ROCKFORD, Ill. (Rockford News First) - Four medical societies have created a shared framework and clinical guidance that connects women’s heart health to distinct life stages. This helps clinicians identify cardiovascular risk and act earlier.
This framework was created through the efforts of the American Heart Association, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine.
Dr. Sadiya Khan with Northwestern Medicine explains cardiovascular disease has been the leading cause of death for women for a long time, and experts have recognized the need to change how they approach prevention.
“We think about hearts in men and women the same way and think about approaching prevention the same way,” she shared. “Yet women experience unique biological transitions that men don’t experience. Periods, pregnancy, perimenopause, and menopause. And we now have evidence that suggests those things are important to consider in every conversation about cardiovascular care.”
Throughout the three-part publication, experts highlight how female-specific biology affects girls’ and women’s hearts and creates a “Female Life Stage” framework to help protect heart health from puberty through menopause and beyond.
“Your age at your first period, if you have a pregnancy complication like preeclampsia, if you have an early age at menopause, those are all what we call risk enhancers that can help us really personalize your heart care plan for optimizing your health,” she pointed out.
Dr. Khan emphasizes that the important piece about the framework is really thinking about it from a positive lens of what constitutes healthy aging and biological norms.
Life stages:
Stage 1 - Perimenarche
The transition around the first menstrual period. Approximate age range is 8 – 15 years.
Stage 2 - Ovarian Cycling
Regular ovulatory and hormone cycles are established and when pregnancy typically occurs. Approximate age range is 15 – 44 years.
Stage 3 - Perimenopause
The transition to variable cycle length, skipped cycles and hormone changes. Approximate age range is 45-51 years.
Stage 4 - Postmenopause
The years that begin after menopause or 12 months after the final menstrual period. Approximate age is 51 years and older.
In the framework, experts started with a girl’s first period. Dr. Khan says that really is when women’s heart care starts to change in terms of what we need to pay attention to, the age at that first period, how heavy or irregular bleeding is.
“The second stage, ovarian cycling, or the reproductive years when you’re having periods, may or may not have a pregnancy,” she said. “And thinking about how those signals can really be incorporated into your cardiovascular care.
She says the third stage, or perimenopause, was a really important one to call out as its own stage.
“For a long time, we’ve talked about menopause as you have your last menstrual period and then your postmenopausal, but we know there’s an in-between phase that can last four to seven years and sometimes up to 10 years where women may be experiencing symptoms and those are also connected to your cardiovascular care,” Dr. Khan described. “In the post-menopause stage, the fourth stage, which can account for up to 40% of a woman’s life.”
The societies also call for a national network of Comprehensive Centers of Excellence for Women’s Cardiovascular Care, built on four pillars: interdisciplinary clinical care, professional education and training, research and community engagement.
Dr. Khan hopes this framework will become part of routine conversation, routine car and that patients are as familiar with it as clinicians are.
“When we thought about the female life stages and the framework, the important part of the staging and the names were that it were not just easy for all of the clinicians, primary care, family practice, cardiology, OB-GYN, MFM to recognize, but also something that could be communicated with patients and patients could bring up and talk about,” she shared.
Khan goes onto say the experts behind the framework want to empower every woman to have that awareness and understanding of what their health symptoms mean and what the action plan for it is so that healthcare is a partnership.
“I think one of the other pieces that is really important is thinking about this from a holistic perspective, that if we can approach women’s health from this lens, we can really think about how we start earlier in really in that adolescent teen stage to talk about heart health at every encounter,” said Dr. Khan. “Too often I hear most women say, no one’s ever talked to me about my heart health, and I just assumed I wasn’t at risk. And so starting to bring that into the conversation, not to be scary about risk of heart disease, but to say, how do we keep your heart health at its best level for as long as possible?”
