Somewhere between the years of hot flashes and the quiet work of getting older, many women have come to carry a strange blind spot: they fear cancer more than the heart, even though the heart is what most often takes them. A survey of over seven thousand women across six countries, gathered under the European CARAMEL project, shows how thinly this knowledge is spread, with awareness varying sharply from Ireland to Colombia. The findings suggest the menopause years are a window that many women pass through without being invited to look after their hearts, and that the people best placed to open
Most Midlife Women Have Not Discussed Heart Health With a Clinician, Study Finds
Women with intellectual disabilities largely received no menopause information, and many experiencing heart warning signs waited rather than seeking emergency care.
Women are waiting to be asked, and clinicians may be waiting too.
Mark
The headline number is 48%. Why does that matter more than the other figures?
Mimi
Because it's the foundation. If only about half of women know heart disease is their leading killer, the rest of the silence makes sense. A third named a cancer instead.
Luke
Worth noting the range: 67% in Ireland, 19% in Colombia. A single average hides a lot, and these were survey respondents, mostly university-educated by the researchers' own account.
Mark
So the real picture may be worse?
Mimi
That's what Dr. O'Donnell says: the gaps are probably greater in the wider population.
Luke
"Probably" is her inference. The study didn't measure the wider population, so it's a reasoned expectation, not a finding.
Mark
What struck you about the doctor visits?
Mimi
Women waiting to be asked. Among those with high blood pressure, 48% said they expected the professional to raise it. And clinicians may be waiting too.
Luke
The survey captures what women reported, not what clinicians intended. We don't know how often clinicians actually raised it and were not recalled.
Mark
And the women with intellectual disabilities?
Mimi
78% told nothing about menopause beforehand, and none who had a heart scare called emergency services. Their request was a symptom diary so they're believed.
Luke
That group is small within the sample, and the source doesn't give the count, so I'd treat those percentages cautiously. The pattern is stark, but the numbers behind it are unstated.
Der Puls
- Fewer than half of midlife women know heart disease is their leading cause of death, while many still picture cancer as the greater threat.
- Nearly half had not spoken with a health professional about their heart in the past year, even among women already living with high blood pressure.
- Menopause symptoms such as fatigue, poor sleep and mood swings go largely unaddressed, and many women treat them alone or not at all.
- Women with intellectual disabilities were left furthest behind, receiving little menopause information and often waiting rather than seeking emergency care during heart warning signs.
- The CARAMEL team has launched a CVD Prevention Portal for women and clinicians, while women themselves ask for simple, warm and trustworthy guidance outside commercial apps.
Somewhere between the years of hot flashes and the quiet work of getting older, many women have come to carry a strange blind spot: they fear cancer more than the heart, even though the heart is what most often takes them. A survey of over seven thousand women across six countries, gathered under the European CARAMEL project, shows how thinly this knowledge is spread, with awareness varying sharply from Ireland to Colombia. The findings suggest the menopause years are a window that many women pass through without being invited to look after their hearts, and that the people best placed to open that door are often waiting for someone else to knock.
Ask a woman between 40 and 60 what is most likely to kill her, and about one in three will name cancer. Fewer than half will name heart disease, which is the true answer. That gap is at the heart of a survey of 7,470 women in Ireland, Spain, Greece, Croatia, Lithuania and Colombia, carried out under the CARAMEL project and published in BMC Women's Health. Awareness ran from 67% in Ireland down to 19% in Colombia, and fewer than half knew that early menopause raises heart risk.
Even women who knew the facts often did not feel at risk. Half of those whose own risk factors placed them in a high-risk group did not see themselves that way. Researchers noted that most participants were university-educated, so the wider population likely knows even less.
Many women are waiting for a clinician to raise the subject. Nearly half had not discussed their heart with a professional in the past year, including three in ten of those already diagnosed with high blood pressure. Menopause itself is also underdiscussed, and four in ten women use no treatment for their symptoms. Fatigue, sleep trouble and mood swings were common, and many who did see a professional felt their physical symptoms were addressed while their emotional ones were not.
Warning signs of a heart attack are poorly known beyond chest pain. Many women who worried about their hearts waited to see what would happen, and very few called emergency services. Women with intellectual disabilities were furthest behind, with most having had no menopause information and none of those who had a heart scare calling for emergency help. One woman said clinicians "don't listen to you."
