains Jessica Shepherd, M.D., board-certified GYN, menopause expert, and author of Generation M.
"Women often report fatigue, shortness of breath with exertion, indigestion, or sleep disturbances—symptoms that can be dismissed as stress, aging, or even menopause itself. But these can also be subtle signs of underlying heart disease.”
The goal is to cut through the confusion and rewrite what heart health looks like for women in perimenopause and beyond. By recognizing the early, often silent signs of heart disease, women can take proactive steps to strengthen their cardiovascular health before a crisis occurs.
Heart disease: The leading cause of death in women
The numbers tell a sobering story:
- Heart disease kills more women than all cancers combined
- 1 out of 2.6 women die of coronary artery disease (CAD)
- Many women, and their doctors, still underestimate this risk
Why women's heart disease goes undiagnosed
Historically, cardiovascular research centered on men. As a result, clinical guidelines, diagnostic tools, and even symptom checklists were not designed for women. This leads to misdiagnosis and under-treatment.
Women are often less likely to receive preventive recommendations, experience delays in diagnosis, and receive less aggressive treatment compared to men with similar cardiac risk profiles.
When risk skyrockets
Perimenopause represents a critical turning point in a woman's cardiovascular health trajectory. Estrogen has a protective effect on blood vessels, helping to keep them flexible and reducing the buildup of plaque. Once levels decline during perimenopause and menopause, women face a sharp rise in risk, even if they don't fit the "classic" profile for heart disease.
"Women in midlife are often balancing multiple roles—caring for aging parents, supporting children, managing careers, and carrying the invisible 'mental load,'" notes Shepherd.
Chronic stress wreaks havoc on your cardiovascular system by:
- Elevating blood pressure
- Increasing inflammation
- Disrupting sleep patterns
- Changing how women respond to stress differently from men
That's why every woman should know her heart health stats by midlife. Understanding your personal risk factors becomes increasingly important during this transition phase when cardiovascular vulnerability increases dramatically.
Women's heart symptoms aren't always obvious
Forget everything you think you know about heart attacks. Women are more likely to have heart attacks without chest pain. Instead, watch for these often-dismissed symptoms:
Immediate warning signs include:
- Persistent, unexplained fatigue
- Shortness of breath with mild activity
- Neck or jaw discomfort
- Nausea or vomiting
- Sleep disturbances
- Chest pressure (not necessarily sharp pain)
- Unexplained dizziness
- Swelling in the legs or feet
"Women's heart disease doesn't always follow the textbook, and 'normal labs' don't always mean everything is fine. If your body is telling you something feels off, that matters," says Shepherd.
Coronary microvascular dysfunction & women
Women tend to experience coronary microvascular dysfunction, which affects the heart's smaller vessels. These don't show up on standard angiograms and often present as vague, diffuse symptoms that are easy to brush off.
Women of all ages, especially younger women, are more likely than men to develop this type of heart disease.
In microvascular disease, the heart doesn't receive as much blood as it needs to do its job well. Patients may sense this as discomfort or pain in the chest, or in another area of the upper