Women warned about the hidden signs of heart disease as experts outline the risks

Heart disease can develop quietly, with warning signs that may be missed in routine checks or never recognised at all.

By the time it becomes obvious, the harm may already be severe.

Cardiovascular disease is the leading cause of death in women and girls worldwide, even though it has long been viewed within medicine as mainly an issue for older men.

That is especially concerning because case numbers are expected to climb sharply in the years ahead.

Now, new joined-up guidance has been published to show women which warning signs to watch for when protecting their heart health.

Some of those clues can appear as early as the teenage years.

Rather than treating periods, pregnancy and menopause as separate parts of life, experts say women should consider the full picture, since each stage can reveal information about risks that may last for decades.

A group of major US medical organisations has recently issued coordinated guidance on women’s cardiovascular health, stressing the need to identify risk factors throughout life instead of waiting until it is too late.

The guidance focuses on five key stages when women and their healthcare professionals can assess cardiovascular health more closely: adolescence, the reproductive years, pregnancy, perimenopause and menopause, and postmenopause.

Dr Lucy Hooper, a private GP and co-founder of Coyne Medical, says the main message is that women should take heart health seriously long before middle age.

“The most important overall message is that women’s cardiovascular health needs much more attention throughout every stage of their lives, not just when they reach middle or older age,” she exclusively explained to Tyla.

“Cardiovascular disease is the leading cause of death in women worldwide, but we still tend to think of heart disease as a male problem.”

So what should women be looking for, and what practical steps can help protect them?

Stage 1: Perimenarche (Puberty)

Heart disease may seem far away during childhood and the teenage years, but the foundations of cardiovascular health are laid much earlier than many people realise.

The transition around a girl’s first period is an important time to pay attention to hormonal health, menstrual patterns and emotional wellbeing.

This life-stage approach encourages healthcare professionals to consider these factors alongside more familiar markers such as blood pressure and physical activity.

Periods can offer useful clues. While cycles can naturally take time to settle after menstruation begins, heavy or persistently irregular bleeding is worth discussing with a healthcare professional rather than simply putting up with it.

These symptoms do not automatically mean someone has a heart problem. But menstrual irregularities can sometimes be linked to underlying conditions that influence long-term cardiovascular risk.

Dr Hooper points to polycystic ovary syndrome (PCOS), which can be associated with insulin resistance and other metabolic risk factors.

Hormonal changes first kick in around puberty.

“This may largely be explained by shared cardiovascular risk factors, including insulin resistance, diabetes and raised LDL cholesterol,” she noted.

Emotional health matters too. Anxiety, depression and eating disorders can affect overall wellbeing and may have implications for cardiovascular health, so these concerns should be recognised and supported rather than brushed aside.

Healthy habits built in childhood and adolescence can also lay a strong foundation for the future. Regular movement, a balanced diet, enough sleep and open conversations about health all play a part.

According to Dr Hooper, the point is not that teenagers should be worried about heart disease, but that early health concerns should be taken seriously.

Stage 2: Ovarian Cycling

Once regular menstrual and hormonal cycles are established, women enter the stage known as ovarian cycling, which broadly covers ages 15 to 44.

This phase can involve major life changes, from contraception and fertility decisions to pregnancy and the years after childbirth. The new framework encourages clinicians to take these experiences into account alongside more familiar cardiovascular risk factors.

Irregular or heavy menstrual bleeding should not automatically be dismissed as something women simply have to live with. Depending on the cause, it may be linked to hormonal conditions that influence metabolic health. Heavy bleeding can also lead to iron deficiency, which can affect energy levels and wellbeing.

Some women experience stronger mood symptoms tied to their menstrual cycle, including premenstrual dysphoric disorder (PMDD). Emotional health, stress and sleep are also part of the wider cardiovascular picture.

This does not mean every menstrual symptom points to a heart problem. It means reproductive health patterns can provide useful information and should be considered part of a woman’s broader medical history.

Dr Hooper says women should know the numbers that reveal cardiovascular risk, even when they feel completely well.

“I would love women to know their blood pressure and cholesterol numbers as well as they know their weight or BMI,” she told us. “Blood glucose and diabetes risk shouldn’t be forgotten either.”

High blood pressure and raised LDL cholesterol can develop without obvious symptoms, so appropriate testing can help spot problems before they lead to more serious complications.

Dr Hooper also highlights lipoprotein(a), or Lp(a), a largely inherited blood particle linked to an increased risk of cardiovascular disease. She says adults should consider having their Lp(a) measured at least once in their lifetime.

Stage 3: Pregnancy

Pregnancy is not listed as a separate age group in the framework because it can happen during the reproductive years and its effects can continue long after birth. But research now recognises it as a particularly important period for assessing cardiovascular risk, especially since heart disease is a leading cause of death among pregnant women in the United States.

