The Gap Has Been Bridged! (Part 3 of 3)

a broken road bridge with Wonder Woman bridging the gap

The final part of the trilogy! (Jeezo…. these 3 blogs have been an effort I don’t mind telling you!)
A summary of the answers – and my personal conclusions – to the questions posed in Parts 1 & 2
The information and links to websites/scientific research were correct as at February 2022
Remember, everyone is different and everybody’s experiences are unique, this is my personal story.

* NONE OF THE FOLLOWING SHOULD BE REGARDED AS PERSONAL MEDICAL ADVICE *

PLEASE SPEAK TO YOUR HEALTHCARE PROVIDER

(whilst armed with your research, symptom diary, hand-outs from reliable websites)

Definitions

  • Menopause – when a female stops having periods, usually classed as 1 year after her last period
  • Myocardial Infarction – (MI) a heart attack
  • Atherosclerosis – when heart arteries are fully or partially blocked by ‘gunk’
  • Microvascular system – the teeny, tiny blood vessels/arteries that bring most of the blood (therefore oxygen) to the heart muscle
  • Dysfunction – something is a ‘bit broken’, it’s not working correctly
  • MINOCAMyocardial Infarction with Non Obstructive Coronary Arteries
    heart attack with no blockages in the arteries of the heart.
  • SCAD Spontaneous Coronary Artery Dissection
    spontaneously, a tear/bruise occurs within an artery, causing a blockage, resulting in a heart attack.

Why Am I Interested in This?

Because my menopausal symptoms were CARDIAC related and having something wrong with your heart is well… kindof a big deal.
Plus, no cardiologist has expressed any interest in my menstruation status.
Which is worrying, now that I know what I know.

I now have my answers.
I am grand!
But, I have had the time (& bucket loads of tenacity) to be able to find (& fund) the resources and help that I needed.
But there must be 1000’s of women who do not have the time, energy nor resources to find their way to the information that they need, to be able to make an informed decision.
I hope that all of this information can reach and help others who are still suffering

I was a very active, healthy, ex-dancer, who has worked in the fitness industry all her life.
The only cardiac risk factor that I have is:

BEING PERI-MENOPAUSAL.

Fact 1

Menopausal Symptoms Include Cardiac Issues.


Who knew?!!
All of the symptom checkers I have found include these.
(I would love to be able to find a copy of the ORIGINAL Greene scale – I wonder how long these particular symptoms have been known about?
If anyone can help me to find early Greene Scales, that would be very much appreciated)

Fact 2

Oestrogen Keeps Our Blood Vessels Healthy

So….. at this point in time, my understanding is,
in women whose oestrogen levels are declining – whether by slowly & gently dipping, or crashing through the floor at the speed of light ! – this must mean that our blood vessels cannot be as healthy and relaxed as before.
Yes? You with me so far?!

Fact 3

The body will always prioritise survival over reproduction.

Although folks may not realise that they know this already – they do know!
I’m sure everybody has heard the phrase, “if you relax/forget about trying to get pregnant, you will!”
(A rather insensitive thing to actually say to a woman who is trying to get pregnant, by the way.
Just a head’s up on that one)
The majority of mid-life, menopausal women are NOT attempting to become pregnant, so why is this relevant?


If a human is stressed, the brain will prioritise cortisol production over progesterone – they are both made from the same, very initial, ‘building blocks’.
Whilst having a, physiologically, stressful time, the body does not want you to be eating, sleeping nor having sexy time. It prioritises the ‘running away from this shit’ type of hormone ie. cortisol etc.
The brain wants you to survive.
Whilst there is a perceived state of famine/drought/war etc. it will prioritise using its’ hormone building blocks to make cortisol etc, rather than progesterone.

The endocrine system is super-complex and more complicated than I am qualified to go in to.
There is a really good explanation here – The Fork Clinic – hormone-series-cortisol-and-progesterone.

Fact 4

Progesterone has cardioprotective effects

NB. there is very little research on the effects of progesterone and what there is, is behind a paywall and only available to those in the medical profession. Plus, it is very difficult to scientifically measure progesterone levels. They fluctuate throughout the day, week and month….. and that’s even BEFORE we add in the chaos of menopausal crazy hormone wanderings/crashings and peakings!!
However, this link, goes a little way to validating what I’m waffling on aboot!

Progesterone has cardioprotective effects. ► Progesterone exerts rapid effects on cardiovascular cells. ►Membrane progesterone receptors (mPRs) are expressed in human cardiovascular cells. ► Specific progesterone receptor binding identified on human vascular endothelial cells. ► mPRs mediate rapid progestin signaling in human vascular endothelial cells.

So, at this point in time, my understanding is:
for mid-life women, whose oestrogen & progesterone levels
are crashing through the floor, they may be susceptible to the declining health of their blood vessels. PLUS, if they are experiencing increased levels of stress, they may be experiencing a bit of a double whammy, yes?

Could this explain why some women experience the menopausal symptoms of cardiac issues?
And, coming back to SCAD heart attacks in particular, which is what started all this bloomin’ research off!
How does this relate to the guys who experience SCAD heart attacks?

