With menopause comes a whole host of—sigh—body changes, from hot flashes to heart palpitations. But sometimes a fluttering heartbeat and that out-of-nowhere flushed feeling can signal more than just the natural transition to menopause. According to a paper recently published in the European Heart Journal, high blood pressure symptoms in women are “often mistaken” for signs of menopause both by doctors and by women themselves.

In the paper—a consensus document from a panel of European cardiologists, gynecologists, and endocrinologists—the authors recommend “intensifying” the detection of high blood pressure in women over age 50 because of the overlap in symptoms between menopause and hypertension, and the risks to heart health this could present to women. According to the document, high blood pressure in middle-aged women can cause headaches, chest pain, shoulder pain, and trouble sleeping, in addition to heart palpitations and hot flashes. So, basically, hypertension can look a whole lot like menopause.

“High blood pressure is called hypertension in men but in women it is often mistakenly labeled as ‘stress’ or ‘menopausal symptoms,’” Angela Maas, M.D., Ph.D., an author of the paper and director of the Women’s Cardiac Health Programme at Radboud University Medical Center in the Netherlands, said in a press release from the European Society of Cardiology (ESC). “We know that blood pressure is treated less well in women compared to men, putting them at risk for atrial fibrillation, heart failure, and stroke—which could have been avoided.”

An Ongoing Issue In Women’s Health

High blood pressure is far from the only health condition that tends to be overlooked in women. “Women in general, and especially women of color, are oftentimes dismissed when they make complaints about their health,” says One Drop health coach, Lisa Graham, a registered nurse (RN) and certified diabetes care and education specialist (CDCES). As a result, she explains, “sometimes the extra steps that need to be taken in the area of health assessment and diagnosis are not completed.”

Plus, in the context of hypertension and related heart conditions, women’s symptoms can look different than men’s. “Symptoms of heart disease are often milder in women, harder to detect, and easy to confuse with hot flashes or other illnesses,” explains Graham.

Why Blood Pressure Is Called the “Silent Killer”

The truth is, while menopause and hypertension symptoms can sometimes overlap, high blood pressure often doesn’t have any early symptoms, says Graham. “In some cases when blood pressure is very high, it can result in headaches, dizziness, and nosebleeds,” she explains. “But that is rare.”

It’s more than a matter of menopause and hypertension’s similarities, though. Simply put: “As women age, their risk of heart disease increases,” says Graham. In part, this happens because of dropping estrogen levels around menopause. “Estrogen has a protective effect on our heart,” she explains. But the decline in estrogen during menopause may contribute to metabolic changes that can lead to increases in blood pressure, abdominal fat, blood cholesterol, and blood sugar—all of which can raise our risk of heart disease (which, in case you don’t know, is the leading cause of death for women in the U.S.), notes Graham.

Taking Care of Your Heart Beyond Screening and Healthy Habits

Obviously it’s a good idea to stay on top of screening health measures like our blood pressure, blood sugar, and weight as a means of preventing heart disease. And, in our day-to-day, a steady workout routine and a kitchen stacked with heart-healthy fruits, veggies, whole grains, and lean proteins are musts. But how do we ensure that we’re proactively advocating for our health, especially in the face of possible discrimination at the doctor’s office?

First, remind yourself that you’re in charge, and that your doctor represents just one piece of a much bigger puzzle. “It is important for women to build a healthcare team, knowing that you are the manager of your team,” says Graham. “Your doctor is part of the team, but there are other members on the team including specialists, therapists, health educators, and health coaches who can support you along the journey.”

Here are some more tips from Graham on taking charge of your health:

• Write it down. Listen to your body and keep notes of how you're feeling between doctor's visits. Oftentimes, small things happen between visits that may be important to mention to your doctor. Take these notes with you to each visit and review them with your doctor or specialist, so you don't forget important insights.
• Build a relationship with your doctor. Let them know that you want to take an active part in taking care of your health. Have discussions with your provider, so you're not just being told what to do.
• Be open to second opinions. If you feel your doctor isn't listening or your needs aren't being met, that is the time to rely on other members of your team or find another doctor that can be more attentive to your needs.
• Hold yourself accountable. Share your health goals with your family and friends or your One Drop coach, so they can help you stay on track and offer support along the way.
• Educate yourself. Attend education classes to learn more about your health and how to manage your condition. The Centers for Disease Control and Prevention (CDC) has tons of information on evidence-based, self-education programs for different chronic conditions. You can also find resources via your state's health department and other local health organizations to see what types of programs are most accessible, either virtually or in-person. Or, download the One Drop app for real-time information and guidance on self-care for chronic health conditions.

This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations at One Drop.