Hormone therapy use varied enormously by place, with 65% of Irish women having used it compared with 6% to 19% elsewhere. The researchers stress the aim is not that every woman takes HRT, but that every woman gets clear, balanced information to decide with her doctor. CARAMEL's new CVD Prevention Portal is meant to help women and clinicians do exactly that, and the women surveyed asked for it to be practical, warmly written and free of the commercial noise that has put them off many apps. For any woman with concerns or symptoms, the advice is simple: speak to a primary care doctor or another health professional.
Ask a woman between 40 and 60 what is most likely to kill her, and about one in three will name a cancer. Fewer than half will give the right answer, which is heart disease. That gap sits at the center of a survey of 7,470 women in six countries, published in BMC Women's Health.
The women were in Ireland, Spain, Greece, Croatia, Lithuania and Colombia. Their responses were gathered under CARAMEL (CArdiovascular Risk Assessment in MEnopausaL women), a Horizon Europe project. Women and clinicians in all six countries also took part in interviews and co-design workshops, and researchers in Trinity's School of Nursing & Midwifery analyzed the data. Only 48% of the women knew heart disease is their leading cause of death. Awareness ran from 67% in Ireland to 19% in Colombia. Fewer than half (45%) knew that an early menopause raises heart risk.
Knowing the facts did not always mean feeling at risk. Half of the women whose own risk factors put them in a high-risk group did not see their risk as high. One Irish woman said: "There's an awful lot of talk about menopause… but I never really got the whole cardiac thing… How come I didn't know about it?" Dr. Sharon O'Donnell, associate professor in critical care nursing and CARAMEL lead, noted that most participants were university-educated, so the knowledge gaps in the wider population are probably larger.
Many women are waiting for a clinician to bring it up. Nearly half (47%) had not discussed their heart with a professional in the past year, including three in 10 of those already diagnosed with high blood pressure. Overall, 27% had that diagnosis, and 48% of those women said they expected the professional to raise the subject if there were a problem. Diagnosed heart disease was much rarer, at 10%, which the researchers read as a sign that the menopause years are a window for prevention.
Menopause itself goes underdiscussed. Almost one in three women (31%) had not talked about it with a professional in the past year, and fewer than one in four did so at most visits. Four in 10 used no treatment for symptoms. Seven in 10 had experienced fatigue, and two in three had sleep problems and mood swings. About half reported brain fog and anxiety. Hot flashes were less common than fatigue, sleep problems or mood swings. Among women who did see a professional, almost one in four said physical symptoms were addressed but emotional ones were not.
Heart attack warning signs were poorly known beyond the classic one. Some 95% knew chest pain can signal a heart attack, but far fewer recognized unusual fatigue (57%), nausea (47%), indigestion (38%) or anxiety (34%). More than half (55%) had at some point worried something might be wrong with their heart. Waiting to see what happened was as common a response as contacting a doctor, and fewer than one in 10 called emergency services. Others rested or told a partner or friend.
Hormone replacement therapy use depended heavily on place. Two in three Irish women (65%) had used it, against 6% to 19% elsewhere. Nutritional supplements (36%) were used more than any medical treatment. Use tracked whether a woman had seen a gynecologist or private menopause clinic more than her education or income, and the site mattered most. Among women with the heaviest symptoms and poor health, one in four used no treatment and one in two no medical treatment. The researchers stress that the point is not that every woman needs HRT, but that each deserves clear, balanced information to decide with her doctor.
Women with intellectual disabilities were furthest behind. Four in five (78%) had been told nothing about menopause before it began, compared with 45% of Irish women in general, and only 36% knew heart disease is the leading cause of death in women. Nearly all had had blood pressure checked in the past year, yet 53% had no conversation about heart health. None of those who had experienced a heart scare called emergency services. One woman said clinicians "don't listen to you, and they don't think you understand anyway."
Two in three women (67%) wanted menopause information via an app, yet only 5% had used one, citing commercial feel, ads and data worries. They asked for practical, warmly written advice. CARAMEL has built a CVD Prevention Portal for women and for clinicians advising them. O'Donnell urges women with concerns or symptoms to contact a primary care doctor or other health professional.
Bemerkenswerte Zitate
More than half of women who participated were unaware of their risk of heart disease or that menopause can increase that risk.— Dr. Sharon O'Donnell, CARAMEL lead, Trinity School of Nursing and Midwifery
They don't listen to you, and they don't think you understand anyway.— Woman with intellectual disability, study participant
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