Heart disease is the #1 killer of women, yet many symptoms—fatigue, shortness of breath, back pain, and even sudden aging—are often ignored or misdiagnosed. In this episode of The Menopause Health Podcast, Susan Sly speaks with Dr. Robert Burke, MD, FASE, FSCAI, a leading board-certified cardiologist with expertise in heart imaging and interventional cardiology. They discuss the critical link between menopause and heart health, how declining hormones impact cardiovascular risk, and why so few women receive hormone replacement therapy (HRT). Learn how to advocate for yourself, when to seek a second opinion, and how wearables like the Apple Watch can help monitor heart health. Don’t miss this essential conversation on protecting your heart during menopause.



About Dr. Burke:

Dr. Robert Burke is a Mayo Clinic trained cardiologist and echocardiographer who is the Director of Noninvasive Cardiodiagnostics and structural heart imaging at HonorHealth in Scottsdale Arizona. He has served in this role for more than 15 years and was instrumental in developing the interventional echo program for his institution starting in 2011. He has been involved with multiple research trials involving TAVR/TAVI, mitral and tricuspid interventions. He is originally from New Jersey and received his undergraduate and medical degrees from Rutgers University.

Connect with Dr. Burke:

LinkedIn: @robert-burke-md-fase-fscai-79a43b96/

About Susan Sly : 

Susan Sly is the host of The Menopause Health Podcast and the Founder and CEO of The Pause Technologies, an AI-enabled platform helping women navigate menopause with precision recommendations and gamification. A seasoned entrepreneur and MIT Sloan graduate, Susan is a second-time AI startup founder. Before The Pause Technologies, she co-led a computer vision company that achieved the largest retail deployment at scale for both interior and exterior analytics. Globally recognized for her work in AI, Susan continues to pioneer the intersection of technology and women’s health, empowering women with the tools to thrive.

Connect With Susan Sly:

LinkedIn: @susansly

LinkedIn: The Pause Technologies Inc.

Website: https://thepause.ai/

Subscribe to our free newsletter here: https://thepause.ai/newsletter/

Hello and welcome to The Menopause Health Podcast. I'm your host, Susan Sly, and today's episode, we are going to talk about the symptoms that women choose to ignore, that could, in fact, be extremely dangerous. And my guest today, Dr. Bob Burke, is a board-certified cardiologist, and he has hundreds of five-star reviews.

And in this episode, we are going to be talking about why women should trust their gut, signs and symptoms, that there might be an issue with your heart that you're ignoring, and what are some very easy things to do that can help you mitigate heart disease and stroke.

So before we get into the show, I want to talk about thePause™ app. The app is live for our initial test users, and it is available on iOS. We already have many five-star reviews. When you start to use the app, you will answer a few questions, and we will tell you which phase of perimenopause or menopause you are in.

There are 10 different stages, and so that's the first thing. Then you will get to engage with your own personal AI agent. Her name is Harmoni™, and she can give you recommendations on diet, lifestyle, and mental health.

And we have fun challenges, your daily resilience score, to be able to give you feedback in your body. And we'll talk about this in this episode with Dr. Burke, why that is so important.

So with that, let's go ahead and get started with this episode of The Menopause Health Podcast.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.

Susan, welcome to The Menopause Health Podcast, your go-to resource for practical advice, brought to you by credentialed health professionals and industry experts. Here is your host, Susan Sly.

Well, Dr. Burke, thank you for joining me on The Menopause Health Podcast. And I've been really looking forward to this episode, because one of the things that we know, and we've spoken about it on the show before, but if you're a new listener, listening, you might not know the stat that in the United States alone, heart disease kills more women than all of the top five cancers combined.

And Dr. Burke and I were talking prior to the show about this whole concept of "you don't know what you don't know," and it is a silent killer.

So I want to jump right in.

Dr. Burke, what are some of the symptoms of heart disease that women might be attributing to something else and sort of pushing off to the side, but could be indicators that something is wrong?

Well, Susan, thank you again for having me on the show. I greatly appreciate it. And you know, I really am honored to be a part of the show and to be able to bring some of this stuff to the fore.

As you know, we've spoken about this privately, you know, just off the record, that women's heart disease is ridiculously common.

