The Gap Has Been Bridged! (Part 3 of 3)
Or has it?……
Here is a round-up of the answers - and my personal conclusions - to the questions posed in Parts 1 & 2
The information and links to websites/scientific research were correct as at February 2022
Remember, everyone is different and everybody's experiences are unique, this is my personal story.
* NONE OF THE FOLLOWING SHOULD BE REGARDED AS PERSONAL MEDICAL ADVICE *
PLEASE SPEAK TO YOUR HEALTHCARE PROVIDER
(whilst armed with your research, symptom diary, hand-outs from reliable websites)
Definitions
Menopause - when a female stops having periods, usually classed as 1 year after her last period
Myocardial Infarction - (MI) a heart attack
Atherosclerosis - when heart arteries are fully or partially blocked by 'gunk'
Microvascular system - the teeny, tiny blood vessels/arteries that bring most of the blood (therefore oxygen) to the heart muscle
Dysfunction - something is a 'bit broken', it's not working correctly
MINOCA - Myocardial Infarction with Non Obstructive Coronary Arteries
heart attack with no blockages in the arteries of the heart.SCAD - Spontaneous Coronary Artery Dissection
spontaneously, a tear/bruise occurs within an artery, causing a blockage, resulting in a heart attack.
Why Am I Interested in This?
Because my menopausal symptoms were CARDIAC related and having something wrong with your heart is well... kindof a big deal.
Plus, no cardiologist has expressed any interest in my menstruation status.
Which is worrying, now that I know what I know.
I now have my answers.
I am grand!
But, I have had the time (& bucket loads of tenacity) to be able to find (& fund) the resources and help that I needed.
But there must be 1000's of women who do not have the time, energy nor resources to find their way to the information that they need, to be able to make an informed decision.
I hope that all of this information can reach and help others who are still suffering
I was a very active, healthy, ex-dancer, who has worked in the fitness industry all her life.
The only cardiac risk factor that I have is:
BEING PERI-MENOPAUSAL.
Fact 1
Menopausal Symptoms Include Cardiac Issues.
Who knew?!!
All of the symptom checkers I have found include these.
The earliest Greene scale that I have found so far with cardiac symptoms noted is 1976.
Their is also a wonderful story on Dr Sarah Ball’s instagram about ‘The Crisis In a Women’s Life’, which mentioned palpitations from…… 1938! I know! 1938!!
Fact 2
Oestrogen Keeps Our Blood Vessels Healthy
So..... at this point in time, my understanding is, in women whose oestrogen levels are declining - whether by slowly & gently dipping, or crashing through the floor at the speed of light ! - this must mean that our blood vessels cannot be as healthy and relaxed as before.
Yes? You with me so far?!
Fact 3
The body will always prioritise survival over reproduction.
Although folks may not realise that they know this already - they do know!
I'm sure everybody has heard the phrase, "if you relax/forget about trying to get pregnant, you will!"
(A rather insensitive thing to actually say to a woman who is trying to get pregnant, by the way. Just a head's up on that one)
The majority of mid-life, menopausal women are NOT attempting to become pregnant, so why is this relevant?
If a human is stressed, the brain will prioritise cortisol production over progesterone - they are both made from the same, very initial, 'building blocks'.
Whilst having a, physiologically stressful time, the body does not want you to be eating, sleeping nor having sexy time. It prioritises the 'running away from this shit' type of hormone ie. cortisol etc.
The brain wants you to survive.
Whilst there is a perceived state of famine/drought/war etc. it will prioritise using its' hormone building blocks to make cortisol etc, rather than progesterone.
The endocrine system is super-complex and super complicated. I will endeavour to explain it in posts to come.
Fact 4
Progesterone has cardioprotective effects
NB. there is very little research on the effects of progesterone and what there is, is behind a paywall and only available to those in the medical profession. Plus, it is very difficult to scientifically measure progesterone levels. They fluctuate throughout the day, week and month..... and that's even BEFORE we add in the chaos of menopausal crazy hormone wanderings/crashings and peakings!!
However, this link, goes a little way to validating what I'm waffling on aboot!
So, at this point in time, my understanding is:for mid-life women, whose oestrogen & progesterone levels are crashing through the floor, they may be susceptible to the declining health of their blood vessels.
PLUS, if they are experiencing increased levels of stress, they may be experiencing a bit of a double whammy, yes?
Could this explain why some women experience the menopausal symptoms of cardiac issues?
And, coming back to SCAD heart attacks in particular, which is what started all this bloomin' research off (!) how does this relate to the guys who experience SCAD heart attacks?
Because they produce progesterone too.
Remember, both men and women produce progesterone, testosterone and oestrogen.
In Kate Muir's book, 'Everything You Need to Know About The Menopause (but were too afraid to ask)' you can find 100's of references to scientific papers, including those on palpitations, such as this one:
“A recently completed review found that palpitations prevalence was
4 to 40% in premenopausal women,
20 to 40% in perimenopausal women, and
16 to 54% in postmenopausal women”. Source.
And remember The British Heart Foundation information by Professor Juan Carlos Kaski?
"Women, particularly around or after the menopause, are more likely than men to get microvascular angina". Source
And remember Dr. Scott Cameron's information?
"changes in oestrogen are independent predictors for MINOCA
in comparing women who have MINOCA, to women who have 'traditional type' heart attacks, the difference is that, in MINOCA, there is a dysregulation [the mechanism is a bit broken] of the oestrogen receptors.
