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My story: HRT and heart health

When Jill, 50, suffered a rare type of heart attack in March 2021, she was surprised by how quickly HRT relieved her debilitating cardiac symptoms.

“I had a spontaneous coronary artery dissection (SCAD) heart attack in March, 2021. This happens when the wall of a heart artery spontaneously tears or bruises, which causes a heart attack.

I’ve worked in the health and fitness industry all my life as a fitness instructor, personal trainer, aerobic studio manager and physical therapist. I eat healthily, go to the gym and enjoy 5K runs – I have a healthy lifestyle and do all the right things to support my heart health. I don’t drink, smoke or have high blood pressure, and have no cardiac risk factors.

So why did I end up having a very rare type of heart attack?

Although I still don’t have all the answers, I’ve since found out that the average SCAD patient is female and aged 44-53 – the time of life when many women experience symptoms of the perimenopause and menopause. Common menopausal symptoms include palpitations and breathlessness, regardless of whether a person has had a SCAD heart attack or not, and I learned that the British Heart Foundation notes that microvascular angina occurs most commonly in women at the time of menopause, between the ages of 45 and 55.

Like me, many SCAD patients continue to have ongoing cyclical chest pain and other cardiac symptoms. I was having acute cardiac ‘events’ in the first week of every month, along with uncomfortable chest tightness and laboured, difficult breathing, palpitations and ‘heat’ when going to sleep each night. These symptoms are usually treated with cardiac drugs which, in my case, made me feel even worse. At times I was literally floored with pain, on my hands and knees and unable to breathe while my vision went black.

I experienced such severe, ongoing chest pain after my SCAD that I was determined to find a treatment that would help. After watching the Davina McCall documentary, ‘Sex, Myths & The Menopause’, my research led me to Dr Louise Newson. I’d worked through mountains of medical studies and papers and written pages of notes before I realised that my intense hot flushes and cardiac symptoms could be linked. After a consultation at a menopause clinic, I discovered that SCAD isn’t a contraindication for HRT, so I began a closely-monitored HRT regimen – and my cardiac symptoms stopped almost straight away.

Since starting HRT, I have no cardiac symptoms at all and, following an angiogram, I was told that my heart is ‘beautiful and healthy’. Micronised progesterone has completely relieved my ongoing chest pain but if I stop taking the Utrogestan for more than five days, my symptoms return. The one silver lining of the estrogen shortage is that I’ve discovered I can only be off estrogen for about two weeks before the same thing happens. Under the care of the menopause clinic, I now use a combination of Estradot patches and Estrogel, and we’ve worked out that if I take Utrogestan for 23-25 days per month, and come off it for 5-6 days to have a menstrual bleed, both my heart and womb are happy!

If it hadn’t been for the specialist menopause clinic, I’d still be rather unwell and unable to drive on motorways or travel on public transport – as a hot flush would result in me nearly passing out.

I’m now on a mission to raise awareness, not just about SCAD as that is quite rare, but cardiac symptoms in general for women such as chest pain and palpitations.

I’d like women and healthcare professionals to be aware that such symptoms could be hormone related, because once you go down the ‘cardiac route’ and see specialists, they are not interested in thinking about your hormones at all in my experience. I mainly just had cardiac symptoms and hot flushes, and not many of the other menopausal symptoms you read about.

It’s so important to know your body, and think about hormones as it can be tricky to get an accurate diagnosis for a woman in midlife.

No one in the large city hospital that treated me had seen an SCAD patient before (including the paramedics, consultants, doctors and nurses), and no one in cardiology ever asked me about my menstrual cycle. We will always benefit from more research, but we desperately need to push for training in the perimenopause and menopause, especially within cardiology, and it’s also important that women feel able to advocate for themselves if they are experiencing worrying or unexplained cardiac symptoms during the perimenopause or menopause.”