You know, as Americans, like you said, women's heart disease is the number one killer.

So, you know, unlike a lot of our previous assumptions or misconceptions, you know, women are not immune to coronary disease and other heart diseases.

It's very, very real, and problematically, you know, we always expect heart disease to be, you know, Elizabeth, it's the big one, and, you know, just this typical crushing chest pain.

And even in men, that's foolish, because things don't work out that way. In medicine, there's always going to be variability.

Now, in spite of the fact that women make up more than half the population, women's symptoms are called, quote-unquote atypical.

That's a little bit dismissive, but that really has been the history of navigating women's heart disease and women's health to a very large degree specific to heart disease.

You know, the quote-unquote typical things will still happen, chest pain, with activity, exertion, you know, doing something with high heart rates.

And that's generally pretty simple. And I think that most women, if they feel chest tightness or pressure or they're short of breath, yeah, okay, they're going to pay attention to that and get a value.

Weighted but less obvious things, some shortness of breath with activity, chest pain or discomfort that can happen actually during sleep or wake you from sleep, chest pain that happens with emotion and stressors.

And I sort of hate to say it that way, but it's just—it's psychological stuff. And anytime you say emotional and women, you get dismissed, you know?

And that's a problem, because we know that you can provoke angina.

And these are—this is old, old data. This goes back to the '60s with emotional stress tests, where they would go and have a drill sergeant yell at guys, and then those guys would get chest pain from their angina.

Okay, I'll take that leap of faith that emotional stressors work in women too. I've seen that, and that's been a presenting complaint for a lot of women.

Sometimes you feel your heart race or pound or skip, and there's no reason for it that, again, can relate to heart disease.

It may be a rhythm problem, but it can also be a coronary problem, and it's really hard without data to make that determination.

One of the most frustrating things as a cardiologist is having patients who have seen other providers, whether it's urgent care or a primary doc or ER, and they get dismissed because, well, you know, "it's anxiety" without doing any real testing.

I think that dismissive level of or approach to care, it's inappropriate.

You know, at this day and age, we have the ability to work with honest-to-God data. We can do EKGs, we can do blood work.

We can do ultrasounds of the heart that have no radiation exposure. They're not going to increase the risk of anything because of radiation.

It's all ultrasound, the same stuff that we use to look at the babies before they're born.

So that's about as low risk as we get.

And we can do more invasive things. Yes, we can do CAT scans and angiograms and all that to be truly definitive, but I think that if a diagnosis is being leveraged based upon symptoms that a woman is worried about, if there's no data, you don't really have a diagnosis.

So I think that's really important for women to appreciate and also to remain their best advocate, because ultimately, nobody else can take care of you, and nobody else knows what you're feeling.

So if something just isn't right, you've got that little voice inside of your head that says, "You know this, something's wrong, something's weird."

You know, you need to advocate for yourself, you need to keep going until you get a reasonable answer so long you did answer to a very brief question.

It's a great answer, and the search for the truth, in my own experience, can be—it can be time-consuming. It can be exhausting, especially when you have a lot of other things going on in your life, right? And that's for women and for men.

I want to ask you, and I don't know, Dr. Burke—it's Fact or Fiction—that there can be some other subtle signs that something is going on with the heart that aren't necessarily the chest pain piece.

And I have heard that men and women can have different symptoms. Is that true?

It—

—is, you know, and there—there are men who have symptoms that are more typically feminine or female and vice versa.

But the subtle stuff and the things that may not be appreciated are changes in exercise tolerance or energy, and we all have that from time to time.

But if things just aren't going in the right direction, and certainly, I think the best one is when people feel that they got older quickly, and that is the most nebulous, vague thing, but I've heard it time and again where I just—you know, "I'm just getting old."

You know, you're 60 years old. You don't just get old overnight.

You know it—something is going on, and you need to have a very open mind with regard to what may be cardiac because if you don't have an open mind, you shut that down, and then you wait for something else to happen.

The scariest stuff that we navigate are patients—more often women than men—who have the quote, unquote silent heart attack.

They have an event—maybe while they're sleeping. It can be small, but they wake up and they just feel crappy.

And you know, "Well, maybe I've got the flu, I've got a cold, I'm just run down. I've got a lot of stress. I'm working too hard," you know, whatever else.

