What are the 5 Hidden or Atypical Heart Attack Symptoms in Women?

Why Heart Attack Symptoms Are Different in Women

Heart disease is the leading cause of death in women. For women, heart attacks often present differently than in men. Rather than sudden, severe chest pain, women are more likely to experience vague, gradual, or non-chest symptoms. Declining estrogen levels during perimenopause and menopause affect vascular function inflammation, and plaque stability, increasing cardiovascular risk. Women are also more likely to have microva scular disease or plaque erosion rather than large-vessel obstruction, which can produce less obvious symptoms. Additionally, cardiovascular diagnostic criteria, clinical trials and patient education materials historically centered on male presentations, and implicit bias may lead both patients and clinicians to underestimate risk in women. Together, these factors can contribute to delayed recognition and delayed treatment. Women are more likely than men to be sent home from the emergency room while experiencing a heart attack.

Classic vs. Atypical Heart Attack Symptoms in Perimenopausal and Menopausal Women

Women do experience classic heart attack symptoms, such as intense chest pressure radiating down the left arm, they just occur less frequently than in men. Many women experience heart attacks without any significant chest pain at all. The symptoms perimenopausal and menopausal women most frequently report are:

• Unexplained or extreme fatigue

• Upper back, shoulder, or neck pain

• Jaw or throat discomfort

• Indigestion-like pain, nausea, or vomiting

• Shortness of breath or lightheadedness

These symptoms are often mistaken for gastrointestinal illness, anxiety, musculoskeletal strain, or other menopause-related discomfort. This can lead to delays in care, which could have negative impacts on the woman’s health. Knowing to recognize that these signs may be a cardiac event is critical for earlier intervention.

The 5 Hidden Heart Attack Symptoms to Watch For

These symptoms are also the five most overlooked signs of a heart attack and can easily be attributed to other issues or conditions:

Unexplained, persistent fatigue

Fatigue that is sudden, severe, or disproportionate to activity especially when it interferes with daily functioning. This may signal that the heart is not receiving enough blood.

Upper or mid-back pain

Discomfort between the shoulder blades or in the upper back, which is not due to injuryor posture, can indicate cardiac ischemia (inadequate flow of blood).

Jaw pain or discomfort

Pain, pressure, or aching in the jaw, neck, or throat that sometimes radiates from the ear or chest might be cardiac in origin.

Indigestion, nausea, or heartburn-like symptoms

Gastrointestinal sensations that are new or have no clear dietary cause are frequently reported by women during heart attacks.

Sudden shortness of breath

Difficulty breathing at rest or with minimal exertion, especially when new or unexplained. These symptoms may occur alone or alongside mild chest discomfort. A clinician should evaluate anyone experiencing any of these symptoms alone or in combination right away.

How Hormonal Changes in Perimenopause and Menopause Affect Heart Health

The menopause transition causes a shift in cardiovascular physiology. Declining estrogen levels contribute to endothelial dysfunction and increase arterial stiffness. The decrease in estrogen adversely affects cholesterol levels as well as impairs glucose regulation. Both elevated cholesterol levels and elevated blood sugar raise the risk of coronary artery disease.

Hormonal fluctuations also cause a myriad of symptoms such as fatigue, palpitations, anxiety and sleep disturbances that can make it harder for women to distinguish commonly occurring menopausal symptoms from serious heart conditions. Many women and clinicians underestimate their cardiovascular risk during this transition, despite evidence showing increased heart disease risk. Prevention during this life stage should be proactive and individualized to each woman’s biology.

Why Atypical Symptoms Are Often Missed or Dismissed

During menopause, atypical heart attack symptoms such as fatigue, indigestion, and back or shoulder discomfort can be mistaken for more common issues like stress, indigestion, or mechanical back pain. Without the education and awareness that these symptoms can be cardiac, many women continue prioritizing work, childcare, or other routine responsibilities and may delay seeking care, especially when similar concerns have previously been minimized or dismissed in clinical settings.

Healthcare systems can also delay symptom recognition. Differences in how cardiovascular disease presents in women, combined with gaps in training and diagnostic approaches that are less sensitive to these presentations, can make early recognition more challenging and may contribute to delays in care, increasing the risk of complications.

If You Have Symptoms:

If you have symptoms such as unexplained fatigue, shortness of breath, chest pain, back or jaw pain, nausea or indigestion-like discomfort that are new, persistent or worsening, call your doctor right away, particularly if any of the symptoms occur together or feel different from what you’ve felt before. If you are concerned or unsure, it is always important to be safe and talk to a doctor.

When seeking care:

• Clearly describe all symptoms, even if you are unsure if they are related to your heart

• Mention if you are in perimenopause or menopause

• Ask for cardiac evaluation if symptoms feel unusual or severe

• Early action can prevent a heart attack and reduce long-term complications from heart disease

Reducing Your Heart Disease Risk During Perimenopause and Menopause

Reducing cardiovascular risk during the menopause transition involves both lifestyle modifications and medical interventions:

• Regular physical activity and a heart-healthy diet

• Have blood pressure, cholesterol, and glucose monitored

• Stop smoking and drink alcohol in moderation

• Engage in activities to reduce stress and maintain a healthy sleep schedule

• If needed, discuss hormone replacement therapy and its risks and benefits with your doctor

• Prevention plans are most effective when individualized, accounting for each woman’s risk factors

Menopause-Trained Providers

Persistent, severe, or confusing symptoms can be evaluated by a healthcare provider trained in menopause care. Through digital healthcare companies like Alloy you can connect to a menopause-specialized Doctor within hours of submitting your request for a consultation.