For many women, perimenopause (period before menopause) arrives with a mix of symptoms that feel unsettling but familiar: racing heartbeats, chest tightness, breathlessness, night sweats, and a level of fatigue that seems out of proportion to daily life. These experiences are often framed as hormonal. Sometimes they are. But research suggests that the story may not always be that simple.
The latest figures from Norway show a sharp increase: there are now 50 percent more cases of heart failure and 30 percent more heart attacks than ten years ago. Yet many women still encounter delays in diagnosis, especially during midlife. That is where two bodies of research begin to intersect in important ways.
What women report and what studies show
Qualitative research (research that explores perceptions) into women’s experiences of heart disease consistently finds long gaps between the first appearance of symptoms and a formal diagnosis. In interviews conducted after women experienced a heart attack, many described months or even years of warning signs: unusual fatigue, shortness of breath, sleep disturbance, or chest discomfort, that were attributed to stress, menopause, or simply aging.
In the study, women spoke about symptoms being minimized by themselves or clinicians. Some were reassured; others were treated for anxiety or stress. Few initially underwent a thorough cardiovascular evaluation.
Quantitative data (containing measurable outcomes) echo this pattern. In a several large studies, researchers showed that women, especially younger and midlife women, are more likely than men to present with so-called “atypical” heart attack symptoms. These presentations can complicate recognition and may contribute to delays in diagnosis and treatment.
Separately, menopause research has documented how women in perimenopause often describe feeling dismissed when presenting with palpitations, chest tightness, or profound fatigue. These symptoms are frequently labeled as panic attacks or stress-related. Cardiovascular evaluation is not always part of the conversation.
When these findings are viewed together, a concerning pattern emerges: the menopausal transition is a period of real biological change, yet it is not consistently treated as a window for cardiovascular risk assessment.
Why midlife matters biologically?
What we already know from research is that menopausal transition is associated with shifts in blood pressure, lipid levels, insulin sensitivity, and vascular function. Cohort and imaging studies suggest that this period may mark an acceleration of cardiovascular risk for some women.
This does not mean that palpitations (pounding heartbeats) during perimenopause are usually a sign of heart disease. In many cases, they are benign and hormonally driven. But it does mean that midlife symptoms occur against a background of changing cardiovascular biology. Context matters.
The challenge is not to medicalize every hot flash or anxious moment. It is to recognize that cardiovascular disease in women often presents differently, and that midlife may be a critical opportunity to look more closely.
What this means in real life
For women in their 40s and 50s, the overlap between hormonal symptoms and cardiovascular risk can be confusing. Fatigue might stem from poor sleep due to night sweats. Breathlessness might reflect anxiety. Or those symptoms might signal something else entirely.
The research does not suggest widespread misdiagnosis in every case. It does, however, show that women’s cardiac symptoms have historically been under-recognized and sometimes psychologized (attributed to stress or emotional factors). That legacy shapes how symptoms are interpreted today.
For clinicians, this intersection should highlight the importance of not defaulting to stress or menopause as an explanation without considering cardiovascular risk factors. For women, it underscores the value of understanding that perimenopause is both a hormonal transition and a broader health crossroad.
Seeing the Whole Picture
It is important to keep perspective. Most midlife symptoms are not heart attacks. Cardiovascular disease develops over time, influenced by genetics, lifestyle, metabolic factors, and social and economic conditions. Hormonal change is one piece of a larger puzzle.
At the same time, the menopausal transition represents a moment when cardiovascular risk may shift, and when women’s symptoms deserve careful listening.
As awareness of women’s heart health continues to grow, the question is not whether perimenopause is problematic. It is whether we are fully using this phase of life as an opportunity to understand and support women’s long-term cardiovascular health.
Avoiding the Blind Spot
If you’re in your late 30s to 50s and notice new symptoms, especially mood changes, sleep problems, palpitations, chest discomfort, or unusual fatigue - ask your doctor directly whether they could be related to perimenopause and whether your cardiovascular risk has been properly checked. If you feel dismissed and you are still concerned, seek a second opinion from a clinician with specific experience in menopause or cardiovascular health.
Fact Box: Symptoms You Shouldn’t Ignore
If you are in your 40s or 50s, pay close attention to these signs. They may be related to hormonal shifts, but they can also be early signals from your heart:
Palpitations: The feeling that your heart is skipping a beat, racing, or pounding unusually hard.
Unusual Fatigue: An exhaustion that doesn't improve with rest, or that feels distinctly different from "normal" tiredness.
Chest Discomfort: Not necessarily sharp pain, but a feeling of pressure, heaviness, or a "tightening" sensation.
Shortness of Breath: Getting winded more easily than before during moderate activity (like walking upstairs).
Sleep Problems and Anxiety: Difficulty sleeping or a new sense of unease/anxiety that is often dismissed as purely psychological.
Norwegian version of the article can be found here
Sources:
Norwegian Institute of Public Health. *The Cardiovascular Disease Registry: report for 2024*. Oslo, Norway: Norwegian Institute of Public Health; 2025. Accessed February 10, 2026. https://www.fhi.no/publ/2025/hjerte--og-karregisteret-rapport-for-2024/
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