And we rationalize a lot.

So again, those very nebulous things of loss of energy, feeling like you got older, quite literally overnight.

For some folks, that deserves an answer, because it just shouldn't be happening that way.

To think about that—there's so many.

One of the stories that comes up as you—as you say that is, I had a good friend, and his name was Ken, and he was 46 at the time, and he was my running partner.

And anyway, he said, "Susan, I just feel so old."

And I went, "Ken, you're 46. Like, you're not old, like the—you know."

And—and 90 days later, he got diagnosed with stage four cancer, and he—he died at 47, leaving his wife, Rachel, and their two children, Stella and Michael.

And it was just—it was so fast.

And I love that you said that because it's not normal just to wake up one day and say, "I suddenly feel old."

I mean, he never said that before.

I want to ask you. And again, I don't know if this is Fact or Fiction.

I had another friend, a girlfriend, who's had numerous heart attacks, and she said one of her first symptoms was actually pain between her shoulder blades in her back.

And again, these things we don't necessarily associate with the heart.

Is that myth in the whole left arm thing? I don't know.

So—

Yeah, to your point. You know, the classic—you know, you have chest pain, pressure. It's in the left side of the chest. It may irradiate to the shoulder. It may radiate to the jaw, may go down the left arm.

If you've got that—great—it's a slam dunk.

You know, a med student is going to diagnose your coronary disease.

But I've had patients who have jaw pain and—or they've had belly pain.

They think that they've got, you know, a stomach problem. They think that they've got GERD.

They had pain between the shoulder blades, just like you described.

Any of those symptoms—and really, almost anything from your nose down to your belly button—can clearly be related to the heart.

And that's why having a very open mind and just being flexible in the way that we approach this becomes incredibly important.

You know, the weird symptoms—let's say it feels like reflux.

And you know, "Oh, I've had heartburn before."

And I've done hundreds of patients with heartburn that was really their heart and not their stomach.

They're popping Tums. They're popping whatever.

You know, they do their Pepcid, they do other antacids or whatever, and it's not getting better.

Interestingly, the pattern, though, tends to be more exertional.

So if you're getting heartburn when you're going out for a jog, that's not normal.

You know, you deserve more than "Here's your antacid. Have a nice day."

You know, "Take some Pepto-Bismol. You'll be fine."

It needs to be evaluated.

So anyone listening—what I'm hearing from you is—anyone listening, watching, and you're thinking, "Something just doesn't feel right."

Trust your gut, right?

And we know now in science that the bulk of serotonin is produced in the gut.

The gut is considered the second brain.

And this whole concept of your gut—there is truth to that.

One said, "It's just stress."

Another one said it was PMS.

And it turned out I had an amoeba, and it was shutting down my organs, right?

And so I know from experience that if something doesn't feel right, we do have to pursue it.

I want to go back to what you said about the data.

And we say in women's health that there is a data desert, and I don't know that everyone listening, Dr. Burke, really understands what that means.

And I want to share—so our mutual friend, Mia.

Mia and I were at Consumer Electronics Show, and I was speaking on agentic AI, and there was another panel, and one of the panelists—who is an AI investor—you know, they—they write checks for $50 million, $100 million.

He said, "Well, all the data is already created on humans. It's already been validated. We don't need any more data. We can just use synthetic data."

And I—I started laughing out loud, and it was so quiet, and Mia looks at me, because I—I know this is not true.

I don't think people realize, especially for women's health, what a data desert it is.

And Dr. Mitzi Krockover was on the show—we talked about this a little bit.

But could you share, from your perspective, as a cardiologist, as someone who is a specialist in AI, why we can't be building these predictive models yet because of the lack of data?

We've got an incredible paucity of data.

We've—we, the royal "we"—have been following.

And I'll use cardiac disease as the specific area.

We have more data looking at coronary artery disease than probably any other singular disease state in the world, and that—that's a very simple statement.

You know, most—there's been tons of data, mega trials with tens of thousands of patients, and even within those, we have a lack of representation of women.

We have a lack of representation of pretty much every minority.

And to extrapolate from—typically—a bunch of old white guys to the rest of the world is foolish.

We don't have that data.

