Cardiovascular disease is the leading cause of death among women, the root cause of one in three deaths annually, and heart disease kills more women than all forms of cancer combined. Watershed moments in a woman’s life, such as pregnancy and perimenopause/menopause can contribute to cardiovascular risk.

45% of women aged 20 and above live with some form of heart disease. However, only 44% of women recognize that it is a health threat. 

From Emergency Medicine to Women’s Health Advocate

Dr. Amy Louis-Bayliss has been an MD for nearly two decades and has worked in the Greater Toronto Area since 2011 as an Emergency Medicine Specialist. 

Dr. Amy is a tireless advocate for women’s healthy aging. Her interest in menopause and healthy aging stems from years of frustration working within Canada’s public healthcare system, observing the painstaking efforts to treat and manage illness once it was already ‘too late.’ She has witnessed countless women coming to the ER as a desperate last resort for help they couldn’t find anywhere else. 

More personally, she faced her own health challenges as she entered her forties and was unable to find adequate preventative healthcare options within the public system. 

Discovering the Impact of Perimenopause and Menopause

“It’s only been in the last few years that I’ve learned about perimenopause and menopause. Especially how it impacts women’s health as they present to the emergency department in their 40s and 50s. Truthfully, I couldn’t believe that I was teaching residents and teaching medical students at the University of Toronto medical school and didn’t know anything about it,” admits Dr. Amy. 

It was a professional lecture by Dr. Natalie Gamache, who is a gynecologist in Canada, that catalyzed Dr. Amy to refocus her medical practice on women’s health. “That lecture truly opened my eyes,” says Dr. Amy. “In my practice of emergency medicine was I spending a lot of my time seeing women once they were sick. I was diagnosing their heart attacks. I was diagnosing their hip fractures. I was talking to their family members about dementia. I was entering  my 40s, I and began thinking, “How do we prevent this? How do we take an active role in our health so that we do everything we can preventatively? Before we’re sick and diagnosed.”

So, over the last several years, Dr. Amy re-trained in women’s health and menopause care. Today, she is the CEO and co-founder of Lume Women + Health: Elevated healthcare for Canadian women, by Canadian female MDs. Lume is more than a clinic—it is a space built around the whole health needs of women, where every woman feels seen and heard.

Estrogen’s Role in Heart Health

Estrogens are a group of hormones that play a central role in a woman’s sexual and reproductive development. In addition to regulating the menstrual cycle, estrogen affects the reproductive tract, the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain. Secondary sexual characteristics, such as pubic and armpit hair, also start to grow when estrogen levels rise. Many organ systems, including the musculoskeletal and cardiovascular systems, and the brain are affected by estrogen. 

So as a doctor with a focus on women’s health, understanding the impacts of estrogen, and the impacts of perimenopause and menopause is central to Dr. Amy’s work. 

Understanding Cumulative Health Risks

“As we age, our risk for disease is going to go up as as natural part of aging. When you are 85, 87, or 89, you will not have the same health that you had in your 30s and your 40s. And a lot of that is due to the accumulation of risk factors, meaning your lifestyle choices, your genetic risk, and your environmental risk,” she explains. “What is important for people to understand is that these risk factors accumulate over years, and primes the body for disease to take place. Many women and men think, “I’m young. I don’t have to worry about heart disease, or dementia or osteoporosis. What they don’t understand is that these disease processes begin 20, 30 or even 40 years before they present as an acute problem.”

Estrogen has a protective effect on quite a few of the diseases that impact women, including their heart health. It is anti-inflammatory. It impacts your lipid or cholesterol levels, and it has an impact on the elasticity of the blood vessels. It affects your blood sugars. So when women go through the menopause transition, that loss in estrogen adds to that risk that’s accumulating over time. 

The challenge is that many women are unaware that the transition into menopause and the loss of estrogen puts them at greater risk of heart disease.

