Heart Symptoms in Women Over 40: 3 Midlife Signs You Shouldn’t Ignore (and What Helps)

The headline women weren’t taught

February is American Heart Month. And if you’re thinking, “Okay… but I’m not a heart disease person,” I want to gently challenge that. Heart disease is the leading cause of death for women in the United States—and it can affect women at any age. That’s not meant to scare you. It’s meant to give you the information most women never got clearly.

Because here’s what happens in midlife: you feel different, but the symptoms can look “normal.” Stress. Fatigue. Weight shifts. Shortness of breath that you blame on being out of shape. And the result is that women often minimize things that deserve attention. There are some very common heart symptoms in women over 40 that you may not be considering.

Let’s fix that.

Why heart health gets tricky after 40

Midlife is not just a busy season of life. It’s also a physiological transition. The menopause transition has been linked with changes in cardiometabolic risk factors—things like blood pressure and cholesterol markers.

Are hot flashes linked to heart disease?

Hot flashes (vasomotor symptoms) have been linked in research to a less favorable cardiovascular risk profile—things like higher blood pressure, insulin resistance, and cholesterol changes.

Some studies also connect more frequent or persistent hot flashes with higher risk of cardiovascular events as women age. That doesn’t mean hot flashes cause heart disease. The more useful takeaway is this: if hot flashes are a big part of your life right now, it’s a good time to support the heart basics—sleep, stress, movement, and fiber-forward eating.

3 midlife signs your heart may need more support

1) Your stress tolerance suddenly tanked

If your fuse feels shorter than it used to… you’re not imagining it. Stress doesn’t just affect your mood. It affects sleep, blood pressure patterns, cravings, and your ability to recover. And high blood pressure is a major risk factor for heart disease, making stress one of the biggest heart symptoms in women over 40.

What it can look like:

• You’re “fine” until one small thing happens and your body feels like it’s in a fire drill.
• You’re exhausted at night but can’t wind down.
• You wake up with your brain already racing.

There are simple tweaks you can do to relieve stress. Try a 60-second downshift daily:

• inhale through your nose for 4
• exhale for 6 Repeat 5 times. The longer exhale helps your nervous system downshift.

2) Energy crashes are becoming the default

Tired is one thing. Crashing is another. If you wake up tired, crash in the afternoon, or feel wiped out after normal days, it’s worth checking in medically—because fatigue can have multiple causes. But from a habits standpoint, one of the biggest midlife patterns I see is unstable fueling.

Common midlife crash pattern:

• coffee for breakfast
• light lunch
• “why am I starving at 4pm?”
• snacky evening + poor sleep
• repeat

This week, try adding one stabilizing food at each breakfast. Here are a couple of ideas:

• protein anchor (soy yogurt, tofu, beans, protein smoothie)
• fiber (berries, oats, chia/flax)

3) You’re dismissing symptoms because they don’t look like the movies

Most of us were taught a heart event looks like dramatic chest-clutching. But women can experience symptoms like shortness of breath, nausea/vomiting, back or jaw pain, and unusual fatigue—sometimes alongside chest discomfort, sometimes not.

What can you do? Don’t spiral. Just stop minimizing. If symptoms are new, worsening, or concerning, get medical care.

A simple 7-day heart support plan (no tracking)

If you want something you can actually do this week, try this:

1. 10-minute walk after one meal, most days
2. One fiber add-on daily (beans or oats are easiest)
3. One 60-second downshift daily (4/6 breathing)

Notice what happens with your energy levels, cravings, sleep and mood.

When to seek medical care

If you have urgent symptoms—new chest pressure, severe shortness of breath, pain radiating to jaw/arm/back, nausea with sweating—seek immediate medical help. Women’s symptoms can be different, and it’s better to be checked than to talk yourself out of it.

American Heart Month is a great reminder that heart health isn’t a “later” topic. It’s a midlife topic. If you want help making this personal, I offer a free Midlife Wellness Call. It’s a calm conversation where we map out what’s been hardest and what your next steps should be.

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