And even within that data, the worst part of it is that we have disagreement in how to interpret many of those trials that are really focused on old white guys.

So we can't come to consensus on a lot of things right now, in spite of having the most robust data set for a singular disease state to say, "Well, this is what we should be doing."

We continue to re-evaluate, we continue to publish more, we continue to do more—and—but still, unfortunately, focused on predominantly old white guys, and there's a bias, because those are the people that are approached to be involved in a trial.

They're the ones who are willing to volunteer to be in a trial.

Outside of—you know—the white population, there's a lot of distrust of the medical system and doing research, and historically, that is well-founded with things that have happened in the past.

You know, our last century—even with a lot of misuse and inappropriate experimentation on humans.

Now, we have different rules that we play by now, but the rules that we're playing by right now don't change the past, and they don't change people's perceptions of whether or not they even want to be involved in a research trial.

We've excluded women from trials historically because it's too complicated.

There are hormones.

What's—you know—what's the risk of?

"Oh, you might get pregnant. Oh my God, we can't do this. We can't do that."

And then we don't—and as a result, we have no data.

We can't pretend that we have that data set, and then just extrapolate and say, "Well, this—this should work for everybody."

It doesn't.

And even within the white male population, the European population is different than the American population.

So—and you know—once you go to Asia, forget it.

We've got—we're absolutely lost when it comes to having data that truly represents women in any of our trials.

And then we have very limited, focused studies like the Women's Health Initiative and DOPS and stuff like that that are useful, but methodologically, you have concerns about, "Well, what can we really say?"

These aren't directly looking for cardiac.

They're looking at something else, and then cardiac is an afterthought.

So we don't have the data.

I think that you—you were absolutely right in laughing out loud because we aren't even at the beginning of getting a reasonable data set to say, "What should we be doing for all of these women?"

Absolutely.

And—and the—I want to talk about the risks in that, but I also want to—I want to step back a bit for the listeners who are not health practitioners to understand the difference between a man's heart and a woman's heart.

And this doesn't even take into account, say, populations like Southeast Asian, where Southeast Asian women have smaller blood vessels than—than white women.

As an example, there's so many nuances around this.

And Dr. Burke, can you talk about the structural differences between a man's heart and a woman's heart?

Because, again, looking at the data and looking at—how would we even begin to create predictive analytics if there is no data to create those algorithms?

But it all starts with anatomy and physiology.

So can you talk about—I mean, 101, right?

What are the differences between a male heart and a female heart?

So, again, you already brought it up.

There are inherent differences in size.

You know, men and women are different sizes.

That's fine, and even at a given height, the men's hearts will be larger than women's hearts in general.

The coronary arteries, at least within Caucasians, are generally larger in both men and women than Southeast Asians.

Southeast Asians really are a challenging group from a coronary standpoint, because they have very small arteries, and they're very much prone toward diabetes and metabolic issues and all of that stuff.

But that—we can go off on that tangent for a while.

But men and women are inherently different.

Shocker, you know.

And size is not the only thing.

When we do something as simple as an EKG, you know, and everybody's had an electrocardiogram or is familiar with it—you know, you see the little strips on the emergency shows and all of your TV shows.

When you do interpretation of the ECG—the electrocardiogram—there are different numeric normative values for repolarization of the heart, and we take that just as a given.

But the thought behind that is, "Well, why in the world do we have different electrical properties of the heart muscle of those cells?"

This is a cellular thing between men and women.

A woman's heart will depolarize a little bit slower than a man's, and that gives us different normative values for something as simple as an ECG.

So it goes much deeper than just, "Well, what does it look like on the outside?"

This goes down to a cellular level, and it goes down to an electrical level, that men's and women's hearts are not the same, and really can't be grouped together as just—"Well, this is the only thing we need to know."

I think that, to your point, that's a very foolish statement, and really undermines where we want to go as a society, and really where we want to go with our science.

The thing I love about this show is I always feel that after every interview, I get smarter, and so where my mind goes—

Disappoint you?

No, you're definitely not.

Where my mind goes in terms of the dangers—so when we think about the fact that we are in the state of whether it's prescribing lifestyle interventions at the lower end, to pharmacological interventions, or surgical interventions at the more extreme end—using the data that was done on males, which I understand is about 70% of that data set came from middle-aged white men.