“There are many disparities in women’s heart health compared to men. However, there’s the added problem that women don’t recognize that they are even at risk for heart disease. If you ask a woman, what are you most likely to die from? Most women will say breast cancer. And in fact, that’s not the case. You are more likely, significantly more likely, to be impacted by a heart attack or stroke,” says Dr. Amy. 

Reproductive Risk Factors

Furthermore, if pressed to consider their heart health, women tend to focus on risk factors such as smoking, high blood pressure, high cholesterol, diabetes, a sedentary lifestyle, and obesity. They rarely consider risks related to reproduction, when in fact those risks are equally significant. 

Dr. Amy elaborates, “For example, if you have severe hot flashes, that is an independent risk factor for heart disease. If you had high blood pressure or diabetes during your pregnancy, that doubles your risk of developing heart disease. If you had recurrent miscarriages, if you had breast cancer or early menopause, these significantly increase your risk for heart disease.” 

Women often dismiss their symptoms or fail to seek medical attention. If they do go to hospital, they often have their symptoms dismissed or overlooked because they are not always “classic” medical textbook in nature. 

When they do get to the hospital, most women will actually have the classic symptoms of a heart attack. But they can also present with a lot more subtle symptoms as well. 

Says Dr. Amy, “It could just be nausea. It could be flu-like symptoms. You may have pain on the right side, jaw pain, back pain, or a general malaise or weakness. Women need to pay attention to all these warning signs. And if they experience any of them, they should see a doctor.” 

Advocating for Your Heart Health

In addition to becoming more informed about one’s risks and more body aware and vigilant, Dr. Amy encourages women to take the driver’s seat on their own heart health journey and advocate for themselves. 

“A big part of advocacy is becoming medically literate, and as a community, to ask for the help we want,” says Dr. Amy. “This is more vital than ever before given that our healthcare system is heavily burdened. Doctors and nurses are burned out. Wait times in the ER are long. So you need to have the knowledge and tools to advocate for yourself and say “I would like to have my heart checked. Can I have an ECG?” 

Dr. Amy also urges women start now — and its never too early — making behavioural changes including exercise, nutrition and sleep, that will yield positive results and benefits down the road. 

The Pillars of Prevention

When it comes to exercise, “It doesn’t have to be super complicated. There’s probably a hundred podcasts, journal articles, posts right now about the proper way to exercise right now. Any exercise, any form of movement is going to deliver benefit. And strength or resistance training to minimize the impact of aging on our muscular and skeletal system is key. I like to say, muscle is medicine,” she notes. 

When it comes to diet, Dr. Amy strongly encourages women to prioritize their protein intake to ensure they have sufficient nutritional support to maintain bone and muscle mass, aiming for 100 to 120 grams of protein a day. They should also take a hard look at their alcohol consumption. 

“Drinking alcohol is something we need to reconsider,” says Dr. Amy. “Alcohol is a massive risk factor for disease and cancer. It’s a bigger risk factor for breast cancer than hormone therapy. It is something we really need to be cutting out. There’s no healthy amount of alcohol. And so if you were going to drink, think about what drinking looks like for you. I urge women to reconsider having more than one or two alcoholic beverages a week.” 

Getting good sleep is another very important component of good health. “If you aren’t rested, you can’t lift the weights. You won’t have the mental capacity to take on the things you want to do in midlife. And the stress of not sleeping is its own independent health risk,” she explains.

Women should be aiming for between six and nine hours a night.

“The risk of sleep apnea rises during perimenopause and menopause. If a person continues to feel exhausted despite getting the proper amount of sleep or finds their sleep is disrupted, they should ask to have a sleep study done,” says Dr. Amy. 

Empowering Women for Healthy Aging

Dr. Amy has found a new purpose and passion in her work in the field of women’s health and healthy aging. Through Luma and her initiative entitled It’s Our Time Canada, she and her colleagues are now helping Canadian women from coast to coast better their health chances.

As a final word, Dr. Amy has this to say to Canadian women.

“Just know, it’s never too late to start. Have agency over your health and take your health into your own hands. Become empowered to age. It doesn’t guarantee you won’t get sick, but it will help pave the way for you to age healthily.”