Dr Angela Maas’s book, A Woman’s Heart: Why Female Heart Health Really Matters, was a revelatory read for me when it first launched. As a newly trained GP transitioning from obstetrics and gynaecology, I wanted to understand the female body beyond the so-called “bikini areas.”
I often found myself attributing symptoms like chest tightness, anxiety, sleep disturbances, and dizziness to menopause or personality traits. But something didn’t sit right—there couldn’t be that many women experiencing this specific cluster of symptoms without an underlying explanation. And I was right.
Dr Maas, an internationally recognised expert in women’s cardiology, sheds light on how the female heart functions differently from the male heart, leading to differences in diagnosis, symptoms, and treatment. Her insights transformed my approach to women’s health, and today, they are an essential part of how I assess cardiovascular risk in my female patients.
Understanding the Female Heart
Women’s hearts are not just smaller versions of men’s. They have unique structural and physiological differences that affect how heart disease develops and presents itself.
- Smaller coronary arteries – Women’s arteries are narrower, making procedures like angioplasty (repairing or unblocking arteries) more complex.
- Different heart muscle structure – This influences how heart failure progresses and responds to treatment.
- Atypical heart disease symptoms – Women may not experience the classic chest pain or pressure associated with heart attacks. Instead, they might feel:
- Chest ‘tightness’ (like a band around the chest)
- Shortness of breath
- Nausea
- Back or jaw pain
- Dizziness and extreme fatigue
- Sleep disturbances and unexplained anxiety
Because these symptoms differ from the male ‘textbook’ signs, women are often misdiagnosed or dismissed, leading to dangerous delays in treatment. High blood pressure—another major cardiovascular risk factor—is also frequently overlooked in women.
Understanding Female Blood Pressure
Think you’re ‘just going through menopause’? Think again!
Hot flushes, palpitations, and stress—many women assume these are simply menopause symptoms. In reality, they can also be signs of high blood pressure. Unfortunately, this misinterpretation delays diagnosis and treatment, increasing the risk of heart attacks, strokes, and heart failure.
While blood pressure naturally rises with age, it spikes sharply after menopause due to a decline in oestrogen levels. Oestrogen plays a vital role in maintaining vascular flexibility—when blood vessels become stiffer, blood pressure increases. Combined with women’s generally smaller arteries and hearts, these changes increase the risk of hypertension and heart complications.
Many ‘normal’ blood pressure values were developed based on young, fit men rather than women. But should a 5’0″, 8-stone woman be assessed the same way as a 6’4″, 16-stone man? Recognising these sex-specific differences in blood pressure regulation is key to better cardiovascular prevention and treatment for women.
The Impact of Hormonal Changes on Heart Health
Your fertility, menstrual, pregnancy, and postnatal history matter far more than you think when assessing cardiovascular risk.
Oestrogen protects the heart by keeping blood vessels flexible and supporting healthy cholesterol levels. However, pregnancy-related conditions like gestational diabetes and pre-eclampsia can serve as early warning signs of future heart disease and metabolic disorders. Despite this, they are often treated as temporary pregnancy complications rather than indicators of long-term cardiovascular risk.
Understanding your reproductive history and how hormonal changes impact long-term health is essential for personalised heart disease prevention and treatment strategies for women.
The Gender Bias in Cardiology
Historically, cardiovascular research has been male-focused, leading to a knowledge gap in women’s heart health.
- Clinical trials were conducted predominantly on men, leaving women underrepresented.
- Diagnostic criteria were based on male symptoms, meaning many women with heart disease are misdiagnosed.
- Women are more likely to be dismissed in A&E when experiencing a heart attack.
- Women are less likely to receive aggressive treatments like bypass surgery or stents and are instead offered lifestyle changes or medication alone.
- Sometimes, women’s symptoms are even misattributed to anxiety or ‘hysteria’ rather than properly investigated.
Your History Matters—Advocate for Your Heart Health
Dr Maas’s work empowered me to advocate for my female patients in ways I never did before. It’s crucial for women to:
- Recognise symptoms early
- Understand their unique risk factors
- Make proactive lifestyle changes – maintaining a heart-healthy diet, staying active, and managing stress
- Prioritise sleep quality, hormone therapy, and mental wellbeing
One of the most powerful messages in Dr Maas’s book is that women must take charge of their own health. That means:
- Asking questions
- Seeking second opinions
- Pushing for the right tests
- Refusing to accept vague reassurances
She also highlights the importance of support networks, encouraging women to build strong relationships with healthcare providers, family, and peers who can advocate for them.
Final Thoughts
Menopause isn’t just about hormonal changes—it’s a critical turning point for heart health. If you’re experiencing palpitations, dizziness, or unexplained anxiety, don’t just dismiss it as menopause. Get your blood pressure checked, be proactive in medical settings, and prioritise heart health.
By recognising the unique ways high blood pressure and heart disease affect women, we can improve prevention, early detection, and long-term cardiovascular outcomes. Staying informed and empowered today means living longer and healthier tomorrow.
