Health And The Real Killer Of Women

As women, we are so knowledgeable about our reproductive organs—about the obvious things that make us female. This is wonderful, but it’s not enough to get a full picture of our health, especially when it comes to mortality rates and quality-of-life outcomes among women. Our health depends on knowing the truth about the real killers of women, including heart attack and stroke, and learning to recognize them even when—especially when—they don’t present in accordance with textbook male symptom patterns.
The best way to apply the knowledge from this chapter in your life and the lives of your loved ones is to use your intuition, your powers of deduction, and your common sense. Despite all our knowledge as doctors, we can’t actually feel or sense what you can feel and sense in your own body. We can’t have the same experience of your symptoms.
If you have symptoms congruent with heart disease or stroke/TIA, and you don’t have the “traditional” risk factors for those conditions, you may be given a different diagnosis by default—just like Birdie or like Julie in Chapter 1. If so, the following may help you navigate your care in order to get the support you need:

  •  If you have any doubts or sense that something is wrong, in the case of heart disease or stroke, beyond what’s been explained to you, start a conversation with your provider. You might ask, “What criteria are you basing that diagnosis on?” If the response is that you don’t have hypertension, aren’t a smoker, and don’t have high cholesterol, you might reply, “But I do have these other risk factors that are specific to women.” You might mention the preeclampsia that necessitated an induction in your second pregnancy or the inflammatory condition that increases your risk of microvascular disease.
  • Express your concerns about the current diagnosis and why you think you may be dealing with a cardiovascular or neurovascular issue—even if those concerns are based mostly on your own gut feeling. This will open the doors to additional conversations, testing, and observation—and, ultimately, help you get the support and treatment you need and deserve.
  • If you are at risk for or have symptoms congruent with microvascular dysfunction, you can also request a specialized stress test (if your hospital facility is able to provide one).
  • Also, be very clear with your provider about what medications you are taking, particularly if you are using birth control pills, have a hormonal implant, or have an intrauterine device (IUD). So many women who come into the ED say no when asked if they take medication, but because hormones raise the risk of blood clotting, they are a genuine concern when it comes to heart and brain health. (We’ll talk more about the role hormones play in our health in Chapter 6.)

What Matters—Your Key Takeaways

  •  Heart attack and stroke are not “men’s” diseases. They are, respectively, the number one and number three killers of women in the United States today.
  • The symptoms and indicators of female-pattern heart attack and stroke may be very different from those for men. Knowing what female-patterns symptoms look like is vital to getting a timely diagnosis and treatment.
  • Women are more likely to have “diffuse” disease, such as microvascular dysfunction, rather than the standard “blocked arteries” that we see in men. This makes it difficult for standard tests to pinpoint women’s heart disease. Also, women with cardiac issues are more likely to be misdiagnosed than men.
  • Both heart attack and stroke carry unique female risk factors. Among these are the use of exogenous hormones such as birth control pills and IUDs, pregnancy and postpartum complications, migraine, and inflammatory disorders.
  • When talking to your provider about your symptoms, always be clear and share as much detail as possible.


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