Jill’s experience of heart attacks and hormones

Until a few years ago, Jill was in denial about her age, the menopause and what that meant for her future health. She had worked for 30 years as a fitness instructor and sports massage therapist; she was incredibly fit and had never given her heart health a moment’s thought. This abruptly changed in 2021 when Jill had sudden and severe pains in her chest and after some doubt and misdiagnoses by the medical team in A and E, she was found to have had at least one significant heart attack, possibly more. Since then, Jill has had ongoing intermittent chest pain, especially when having hot flushes, and she realised her continued cardiac symptoms were potentially linked to her changing hormones.

Dr Louise Newson explains the link with estrogen deficiency and cardiac symptoms, and the increased risk of heart attacks after menopause. Together they discuss gender bias in heart research, the difficulties diagnosing heart attacks in women, the possible reasons for poorer outcomes compared to men and the cardiovascular benefits of HRT.

Jill’s tips to women if worried about your heart:

1. Listen to your body, you know it best
2. Do your own research, such as balance-menopause.com, Blood Pressure UK, British Heart Foundation websites
3. Have someone with you at appointments, or over the phone if not in person
4. If you know there’s something wrong with your heart, ask for a troponin blood test

Follow Jill on social media:

Facebook – @JillMcLagganMassage

Twitter – @JillMcLaggan

Instagram – @thesmilestarter

Episode Transcript

Dr Louise Newson [00:00:09] Hello. I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson House Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of The Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence-based information and advice about both the perimenopause and the menopause.

Dr Louise Newson [00:00:41] So today on my podcast, I’ve got someone called Jill who yet again, like many of my guests, I’ve never met in real life, but I have read her story and really it resonated with so many stories that I’ve heard over the years from the clinic. So I’m very grateful that she’s come to share her story and talk more about how we can improve awareness about the perimenopause and menopause in other areas of medicine, including cardiology. So welcome Jill today. Thanks ever so much.

Jill McLaggan [00:01:15] Thank you. It’s such a privilege. It’s so exciting. I get to meet and speak to Dr Loiuse Newson. It’s brilliant.

Dr Louise Newson [00:01:23] Oh well, there isn’t really much special about me. I’ve just got a mouth and I want to try and help more women. But it’s a joy we’re doing it together with lots of people, including yourself. So tell me a bit about you, if you don’t mind. And if I said to you a few years ago, ‘You’re going to come onto a menopause podcast’, you probably would have said no maybe, would you?

Jill McLaggan [00:01:43] Yes. And it’s not lost on me the irony that I never, ever wanted anybody to know my age. That you know, when I was internet dating I never gave my… I always knocked a few years off.

Dr Louise Newson [00:01:57] Yeah.

Jill McLaggan [00:01:58] And I would never… I just blocked out the menopause completely and utterly blocked out. And I think that’s one of the big difficulties in spreading information about it because even someone like me who’s an anatomy nerd…

Dr Louise Newson [00:02:14] Yes.

Jill McLaggan [00:02:14] I don’t want to know I’m getting old.

Dr Louise Newson [00:02:17] No, of course. No, absolutely. And you’re right. And what’s very interesting, I think, with the menopause is well, two things, actually. One is that it can affect any age. It doesn’t have to be associated with old. But also the second thing is it’s often something we don’t think happens to us. And even when I remember sitting in a clinic quite a few years ago and saying to the consultant, ‘How do you recognise the perimenopause?’ He said, ‘Louise, it’s just obvious. You’ll know when it happens.’ And it was literally around that time that my memory was terrible, my mood was awful, my migraines were worse. But I just thought, ‘That’s not me. Why would I be perimenopause at age 45?’ Of course there’s every reason that I would be. But I think as women, we’re often in denial as why don’t we, even when we’ve got the facts?