And hey, I love middle-aged white men. I'm married to one.

But the reality is, there are some inherent dangers to that, and so women may end up with greater risks.

And can you talk about that?

I mean, this is not an easy problem to solve, and I know we're working to solve this at thePause™, but can you talk about what those dangers are, given—or what the risks are—the very—

There are a lot of risks that we don't fully understand.

You know, making assumptions that we can use the same tools and gadgets and everything, and that's a limitation, because things that we've designed for men don't always fit well with women.

You know, from something as simple as a coronary stent to artificial valve placement—you know, there are differences.

And you know, again, if you've got a larger heart, you know, these gadgets that we like to use—whether it's artificial valve implants or coronary stents—they fit better in a larger area.

And the smaller it is, the more technically challenging things are, and also we end up with limitations, even from a surgical standpoint, as to what we can do safely to provide a cure for different diseases—whether that's coronary disease, whether that's valvular heart disease, all of that.

I think that your first part of the statement—you know, something as simple as diet and lifestyle modification—is incredibly important to address, because that really is fundamental to everything that we do.

And I think that we harp on activity and diet, and we sort of yell at men, and women are just like, "Well, you'll be okay. Just go out and take a walk and it's fine."

I think that that is, again, dismissive, because that diet and lifestyle modification has to be at the forefront.

And unfortunately, particularly in the States, we don't do that well.

We do a really poor job with that—shocking, but it's the truth.

You know, we have more fast food, we have more sedentary patients, we have more of all of those bad things than any other country in the world—with the exception of maybe Australia, because we follow the same rules.

So we've really done ourselves a disservice by not having that as the upfront strategy.

And yes, we have excuses for it in the States, because we build—you know—horizontally, and you need a car to get everywhere.

So there's not that inherent walking to the market.

There's not the inherent "you pick up your food fresh today because you don't have a refrigerator and a deep freeze and all this stuff that you're going to basically be ready for the next three months if you need to on your own."

The houses in Europe are smaller.

The storage is smaller.

Everything is done more in real time.

We don't do that in the States, and also, we tend to be a bit lazy.

So we get the frozen thing, we go, we heat it up, we eat it.

We're done.

And that's really not gonna—that's not gonna be the same.

So that diet and lifestyle part that you—you brought up—critically important.

And again, I do think that there's a bit of dismissiveness with that.

When we talk to women, and it's not, "Well, you really got to get out there and hit the gym."

Most people aren't telling the ladies to hit the—

—gym.

And that—I think there's some—some positive changes, and there are some—there are some universal truths for men and women.

I'll give one example, coming from my background five million years ago as a holistic nutritionist, and I taught at the college level.

But the Framingham Study is one of my favorite studies because it was the most comprehensive study on diet.

Initially, it was meant to study cardiovascular health, but it ended up—because it was so—it was a multi-decade study—looking at the benefits of something as simple as five to seven servings of fresh fruits and vegetables a day.

And to your point, Dr. Burke, most people don't get that—even in a week—in the United States.

And it is—it—there are lots of—and I've heard many, many arguments, whether it's accessibility, whether it's cost, and so forth.

And regardless of a person's particular opinion about it, what the Framingham Study found is, when it comes to cancer—even though we're talking about cardiovascular disease—that five to seven servings of fresh fruits and vegetables a day would lower your risk of all cancers by about 70%.

So even when we were building Harmoni™ for thePause™, she's trained on the Framingham data, because when we look at extensive evidence-based research in terms of lifestyle interventions, right?

So it's—it's things like that that are very simple, yet simple to talk about but not always simple to do.

And I know I'm not perfect.

My gosh, just before we were going to the show, Dr. Burke saw me, and if you're watching on YouTube or wherever you're watching—so I'm—I'm drinking a shake, and I have frozen organic berries in there, so I have two servings of my five to seven I'm aiming for.

And no, red wine doesn't count.

Dr. Burke, you and I love the Apple Watch.

And full disclosure, we are—we have no skin in the game from Apple whatsoever.

I haven't tried the Samsung Watch yet, so I can't speak to it, but I do know that you are a big fan of the new watch and its ability to do an EKG on the fly.

Can you talk about that?