Dr Hooper describes pregnancy as “another really important stress test for the cardiovascular system” because of the major changes the body undergoes in circulation and metabolism.

For some women, pregnancy can reveal vulnerabilities that were not obvious before.

Complications such as pre-eclampsia, high blood pressure during pregnancy, gestational diabetes and preterm delivery have all been linked with a higher risk of cardiovascular disease later in life. Other adverse pregnancy outcomes, including stillbirth, may also matter when assessing long-term risk.

Mental health is important during this period as well. Anxiety and depression during pregnancy and after birth can affect overall wellbeing and have been associated with poor cardiovascular outcomes.

These complications do not mean a woman will inevitably develop heart disease. However, they should not be forgotten once the pregnancy ends.

Even if blood pressure or other test results return to normal after birth, a history of pregnancy complications can still be important. Women who have experienced them should make sure their GP knows about their pregnancy history and ask which follow-up checks may be appropriate.

This matters especially when postnatal care naturally focuses on the baby, leaving mothers with less time to think about their own long-term health.

Stage 4: Perimenopause

The stage leading up to menopause, known as perimenopause, usually happens between ages 45 and 51 and is marked by skipped or longer menstrual cycles and hormonal changes.

Because perimenopause cannot be confirmed with a hormone test, doctors can usually identify it only by asking about symptoms.

This is important because the period is a key turning point for cardiovascular health.

One of the study’s key authors, Dr C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles, said: “Age 50 is a very determinant age to assess a person’s health, in both women and men.”

Agreeing that perimenopause is “a cardiovascular inflection point,” Dr Hooper said: “As oestrogen levels decline, LDL cholesterol tends to rise, alongside increases in visceral fat and changes in metabolic health.”

“Visceral fat is stored around the internal organs, and changes in body fat distribution and metabolic health can influence cardiovascular risk.”

This makes perimenopause an important time to review heart health.

Women should discuss blood pressure and blood sugar with their GP, while also looking at diet and exercise habits.

“If you miss that, you will miss out on improving that trajectory around age 50,” Merz added.

It is also worth mentioning if you have had an early menopause, as that may be relevant to your individual cardiovascular risk assessment.

Menopause does not mean heart disease is inevitable, and not every woman will experience the same changes.

Still, it is a useful reminder that hormonal health and cardiovascular health are connected, and that this stage of life deserves attention beyond symptom management alone.

Stage 5: Postmenopause

Even after menopause, taking care of the heart remains important.

Ongoing monitoring of cardiovascular risk factors is an essential part of long-term health, especially because blood pressure, cholesterol and blood glucose can change over time.

“The fundamentals of a healthy lifestyle remain the same at every stage of life,” Dr Hooper continued. “Regular exercise, but also movement throughout the day, a healthy Mediterranean-style diet that’s low in salt, avoiding smoking and keeping an eye on the things we can’t easily feel, particularly high blood pressure and raised LDL cholesterol.”

She believes women should pay as much attention to these numbers as they do to measurements they may already know well.

“I would love women to know their blood pressure and cholesterol numbers as well as they know their weight or BMI,” she said. “Blood glucose and diabetes risk shouldn’t be forgotten either.”

The practical steps do not need to be complicated. Regular movement, a balanced diet, avoiding smoking and staying on top of health checks can all support heart health over the long term.

Dr Hooper also repeats her advice that adults should consider an Lp(a) test at least once in their lifetime because elevated levels can contribute to inherited cardiovascular risk.

Rather than only thinking about whether heart disease might develop within the next ten years, it can be more useful to discuss lifetime risk with a healthcare professional.

Age, family history, medical background and other risk factors can all help shape that conversation.

The bottom line - don’t wait until something feels wrong

The new guidance serves as a reminder that women’s cardiovascular health deserves attention throughout life, not only once they reach a certain age or start showing symptoms.

From menstrual health in adolescence to pregnancy complications and the hormonal changes linked with menopause, different stages of life can offer valuable clues about future cardiovascular risk.

But the aim is not to panic over every change in the body. It is to recognise when medical history matters, understand the risk factors that can be monitored and have informed conversations with a GP about prevention.

Heart disease warning signs do not just appear in old age (Getty Stock Images)

As Dr Hooper explains, women should focus on regular exercise, movement throughout the day, a healthy Mediterranean-style diet, avoiding smoking and monitoring blood pressure, cholesterol and blood glucose.

She also stresses that cardiovascular health should be considered across a lifetime, not just over the next decade.

In the end, knowing your numbers, sharing relevant medical history and asking questions about your individual risk can help you make better-informed decisions about your health.

Heart disease remains the leading cause of death among women worldwide. This new approach is intended to help women and healthcare professionals spot risks earlier and take action to reduce them before serious problems develop.