Jill McLaggan [00:03:00] Absolutely. And it was… I had another issue, 2014,15 ish. But in 2019, I was back in the gym, I had an excellent trainer who was helping me because I’ve been fit all my life. From the age of five, I was dancing, I did gymnastics, ballet, badminton, you name it, I did it. And I’ve been like that… The way that I was brought up, my mum and dad were like that. It was just normal for us to exercise and I feel really grateful for that because it’s not a chore.

Dr Louise Newson [00:03:40] Yes.

Jill McLaggan [00:03:40] It’s part of my life. It’s just what I do. So for 44 years I’ve been fit. My job from the age of 22, I think it was, I was a fitness instructor, full time personal fitness trainer, then sports massage therapist, I organised the aerobic classes in a number of health clubs, so you can imagine my brain…

Dr Louise Newson [00:04:10] Amazing. Yes.

Jill McLaggan [00:04:10] I knew exactly where 25 aerobic teachers were at one time and in 2019 I was doing a plank in the gym and I looked to the right in the mirror. And I saw my tummy sag and I thought, ‘Oh my God, I’m not actually engaging my core.’ And then I realised I was engaging my core and it was the skin. And at the end of 2018, 19, I met my current partner and I said, ‘Oh my God, I’ve never actually had that before.’ And he said, ‘Everybody has that. I was like, ‘I don’t. This is new.’ And for me, that was the first sign that my body was changing. No matter what I had done in the past. And that was another reason I was a bit freaked out and I thought, ‘No, I’m not impressed with this idea.’ But I’ve always been fit. And then my jobs as a sports massage therapist, obviously that’s a very physical job, always very strong. When patients come into the clinic and they see me, they’re like, ‘Well, you’re not going to be very good.’ Because I’m small.

Dr Louise Newson [00:05:30] Yes.

Jill McLaggan [00:05:31] But you know, I’m mighty. So the thought of it being peri and menopausal. I was in complete denial about that. But if you had said to me a couple of years ago, ‘You’ll have had a heart attack.’ That’s like, ‘What? No way! That’s madness. That’s madness.’

Dr Louise Newson [00:05:55] So tell us what happened then.

Jill McLaggan [00:05:57] February 28th 2021. I had a sudden pain in my chest which made me have to sit down. But after about 15 minutes, it kind of went away. And then because it was lockdown and there wasn’t much else to do, my partner and I went for a drive. I did have a feeling of worry, which was within my body. It wasn’t a conscious worry. And then a couple of days later, after I’d meditated, whilst I was having a cup of tea, I had a much bigger pain in the chest, which brought me to my hands and knees. My partner was on a work call at the time, so he was like, ‘What are you doing?’ And I said, ‘I don’t know.’ So my breathing was shallow, I had a pain in my chest and that lasted, a severe pain, for about half an hour. And then I just sat there and the chest pain continued at maybe five out of ten. Because again, neither Cameron nor I would ever think that I would have had a heart attack, Cameron said, ‘Shall we see if we can walk it off?’ And just for the record people, it doesn’t help.

Dr Louise Newson [00:07:25] So you were having chest pain, in denial about having anything serious going on with your heart, and you went for a walk. Most people would have called an ambulance by this stage. So then what happened?

Jill McLaggan [00:07:35] So after about 10 minutes, I thought, ‘No this isn’t a good idea.’ And I went back home and just rested and I kept thinking, ‘Maybe it’s a muscle spasm, but I’m not sure.’ But I managed to, again, because it was COVID and lockdown I thought to myself, if someone like me, you know, I’m small, I’m fit, if I walk into A&E in the middle of a global pandemic, I’m walking, talking, breathing, kind of, I’m not bleeding, they’ll just… they won’t. So I just carried on with my day, went and did the shopping for my dad to go up to his flat and then later on in the afternoon Cameron thankfully, he has private healthcare through his work, so he got me a GP appointment, a virtual GP appointment, but that wasn’t until 10:30 at night and by 10:30 the other thing that is actual reality is that impending feeling of doom.