Because they produce progesterone too!
Remember, both men and women produce progesterone, testosterone and oestrogen.

In Kate Muir’s book, ‘Everything You Need to Know About The Menopause
(but were too afraid to ask)’ you can find 100’s of references to scientific papers,
including those on palpitations, such as this one:


A recently completed review found that palpitations prevalence was 4 to 40% in premenopausal women, 20 to 40% in perimenopausal women, and 16 to 54% in postmenopausal women

Click here for link

And remember The British Heart Foundation information?

“Women, particularly around or after the menopause, are more likely than men to get microvascular angina”

Professor Juan Carlos Kaski Link to article


And remember Dr. Scott Cameron’s information?

  • “changes in oestrogen are independent predictors for MINOCA
  • in comparing women who have MINOCA, to women who have ‘traditional type’ heart attacks, the difference is that, in MINOCA, there is a dysregulation [the mechanism is a bit broken] of the oestrogen receptors.
    In women who have ‘traditional’ heart attacks, ie with blockages, it is not the oestrogen receptors.

Link to paper : Women With Myocardial Infarction With Nonobstructive Coronary Artery Disease
(Findings From the American Heart Association Go Red for Women Strategically Focused Research) Network


In an article in The Daily Mail, 5/10/2021, Professor of Cardiology at Glasgow University, Colin Berry explains,
“Despite being a recognised medical event, MINOCAs are underdiagnosed in the UK. This is partly due to how heart attacks are taught in medical school – students are told that they are caused by blocked arteries, which is actually sex bias because more women than men suffer MINOCAs”

So…. at this point in time, my understanding is: some women’s menopausal symptoms can centre around affecting the circulatory system and heart.
(Remember, there are 23-25 listed symptoms and not ALL women will experience ALL symptoms.
Well. Bloody hell.
I hope she doesn’t…)

Swapping periods for heart attacks

Fact 5

Cardiology – A very, male dominated profession working to guidelines and protocols, based on research that was done on middle-aged MEN. From the paper in The European Heart Journal 2017

“Thus, current guidelines for prevention, diagnosis, and medical treatment for cardiovascular diseases are based on trials conducted predominantly in middle-aged men.”


To be frank, your average, midlife female pitching up in A&E with chest pain without blocked heart arteries, is going to have a tricksy time getting a correct diagnosis and effective treatment.
(NB. Not necessarily because the consultants are ‘at fault’. But because they have not had the training & don’t have the knowledge.)

Yes, the reason that I have spent months researching this, is for my own health
BUT
It is also for all the other women out there who are who have nothing mechanically ‘wrong’ with their heart but who are having severe, life-altering cardiac issues and they’re scared.

I remember reading a post in the UK SCAD Facebook group from a woman in Glasgow (I think it was Glasgow)
You could hear the worry in her text.
She’d had a SCAD months ago, and was still experiencing ongoing cyclical chest pain and breathing difficulties.

She had been put on the same drugs as myself; clopidogrel, Ramipril, aspirin
and she felt like death on them.
PLUS,
they hadn’t made any difference to her symptoms.
But,

they wanted to put her on MORE heart drugs.


She was *beside herself with frustration and worry
* ‘beside herself’ is a Scottish expression that means really, super upset.

I was upset for her.
Especially when I had just discovered


But, golly, who the hell am I to send a message to say “um… have you thought of trying HRT?”
Jeezo, I wasn’t going to do that.
(Hence this ‘ere blog)
Now. Not every menopausal woman will have a SCAD heart attack! They are very rare.
Absolutely nobody at The Edinburgh Royal Infirmary had ever seen a SCAD patient before (including the paramedics, consultants, nurses, doctors)
But cardiac menopausal symptoms do seem to be very well known OUTWITH the cardiology department in most hospitals.
Hmmmm….
That’s concerning….

Summary

I must admit that I was quite disappointed when the SCAD specialist dismissed the vasospasms/microvascular issues as not relevant:
no particularly logical reason that the SCAD patient population would be particularly prone to it
Except that the majority of us are mid-life females…..?


Final Fact

What Works For Me

And it is the micronised progesterone that is the real diamond in that pile.


As already mentioned in Part 1- Bridging The Gap and in Part 2 I have trialled this 3X deliberately and 1X inadvertently.
In case you’ve not read them, I’ll repeat, because this is important:

Due to my body’s reaction to dropping sex hormones being so extreme,
I was put on the continuous regime initially – 1 tablet every night.
But my womb wasn’t happy.
So we tried, on for 2 weeks, off for 2 weeks.
But my heart wasn’t happy.
My heart can only cope for about 6 days OFF micronised progesterone
So I am now
on micronised progesterone for 25 days – ish and
off for 5-6 days ish.


The ‘inadvertent’ episode was in December 2021, whilst I was moving house, working hard and had bloomin’ Christmas to deal with –
I just got muddled with my days!
I was off progesterone for too long and, guess what?

I needed to use my GTN spray
Again – point proven.
I don’t care what the cardiac guidelines say to be honest –

MY HEART NEEDS MICRONISED PROGESTERONE!