Because I have that—so I press the button, and it's fun, but, you know, tell us—like, you know—why is that valuable, and who might be interested in that feature?

Again, Dr. Burke and I have no—we do—we do not get royalties from Apple.

But Tim Cook, if you want to give us royalties, we'd love them.

So, but—um, anyway, can you—

—turn it down?

That's okay.

So the—the Apple Watch is great, and I've had an Apple Watch for many years right now, and the most recent one.

But the beauty of the Apple Watch is—as a wearable—it has actually been studied.

One of my partners was at USC when they did some of the original validation trials, and it is comparable to medical devices as far as its accuracy.

Of course, Apple is smart enough not to turn it into a medical device, and you need a prescription to buy one, and they certainly wouldn't want to go and cut that off, because that'd be rather foolish.

But the watch has the ability to just hang out in the background and pay attention and look for rhythm problems, and it can provide alerts for rapid heart rate, slow heart rate, and rhythm problems like atrial fibrillation.

Atrial fibrillation is important because it is the number one cause of preventable stroke in the United States, and it's the number one cause of disabling stroke.

Those are the bad ones that—you know—put you into a nursing home.

You can't eat, you can't drink, you can't move half of your body.

I've—

—had five friends in the last year who've had strokes.

So sorry—as a sidebar, this is what you said too—I apologize for cutting you off.

This is my PSA—I have had the pastor of our church had a stroke.

My—three of my girlfriends had strokes.

Two of my guy friends had strokes.

And these were people who were active daily.

And so I just wanted to put that PSA out there.

Apologize.

It's—I'm shocked, actually.

Again—

It's—it's a very real thing, and your experience is not singular.

I think that we've all had friends, family, colleagues that have these events, and, you know, it's—you know, something like the Apple Watch, in and of itself, is a great tool to sort of stay on top of that.

And Susan, to your point about—you know—being able to get an EKG pretty quickly.

If you want to go, you pull up the app, you go, you hold the crown, and you hold it down, and you get a 30-second strip of what's going on with your heart.

That is an incredibly valuable tool for me as a cardiologist, because if I have patients who are having palpitations—their hearts racing, pounding, skipping, whatever—all I can tell them when they talk to me is, "Well, you feel your heart beating. You have 100,000 heartbeats a day. If you felt every one of them, it would drive you nuts in short order."

So feeling your heartbeat doesn't necessarily mean that there's a problem.

It means that you're feeling it.

Having a tool to actually get data—objective data—and say, "Okay, the heart rate was this. It was fast, it was slow, it was irregular."

It was irregular—that can get downloaded into your phone, that can be loaded into the portal, and I can actually look at a rhythm strip and get a much better idea of what we're dealing with.

So sometimes, you know, you're just feeling normal heartbeat stuff, and it's not dangerous.

That's great.

That's good news.

Is it a nuisance? Yeah.

And we all have times when we occasionally feel skipped beats or whatever, and that's completely normal.

But having a tool where you don't have to go to the emergency department, you don't have to go to urgent care, you don't have to go to your cardiologist, and you can get that data and then share it, is incredibly powerful.

And I do think that wearables like the Apple Watch are going to be much more common, and they're going to be really much more integrated into the way that we practice medicine moving forward.

Absolutely.

And—and I do have another question for you.

It's random, and I'll get to it in just a moment.

And that was—when we were building thePause™ App, wearables were such an important integration because of that concept, especially for women.

And looking at—as an example—my daily resilience score.

So when Mia and I were at the Consumer Electronics Show, we were comparing our daily resilience every single day.

So that score is pulling from a variety of things, including heart rate variability (HRV) and so on and so forth.

And it was interesting, Dr. Burke, as each day went down on—you know—between the cigarette smoke and all the stuff in Las Vegas—like, I don't smoke, and neither does Mia, but we have to walk through it, right?

And every day, I started—I think—the week at something like 86, and every day was gradually a little less, a little less.

And it's amazing how our external environment and those stressors do come into play with things like HRV and—you know—other aspects.

Okay, this is my burning personal question.

So I used to be a professional athlete, and one of the things I'm obsessed with in my Apple Watch is my resting heart rate.

And can you share with everyone?

And again, this is really—I want everyone to leave the show with an awareness piece.