Dr Louise Newson [00:08:45] Yes. Which is very common actually, for people that have heart attacks. I’ve seen many people over the years and you do have this sense. So then what happened?

Jill McLaggan [00:08:56] So actually by that time I called Cameron over to my house for the appointment and the GP, like yourself, said, ‘Why are you not at A&E?’ And I repeated what I’ve already said. I would have been taking up time. It’s a global pandemic, etc., etc.. And she said, ‘Go to A&E now.’ So we did. And as I anticipated with chest pain, you are taking straight to the top of the queue. But interestingly, the ECG is normal, the oxygen levels are normal, all my vitals are normal. So by now, as I anticipated, because I’ve not had great experiences with some NHS care, they don’t believe you. They do not believe you. It’s very, you know, once they’ve done your blood pressure and you’re ECG and it’s beating. My heart was beating, I did not have a Hollywood style drama, you know, I’m loathe to say it but I’m going to, ‘male type’ heart attack. Yes. I wasn’t screaming going, ‘Oh my God, I’m going to die.’ I was just saying, ‘I have pain on my chest. It’s been there for about 11 hours. And I’m really, really worried.’ It did refer just up to the side of my… just up the side of my neck a little bit to my ear. So then they took me through once I’ve managed to get through triage – and that was a bit of a fight. I was then in A&E for about 3 hours. They did take blood tests. You know how when you’re in A&E, you have to repeat your story about 300 million times, to 300 million different people. And eventually, the last doctor who was going to discharge me told me that I had gastritis.

Dr Louise Newson [00:11:04] Oh dear.

Jill McLaggan [00:11:05] So, again, if you’re not that bolshie and you’re not that confident and you’re not feeling very well, that’s really difficult to just say, ‘Okay, that’s fine. Cheers.’ And because it was a COVID pandemic, my partner wasn’t allowed in the hospital, so he’s sitting outside in the car park. I phoned him to say, ‘It looks like I’m getting out. I’ve got gastritis, but I know it’s not gastritis.’

Dr Louise Newson [00:11:31] So then what happened then in the end, how was it diagnosed?

Jill McLaggan [00:11:35] Then she went away and she said, ‘I’ll go get your bloods.’ And when she came back with the bloods, she was apology personified. She said, ‘Your troponin levels have been elevated and you have had at least one, if not two heart attacks.’ And within about 2 minutes, my cubicle was full of so many people doing things.

Dr Louise Newson [00:11:56] So, and this is we’ll go on to what happened it in in a bit. But actually, this is very important because we know that a lot of research in heart disease is done in men and a lot of it is then transferred into women. And in fact, when I was at medical school, as you might know, I had no menopause training. But I was taught that women are less likely to have a heart attack than men. Absolutely right, when they’re younger women. And I was taught that this is because estrogen protects the heart system. So that was good. But no one actually told me that menopause was an estrogen deficiency and low estrogen increases risk of a heart attack. The second piece of the jigsaw wasn’t told or I didn’t know until 25 years later, in fact. But actually we know that. So once women become perimenopausal or menopausal and hormone levels, especially estrogen, probably also testosterone decline, then women are more likely to have heart disease, more likely to have a heart attack. But also they present in a different presentation, you know, the central crushing chest pain radiating to the jaw or down the left arm, very classic for men having heart attacks. Women don’t have it in the same way. And you know, although you were having some features suggestive of a heart attack, there are other times people just get a bit light-headed, they feel a bit dizzy, they don’t feel the same. And we’re not taught that at medical school. So all the clinicians you would have seen probably weren’t taught that either because it’s very hard to recognise a heart attack in women. But we also know, and I’m sure you do as well with your extensive reading, that women who have a heart attack actually have a worse prognosis compared to men. And is that because they’re left longer? Is that just because they’re not picked up? Or actually, is there more inflammation and problems going on? And we don’t know because, I don’t know you might tell me how much research is done on women and heart disease compared to men and heart disease. It’s very different isn’t it?