Sadly, it is not available from NHS Scotland, where I live, although it IS available from NHS England.
The Scottish Medicines Consortium info states;
the manufacturer did not present a sufficiently robust economic analysis to gain acceptance by SMC”.
(And can I just say here…. it costs the NHS approximately £5 per 30 tablet pack…..)
So I buy it from the Newson Health Clinic, in England.

(Interestingly, my dad has suffered from oesophogeal spasm in the past.
True to form, us McLaggan’s don’t do things by half….
When his oesophagus completely closes, he blacks out.
On one notable occasion, he fell backwards – as straight as a poker and crashed down on to the hard kitchen floor – concussing himself.
What is it they say, like father like daughter?

Always taking the most dramatic route!
As I have now learned that the GTN spray can resolve both microvascular spasm and oesophogeal spasm, and my dad and I have each had a ‘spasming’ thing……

I wonder if there is a gene that predisposes us to this? Albeit in slightly different conditions?
Who knows!
)

HRT

Now…..
Before everyone starts jumping up and down and getting their knickers in a twist, shouting,
I’ve been told that I can’t take HRT, so what do I do now?!”
I’m not going in to this in this post, I mean, heck, I think that we’ve all had enough links and information for one post!
But.
I promise I will share all the relevant guidelines (& links!) to the current guidance, in my next post.
After I have recovered from writing this trilogy.
Honestly, I have no idea how Tolkien did it.

For now, suffice it to say that, patients and medical professionals alike, have been fed incorrect information about HRT, since the publication of the flawed Women’s Health Initiative study in 2002.
Honestly, it has been and is continuing to be an absolute travesty for women’s health.
Ah, feck it, one more link for ya!
https://www.balance-menopause.com/menopause-library/how-the-us-government-and-the-media-conspired-to-convince-women-that-menopausal-hormone-therapy-was-dangerous

Read it. You will be both amazed and angered.

We give people the hormones thyroxine and insulin, so why not sex hormones?
Men can get testosterone over the counter.
(God forbid that any men should have problems with their sex drive ….)
Whilst 50% of the population have just got to put up with the effects of naturally declining hormones.
And then live with these effects on their heart, bones and brain, for potentially 30-40 YEARS!!!

Calm down Jill, calm down….

What This ALL Boils Down To

What if my ongoing cyclical chest pain and related issues were
NOT solely due to the AFTER effects of having had a SCAD
but were BOTH due to the decline in sex hormones?


They were both due to the same dysregulation of the hormone receptor ‘thingymajiggies’?


Just that, on that 1st occasion

(when an artery spontaneously ripped)
it bordered on the rather more spectacular side of things?


And wouldn’t that explain why I have had a complete resolution of symptoms,
since starting (closely monitored) HRT?

Yes, the science hasn’t yet worked out WHY, SOME women’s response to dropping sex hormones results in microvascular dysfunction but, the human body is complex!
Why do some women suffer horrendous morning sickness during pregnancy, whilst others don’t?
Why do some people have bipolar disorder, whilst others don’t?
Why do some people have hyper/hypothyroidism, and others don’t?
Why do some people develop Type 1 diabetes and others don’t?

BUT WE DO KNOW SOME WOMEN EXPERIEINCE THESE MENOPAUSAL CARDIAC SYMPTOMS,

And yes, my heart is “beautiful and healthy”- as I was repeatedly told.
Which is grand, right?!
But it didn’t really explain what was causing me to be floored with pain, on my hands and knees, unable to breathe, whilst my vision went black.

As my partner said the other day,

“Can you imagine where we would have been if you’d not done all this research, found the Newson Clinic, started HRT babe?
You would still be having all these chest pain issues, not-able-to-breathe-things going on.
I’d be so stressed about you!”

Big Tall Baldy Guy

Why are cardiologists ignoring these facts?

Is it really all STILL to do with the history of women and medicine?
Read more in Advocating For Yourself – If You’re A Woman
Is it STILL the age-old problem that women are just not listened to?


As patients we must remember

Conversely, some doctors would do well to remember this too.
Nobody can know everything about everything!
That’s not humanly possible.
I mean, I’m not going to let even Stephen Fry perform an angiogram on me…
Science and medicine don’t know everything about everything.
In our society, where medicine has become so compartmentalised, so specialised, many have forgotten that the human body is NOT little separate boxes that don’t interact!
Such a bizarre way of thinking.

We must bear this in mind.
And by ‘we’, I mean the patients and their expectations of their medics AND the medics themselves.
Yes, ‘more research’ is always good (preferably on females for female related conditions… just sayin’)
BUT, at a most basic level, all that we CAN do is to
practise compassion for those who are suffering and have some humility in our own limitations.

As a human, that is something that we can all do.


In my next post, I will share the links on the current UK (& US) government approved guidelines on the efficacy, risks and benefits of HRT.
Until then, follow these folks. They are at the cutting edge of the current menopause revolution.

And for further information on SCAD and Heart spasms:

I’m away to slap on some oestrogen gel
Have a good day