In women who have 'traditional' heart attacks, ie with blockages, it is not the oestrogen receptors.
In an article in The Daily Mail, 5/10/2021, Professor of Cardiology at Glasgow University, Colin Berry explains,
"Despite being a recognised medical event, MINOCAs are underdiagnosed in the UK. This is partly due to how heart attacks are taught in medical school - students are told that they are caused by blocked arteries, which is actually sex bias because more women than men suffer MINOCAs"
So.... at this point in time, my understanding is: some women's menopausal symptoms can centre around affecting the circulatory system and heart.
(Remember, there are 23-25 listed symptoms and not ALL women will experience ALL symptoms. Well. Bloody hell. I hope she doesn't...)
Swapping periods for heart attacks
Fact 5
Cardiology - A very, male dominated profession,
who are working to guidelines and protocols, based on research that was done on middle-aged MEN.
From the paper in The European Heart Journal 2017
"Thus, current guidelines for prevention, diagnosis, and medical treatment for cardiovascular diseases are based on trials conducted predominantly in middle-aged men."
To be frank, your average, midlife female pitching up in A&E with chest pain without blocked heart arteries, is going to have a tricksy time getting a correct diagnosis and effective treatment.
(NB. Not necessarily because the consultants are 'at fault'. But because they have not had the training & don't have the knowledge.)
Final Fact - What Works For Me:
Micronised Progesterone
As already mentioned in Part 1- Bridging The Gap and in Part 2 I have trialled this 3X deliberately and 1X inadvertently. (In case you've not read them, I'll repeat here, because this is important)
Due to my body's rather extreme reaction to perimenopausal sex hormone fluctuations, My menopause specialist tried -
Plan A: continuous progesterone regime, even though I was still having periods - 1 tablet every night.
But my womb wasn't happy. Hmm… bit of an understatement really - I bled and bled and BLED…
So we tried -
Plan B: on progesterone for 2 weeks, off for 2 weeks. A typical regimen for women starting HRT who are still having periods.
But my heart wasn't happy.
After about 6 days OFF micronised progesterone, it felt like a portion of my heart would ‘shut down’. It was mostly fine, I was still breathing, no heart attacks or spasms, but I could not get my breath. After a 5-10 minutes of sitting very still, it would all start working again. A tad inconvenient to say the least.
So….. Plan C
on micronised progesterone for 25 days - ish and off for 5-6 days ish.
And all is well.
FACT - My heart needs micronised progesterone
Transdermal Oestrogen
All cardiac symptoms disappeared within 2-3 weeks of starting transdermal oestrogen. The dose was increased over time but, during the ever-present HRT shortages, these symptoms completely reappear when off oestrogen - after about 7-10 days.
FACT - My heart needs more oestrogen than I can currently produce naturally.
Summary
Average SCAD Patients
Menopausal Heart Symptoms
In MINOCA there is a dysregulation of the oestrogen receptors
Microvascular angina more common in women and at around the time of the menopause
I must admit that I was quite disappointed when the SCAD specialist dismissed the vasospasms/microvascular issues as not relevant:
"no particularly logical reason that the SCAD patient population would be particularly prone to it"
Really? The majority of us ARE women at or around the age of a hormonal maelstrom!
And let’s not forget, SCAD heart attacks used to be thought of as a condition that only effected pregnant women - another hormonally chaotic time in a women’s life.
And, for the male SCAD patients, many are either extreme exercisers or had been going through a very stressful period pre SCAD. (Remember, during stress the body uses progesterone (well, in actual fact it’s the precursor to that, pregnenalone but let’s not get into that right now) and uses it to make cortisol. So guys who are stressed may also be deficient in enough circulating progesterone.
Now. Not every menopausal woman will have a SCAD heart attack!
SCAD used to have the classification of ‘rare’ however, as of 2024 they are no longer classed as this.
However, as I said during a research meeting, the patient couldn’t give a stuff about its’ classification.
What matters is, have the healthcare professionals who are treating me heard of it?
.Absolutely nobody at The Edinburgh Royal Infirmary had ever seen a SCAD patient before when I turned up in Feb 2021 (including the paramedics, consultants, nurses, doctors)
But cardiac menopausal symptoms do seem to be well known OUTWITH the cardiology departments and by good menopause clinicians.
Hmmmm....
That's concerning....
What This ALL Boils Down To
What if my ongoing cyclical chest pain and related issues were NOT solely due to the AFTER effects of having had a SCAD but were BOTH due to the decline in sex hormones?
They were both due to the same dysregulation of the hormone receptor 'thingymajiggies'?
Just that, on the 1st occasion
(when an artery spontaneously ripped)
it bordered on the rather more spectacular side of things?
And wouldn't that explain why I have had a complete resolution of symptoms,
when I began (closely monitored) HRT?
And yes, my heart is "beautiful and healthy"- as I was repeatedly told.
Which is grand, right?
But it didn't really explain what was causing me to be floored with pain, on my hands and knees, unable to breathe, whilst my vision went black.
The Big Question Remains….
Why are cardiologists ignoring the above?
If I can find them from reputable websites, why is it so difficult for male cardiologists to believe us?
Is it all STILL to do with the history of women and medicine?
Is it STILL the age-old problem that women are just not listened to?
I sincerely hope that I can help to make a difference in women’s healthcare.
