A cardiologist and endocrinologist had no idea if there was a connection
By Geri Brin, Co-founder, M.D. For You
Illustration by: Cé Marina
Three things happened soon after I stopped taking the hormone estrogen orally: My “bad cholesterol”—LDL—shot up. My bone density decreased. And my scalp started imitating a waterfall. Without warning, perspiration would drench my hair, chest and neck.
I made appointments with a cardiologist and endocrinologist, both graduates from top medical schools who were associated with leading hospitals in New York City. And I mean leading.
"My cholesterol has always been perfect. Do you think my high LDL is connected to loss of estrogen?" I asked the cardiologist.
“I don’t know,” she answered unabashedly, and wrote a prescription for statins to improve my LDL number.
On to the endocrinologist, who told me to take Vitamin D and wrote a prescription for a drug to slow my bone loss. “Do you think my bone density is connected to loss of estrogen?” I asked.
“I don’t know,” she responded. When I read the side effects of the bone drug she prescribed, I didn’t fill the prescription.
Subsequently, I learned that my decision to quit taking estrogen had a great deal to do with my weakening bones and rising evil lipids. When I decided to resume hormone therapy, a menopause specialist prescribed a transdermal estrogen patch. My bone density has since improved. My cholesterol numbers are also excellent, but that may be the statins at work.
I explain in this article why the cardiologist and endocrinologist I saw were ignorant about the impact of decreased estrogen in menopausal women. I hope they’ve both learned a thing or two about it since my visit, especially the cardiologist, since menopause can have a profound effect on a woman’s heart.
"Going through menopause often results in lipid and cholesterol changes for the worse," said Dr. Samia Mora, an associate professor of medicine at Harvard Medical School and a specialist in cardiovascular medicine at the Brigham and Women's Hospital in Boston, MA.
Drops in estrogen, the female hormone, are associated with a rise in total cholesterol levels due to higher amounts of low-density lipoprotein (LDL), the "bad" cholesterol, and another blood lipid (fat) known as triglyceride. Over time this can raise heart risks, which is a reason for concern, as cardiovascular disease is the leading cause of death in postmenopausal women, stressed Dr. Mora in an article on the Harvard Health Publishing website.
"So, it's especially important to track the numbers in perimenopause and the early years after menopause, as LDL cholesterol and total cholesterol tend to increase," she added.
Even so, doctors aren’t getting high marks for their ability to diagnose heart attacks in women, whose symptoms can be notably different than men’s. While chest pain or discomfort is a common female symptom, like in men, we can experience shortness of breath, nausea and or vomiting, and back or jaw pain. And those latter symptoms are not commonly associated with heart attacks, according to the American Heart Association website. Subtle signs can still have deadly consequences, especially if you don’t get help right away.
“Women are underrepresented in the databases that form the basis of diagnoses in medicine —even with diseases as common as heart attacks. This is a dangerous bias that may be driving the rise in female fatalities,” wrote Dr. Marieke Bigg in her book, “This Won’t Hurt. How Medicine Fails Women.”
Heart attack symptoms in females are brushed off as physical manifestations of stress, which is often erroneously dismissed as a psychological, not physiological, problem. Stress, in fact, is a key risk factor in female heart disease. And, observational studies have now shown that psychological factors strongly influence the course of heart disease, reported Dr. Bigg, who holds a doctorate in the sociology of reproductive technologies.
“Stress, depression and anxiety disorders are more associated with elevated risk of heart attack among women than men. A woman’s overall lower socioeconomic status makes her more susceptible to stress and its consequences for heart health,“ she added.
“This Won’t Hurt” covers all the ways in which medicine is not gender-neutral—including research, how patients are treated, policy and funding. It shows how the field of medicine has formed around a male default that excludes women.
“The idea that a woman is defined by her childbearing capacity is pervasive in our world. This is as true of medicine as it is of culture at large, but given the subtle and entangled ways in which people learn about these ideas, repeat them and internalize them until they feel so true they can only be natural, it can be hard to expose the sexist assumptions that travel between culture and medicine,” Dr. Bigg asserted in her book's introduction.
Unlike my sister Baby Boomers, many of whom were as naive as I about our transition to menopause, young women today are demanding to know what it’s all about. They won’t let health care providers dismiss their concerns and symptoms. If they’re not getting the attention and treatment they need—and expect—they’ll figure out where to find it!
More and more women in 2024 are confidently participating in the management of their own healthcare. When the inequities in the medical system are no more, it's highly unlikely they'll relinquish that crucial role.
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