Jill McLaggan [00:13:54] It’s very different. I have got a quote somewhere from somebody who said that the majority of heart research is done on men, which is then sexist, because what happens when a woman has a heart attack?

Dr Louise Newson [00:14:11] Yes.

Jill McLaggan [00:14:11] And the final doctor who was a woman of probably menopausal age, she said, ‘You are the quietest heart attack patient I have ever seen. And I’m going to go up to the acute medical unit and warn them.’

Dr Louise Newson [00:14:31] Very good.

Jill McLaggan [00:14:31] So that was good. That was good. But the other thing, I haven’t been able to get in contact, but there is a Professor Colin Berry who was quoted in a newspaper and he’s at Glasgow University and he said when he’s at medical school they are taught that you have a heart attack if you have a blockage. And they’re not taught about anything else.

Dr Louise Newson [00:15:00] No.

Jill McLaggan [00:15:00] Now I had not been able to contact him to verify his quote, but that is what he apparently said. So when a woman presents with no blocked arteries, they don’t know quite what to do with you.

Dr Louise Newson [00:15:17] So, yes, and this is very interesting because a lot of people it is an atheroma, some build-up of furring in the arteries and then the clot goes and causes blockage. But for a lot of women, I was taught at medical school something called ‘Syndrome X’ where you get spasm of the arteries.

Jill McLaggan [00:15:32] Yes.

Dr Louise Newson [00:15:32] And the spasm then causes a narrowing, but it’s not a blockage. And so there’s a lot of women who then have investigations and are told, ‘Well you haven’t got any blockage, you haven’t got any disease there. So therefore, you’re fine.’ And I’ve seen a lot of women over the years who have had very classic chest pain, angina, when they’ve been cycling or exercising. But their cardiologist has said, ‘Well, they’re fine. They haven’t got a structural problem, exercise through it.’ Well, they can’t. They’re in absolute agonising pain. And we know that actually giving estrogen can help relax the arteries, cause some vasodilation – so make them more relaxed, bigger  really improves symptoms. But people have been very scared of giving hormones to women with heart disease for the wrong reasons actually. So fast forward, you’ve had your heart attack, and then what happened?

Jill McLaggan [00:16:24] And then I was lucky in that the guy who did the angiogram, again I don’t know his name, he was brilliant. I think he already knew about SCAD because he said, ‘There is a type of heart attack that affects younger, healthy, fit females.

Dr Louise Newson [00:16:46] Yes.

Jill McLaggan [00:16:46] And when they did the angiogram, I heard him over the screen going, ‘Look there it is, there it is.’ So a SCAD is short for Spontaneous Coronary Artery Dissection. That’s when an artery spontaneously tears or bruises. They haven’t decided which comes first. And they saw it now. Yes, I had that. It was healing within a week because I took part in a research thing and they had a look and it was healing within a week. But it was after that I continued to have ongoing cyclical chest pain. And initially that can be… in my head, it’s like, ‘Well, I’ve torn something in my heart, so it’s going to take time to recover.’ But because of the…when I say hot flushes, that’s a real general, general description. When I had a hot flush, my heart really got involved in the party. So I would start to feel a bit of a warmth. And then my heart rate would get faster and faster and faster. Not because I’m anxious it would just get faster and faster and then I kind of pass out. My body just goes, ‘No, enough, we can’t do this.’ And then I realised that the hormone issue and the heart issue for me had to be related. They had to be. And then I did end up back in hospital about ten days later. But because they see I’ve been in ward one or nine, a heart ward, as long as my heart is fine they then said, ‘We do not know what’s wrong, we don’t know what happened’, because one of those hot flush things lasted about 3 hours. He said, ‘We don’t know what that was, but it’s not your heart. So you go home.’ Great. Thanks. And then the 6th of June, I had another big bang I call it. I had another big bang, which felt exactly the same as my second heart attack. So Cameron was there, he called the paramedics. I’m on my hands and knees again. But within about 20 minutes, it had passed. And to me, this is my self-diagnosis, nobody’s confirmed it, to me, that was definitely a spasm. When I got into hospital, they did take my troponin levels. They kept me in again overnight and my troponin intervals were nothing like what they were during the heart attack, but they did have a curve. So through my research, I have now learnt that if there is a curve, they call it a delta curve, that needs investigation. And after that episode, a really lovely cardiac registrar decided to give me a GTN spray. That was then what led me to research what a GTN spray was for.

