When we think about a heart attack, many of us probably picture an older man clutching his chest. But heart health in women can look very different — and there is one condition that more women, particularly women in midlife, need to know about.
It is called SCAD.
SCAD stands for Spontaneous Coronary Artery Dissection. In simple terms a tear develops within the wall of a coronary artery. Blood can then collect between the layers of the artery wall creating a blockage or restricting blood flow to the heart. This can then cause a heart attack.
The important thing about SCAD is that it is not the same as the more familiar type of heart attack caused by a build-up of fatty deposits in the arteries. SCAD can happen to women who appear fit and healthy and who may have none of the usual heart disease risk factors. (British Heart Foundation)
Why are we talking about SCAD in a Menopaus’ull newsletter?
Because the age at which SCAD commonly occurs overlaps with the years when many women are experiencing perimenopause and menopause.
Research has found that the average age of SCAD is around 45 to 53 years — a time when many women are experiencing significant hormonal changes. Sex hormones are thought to be associated with SCAD, although the exact relationship is still not fully understood. (JACC)
And this is where things become interesting — and particularly important.
We are increasingly recognising that hormones affect far more than our periods, hot flushes and mood. The menopause transition can influence our cardiovascular health too. Oestrogen has a protective effect on the heart and the changes in hormone levels during the menopause transition are an important part of the wider conversation around women’s heart health. (British Heart Foundation)
This does not mean that menopause causes SCAD.
It also does not mean that every woman in perimenopause needs to be worried about SCAD.
But it does mean that we should be asking more questions about women’s hearts, hormones and health — particularly as research continues to explore the possible role of hormonal changes in this condition.
The symptoms matter
SCAD causes a heart attack, so symptoms can include:
- Chest pain, pressure or discomfort
- Pain spreading to the arm, jaw, back or stomach
- Shortness of breath
- Feeling sick
- Sweating
- Feeling light-headed
Women do not always experience the stereotypical “crushing chest pain” we see in films. Symptoms can be different and may sometimes be mistaken for indigestion, anxiety or something else entirely.
Please don’t ignore possible heart attack symptoms. If you are worried, seek urgent medical help. (British Heart Foundation)
A note about HRT
One of the questions that naturally comes up when we talk about SCAD and menopause is HRT.
The honest answer is that there is still more research needed.
A 2025 study looking at 661 women with SCAD highlighted the overlap between SCAD and the menopausal years but also noted that there is limited evidence to guide decisions about menopause hormone therapy following SCAD. Current consensus is to avoid or minimise systemic menopause hormone therapy in people with a history of SCAD unless an individual decision is made with appropriate specialist input. (JACC)
This is not a reason to stop HRT or change medication without speaking to your healthcare professional. It is simply another example of why women’s healthcare needs to be individualised — and why the conversation between menopause and heart specialists is so important.
Knowledge is power
SCAD is rare, but for the women it affects, knowing it exists can be life-changing.
As women we have spent far too long being told that symptoms are “just stress”, “just anxiety” or “just part of getting older”. And while we absolutely should not panic about every symptom we should also feel confident asking questions and seeking help when something doesn’t feel right.
The more we understand about our hearts, our hormones and our health, the better equipped we are to advocate for ourselves.
SCAD is one more reason why women’s health deserves proper research, proper conversations and proper attention.