And this is a great show, ladies, to share with your partners, with your—you know—brother, whomever it is, because this is—you know—we all have a heart, right?

And so we—we want to protect our hearts.

Could you share, what is the—what is the average resting heart rate for, say, someone who's healthy?

What—what should a heart rate range look like?

If someone says, "Oh my gosh, that's not necessarily in the healthy zone."

Is—are—can you—

—tell?

So that is highly variable, and it does depend upon how much exercise people do and what kind of exercises they like to do.

You know, for endurance athletes, people that are out there running several miles a day, their resting heart rate is going to, more often than not, be technically slow.

You know.

And slower than normal, and can actually be read as abnormal by an ECG.

You know, with heart rates in the 50s at rest, it's not dangerous.

You're not going to pass out.

They don't need pacemakers, none of that stuff.

And I've had elite athletes who have resting heart rates down into the 40s.

They feel fine.

That's just—that's the whole athlete heart and remodeling.

For most of us who are generally active, our resting heart rates may be in the 60s or 70s, that kind of thing, and that's perfectly normal.

For some of my folks who are pretty sedentary, they can still have heart rates in their 60s, 70s, sometimes as much as 80 at rest, but again, not causing any specific problems.

The utility, particularly with the wearables and stuff like that, and if you're using, like, an Oura Ring or whatever else, and you're getting resilience, is looking at—you know—what's happening with your sleep architecture?

What's happening with that heart rate decreasing as we sleep?

Does it decrease quickly?

Does it take a long time to decrease?

What's the heart rate variability (HRV) going on there?

And that heart rate variability and that slowing down of the heart really relates to our autonomic tone, and that's the whole vagal stuff that we talk about with that.

That is a good marker of overall fitness and overall wellness.

Things like yoga are very good for helping to increase autonomic tone, help to decrease the heart rate, help with heart rate variability, and all of those have been shown to be beneficial and markers of being—you know—more healthy, shall we say.

But there are lots of things that we can do that screw that up on a daily basis.

You know, from going to work out late in the day, having to eat late, you know, having that last nightcap or something like that, where the heart rate picks up at night and really doesn't slow down until later into the morning hours.

And it's a good reminder that we do have a direct impact on what happens with our bodies, with the activities that we have.

And you know, when you're at a convention or any meeting where the meetings run late, there's a lot more stuff going on.

You're sort of on your A-game continuously until 9 or 10 or 11 o’clock, because this is the chance to talk with those people.

And it's not that you get to do that every day.

Yeah, you sort of burn the candle a little bit there.

And that is reflected in the resilience, I think, that you’ll see that with a very predictable pattern.

Yes, and it's—I think the—the—the big piece is, and what I'm hearing, and I hope everyone listening is hearing this, is, we've got to trust our gut.

We've also got to know our data.

And our data right now is very much—our data is there, as you know, Shakespeare wrote, "To thine own self be true," right?

We—we don't have these data sets to be able to say, "People just like you should be X, Y, and Z," because it doesn’t exist.

And so knowing your data, and even tracking your data, and I know for myself, Dr. Burke—so my resting heart rate is usually around 46, and once it's in the 50s, I know I am burning the candle at both ends.

And that's the time where I say—and I've had this conversation with your wife—where I say, "Okay, you know what? That’s when I back off from interval runs and hardcore stuff, and I spend a few days doing easier workouts, maybe going for an easy hike, long walk, that kind of thing, until it gets back down."

But it's because I know it, and I’m tracking it, and I’m using wearables, and I’m doing all of those—those things and that.

And I think that one of the pieces is just being in tune with our own bodies.

So we know, "Wait a minute. Like you said at the very beginning of the show, this is not—this is not normal. Something is not right."

And if it feels like it's not right, we tell our children, "See something, say something."

Well, we have to tell ourselves that and look in the mirror.

I have a final, final question for you.

And this is a—you know—it's a big topic, but when it comes to HRT, less than 5% of women in the U.S. are on hormone replacement therapy.

And what we're seeing is a trend that—I liken it to when Botox first started.

Suddenly, everyone is—you know—prescribing hormones, but not everyone is trained to do so.