Dr Louise Newson [00:20:06] So yeah. So those of you listening, it’s glycerol trinitrate, which actually just causes some dilatation of the arteries and can really make a difference. So going forward, is anyone giving you any HRT at all? Have you had any hormones?

Jill McLaggan [00:20:20] I had emailed the clinic after the Davina programme. I’d emailed the Newson clinic because I was… at that point I think it was about May… I’ve not written that down. At that point I knew that there was something hormonal happening with my heart. So I thought, I wonder. So I sent an email and I had an appointment at the end of July. And then on the 6th of June I had that other massive episode and I sent an email to the clinic and a wonderful member of your staff called Sally, she was lovely, I’ve written her name down, so she got me an appointment the next week due to the severity of the issue. And I started estrogen and progesterone and within two and a half weeks my heart issues had resolved by 80 to 90%. Like that.

Dr Louise Newson [00:21:18] And what did your medical team, all the cardiologists, say to you? Do they know about it?

Jill McLaggan [00:21:22] They don’t care.

Dr Louise Newson [00:21:24] They don’t care?

Jill McLaggan [00:21:24] No.

Dr Louise Newson [00:21:24] What have they said then?

Jill McLaggan [00:21:27] I did have a follow up. My first appointment with a cardiologist was sometime in June, and when I asked him the questions, I spent 4 hours preparing for that appointment and he said, ‘Your symptoms will be something else. There’s nothing wrong with your heart.’ And when I asked, for example, when I asked should I still take aspirin, he said, ‘Well, you can if you want. Many people do.’ So that wasn’t brilliant. So then I did have an appointment with the SCAD specialist. There’s only one in the UK, but unfortunately their line is if you can get through the menopause without HRT, all the better. And if you have to have it, the lowest dose for the shortest period of time.

Dr Louise Newson [00:22:29] So that’s very disappointing, isn’t it?

Jill McLaggan [00:22:31] So that was disappointing. So I then, the positive bit, it’s not what you know, it’s who you know. A friend of mine, her wee brother is section head of vascular medicine at the Cleveland Clinic, Ohio, and he was kind enough to have a chat with me. I must say it was not an appointment. I don’t want to get him… It was not an appointment. We just had a chat with my pal’s brother, and he explained everything to me and showed me papers, like changes in estrogen are independent predictors for MINOCA, for Myocardial Infarction with Non Obstructive Coronary Artery. Now that’s amazing. And, then this is exciting, in comparing women who have MINOCA to women who have another sclerotic, normal heart attack, the difference is that in MINOCA there is a dysregulation of the estrogen receptors, and that was in a paper, Predictors for Myocardial Infarction with NOCA, paper by Barrett TJ at New York University, and that was in 2018. So the information is, they don’t yet know why women are more predisposed to it. But the majority of patients are women. And I think the fact that 90% of SCAD patients are women with an average age of 44 to 53.

Dr Louise Newson [00:24:18] Yeah. Well this begs the question with so much, doesn’t it, in what I’m trying to unearth and show and common sense has to prevail with a lot of this. So, you know, we see increasingly people who’ve had SCAD, Spontaneous Coronary Artery Dissection, and even when I was doing a cardiology job many years ago, we saw lots of women with it but never put the pieces together. So it’s really important that we do research in this area, but it’s also very important that women are not denied HRT and certainly do not need to have it for the lowest dose and shortest length of time. Estrogen is very anti-inflammatory in the endothelium, the lining of the blood vessels. It can help the conducting system of the heart, but it also can help build the collagen. It can help support the vasculature. So people are less likely, I’m sure, to have a dissection. And then we also don’t know enough about testosterone. And we know women with low testosterone are more likely to have heart disease. That doesn’t mean replacing reduces the risk, but we don’t know because no one’s done the studies. But certainly testosterone has a very beneficial effect in men on their heart disease risk. And so it is likely to have an effect on women. So we certainly need to do so much more in this space. But I think the sort of learnings from you being so open and thank you very much about your story is thinking about heart attacks in women are not a typical presentation and it’s really important if anybody or anyone you know is having some symptoms that aren’t right, it could possibly be a heart attack. Do not go for a walk. Do not book into a doctor when you can, regardless of whether there’s a pandemic or not, you have to. And so that’s very important. But then also it’s about if someone has had heart disease, when they’re being told about what could be causing it and if that comes up or anything else, Syndrome X, something else or just, you know, angina for unknown reasons. Or even if someone does have established atherosclerosis and does have a clot that’s caused the heart attack, all these women can still usually take HRT, especially when it’s the natural estrogen through the skin, natural progesterone and also testosterone if needed, because they often will benefit. And as you very clearly have said, you can improve your symptoms as well. And so it’s been led by women as well. And obviously you’ve done a huge amount of personal research knowing that the pieces of this jigsaw have sort of come together and actually your future health is going to improve. You’re very fit and well as well, and you want to keep it that way. So having you to sort of talk about that has been really interesting. But I think what we really want, because obviously we’re coming to a close is thinking about, I’ve always have these three take home messages, but what are three things do you think we need to do going forwards? Because it’s horrible hearing your story, but for you having that, there are thousands, millions who knows, worldwide, who have had similar stories and maybe not the same outcome. So what are the three priorities really for sort of research and taking this forward, would you say?

Jill McLaggan [00:27:33] I would say the very, very first one for everything is listen to your body. You’re the one who knows it best.

Dr Louise Newson [00:27:42] That’s very good. Very true. Yeah, I like that view.

Jill McLaggan [00:27:45] As a clinical massage therapist, it is astonishing how many people can’t feel their bodies. So if you can’t learn how to. But listen to your body, do your own research. Now, I know in this day and age, you could find data to prove that bananas can fly. You know, there is so much out there. But the websites that I looked at were your website, the balance website, the Blood Pressure UK website where you had a piece on it, the British Heart Foundation website, because that says on it microvascular angina is most common in women at the time of the menopause. So to me, the British Heart Foundation is a reputable website. And if they know about it, why do my cardiologists don’t? When you go to an appointment or even if you can’t have somebody with you, have somebody on the phone, that’s super important. And the final little addendum, if you know there’s something wrong with your heart, what I have learned is ask for a troponin blood test.

Dr Louise Newson [00:29:01] Yes. Very good. So it’s about being your own advocate, isn’t it? And having a voice and making sure that you’re heard. And that’s really important, not just for heart disease, but for menopause in general. But I’m hoping that your story will be the start of a conversation to springboard more people to think about it. We’re working with cardiologists as well, but we want to do more certainly in this space. So hopefully with time to come, it will be more normalised and actually HRT will be considered as a treatment for people who have having heart attacks. Because it used to be in the eighties, they used to give estrogen acutely in coronary care. So we’ve got a… we need to keep moving forward. So I’m very grateful, Jill, for your time today. So thank you very much.

Jill McLaggan [00:29:44] Thank you. Thank you for the opportunity to spread the information to a wider community.

Dr Louise Newson [00:29:51] Thanks ever so much and take care. Thank you.

Jill McLaggan [00:29:54] Thank you.

Dr Louise Newson [00:29:58] For more information about the perimenopause and menopause, please visit my website balance-menopause.com. Or you can download the free balance app which is available to download from the App Store or from Google Play.

END.