We're seeing women with pellets that shouldn’t have pellets, we’re seeing—you know—there’s—it’s a—it’s a big mess out there because there’s a—it’s—there’s a lot of well-intended folks, but there’s a lot of opportunism because of a great—you know—opportunity to make money.

But very quickly—

Who should not be on hormones, and who may want to seek a certified provider to explore hormones?

Well, I think you—you bring up a great point.

Prior to that, about 22% of women over 40 were on some form of hormone therapy.

Now, like you said, it's less than 5%, so—you know—to a large degree, we have thrown the baby out with the bathwater, as far as trying to navigate what we can do for these women.

Now, unfortunately, we've actually increased medical expenditure for women with that shift.

It's actually been a $4 billion expenditure for women in their 50s.

We spend more because we're now taking care of diseases that would have otherwise been potentially prevented, and that's a real-world number.

So we've also increased mortality for women in their 50s, between 19,000 to 90,000 women per year, depending upon how you want to look at the numbers.

And there's a lot of debate with that, and—you know—I'll just leave it at that, just as something to be aware of.

But when we talk about estrogen-only therapy, which is really what seems to be the best route to go—

You decrease cardiac disease, you decrease deaths, you decrease breast cancer deaths (believe it or not), you decrease stroke deaths, you decrease colon cancer, and you decrease all-cause mortality.

The only thing that seems to be increased a little bit—about 1.5 persons per 1,000 per five years—is blood clots in the lungs, and they're not necessarily fatal, because total mortality actually still goes down.

So across the board, hormone replacement therapy is beneficial, particularly in that younger age group, especially within the 50s.

Going longer has to be individualized, and really should be, and that's where you need to have the discussion with your physician or provider.

But to your point, this has sort of gone off into the weeds of "Everybody can do this."

You know.

You can be—you know—and I have nothing against ATPs (advanced practitioners), whether nurse practitioners, PAs, or other alternative providers, naturopaths.

I work with some great mid-levels and great naturopaths who do a phenomenal job with navigating hormone therapy.

So this is not the MD bashing everybody else, including DOs.

It's a matter of—you want to work with somebody who understands the disease process.

Because—you know—we have to approach it that way with our model.

It's a little bit of a misnomer, because it's just life.

And—you know—if you want to say aging is a disease, well—then okay, everything is a disease process.

Great.

But you want to work with somebody who does this on a regular basis and does have an open mind, and didn’t just take—you know—a weekend course, and now they're starting to do this stuff.

You know, I think that's really the most important part there.

But acknowledging the fact that hormone therapy, when it's done properly, is incredibly beneficial.

There are certainly patients who have very high risk for cancers—whether breast cancer, colon cancer, bronchopulmonary patients, that kind of stuff—that may never be a good candidate for hormone replacement therapy.

But again, that does need to be individualized, and I think that the contraindications are a bit much to throw right here, but again, that is where talking with your physician or provider and making a point of really having a solid conversation is critically important.

And I know in this day and age, it's hard to be able to get to sit down and actually have someone who wants to talk to you for more than 30 seconds before filling out a prescription and saying, "Get your labs and I’ll see you in a year."

But you do need to seek out that level of care so that you have a connection, and so that you know that somebody is actually listening to you and trying to treat you, and not—you know—some numbers on a piece of paper or within the computer chart.

Yeah, and that is huge, and it's—it might be time-consuming.

It might be—you know—you might—you might be—you know, exhausted with it, but really and truly—you know, again, like you said—

Trust your gut, get the second opinion, and—it’s your body, and you know your body better than anyone.

So, Dr. Burke, thank you again for being on the show, and we would love to share the research stats that you had in the show notes so people can look at those.

And again, I have a whole page of scribbly notes here that no one can read but me—not even an AI could read these.

So thank you.

Okay, well, thank you again, Susan, I greatly appreciate the opportunity to be on the cast with you, and this is great.

Thank you.

So, for everyone listening, this has been another episode of The Menopause Health Podcast.

Check out our other great episodes—if today really struck a chord with you, and especially with regard to the research data, check out the show I did with Dr. Nina Burns from NIH and Dr. Mitzi Krockover, where we talk about women’s health data and what is going on.

So with that, go rock your day, and I will see you in a future episode.

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This transcript has been generated using AI technology. There may be errors or discrepancies in the text.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.