The first question my cardiologist asked me, at an appointment I had booked to go through my cardiovascular markers, was how my periods were.
I burst into tears.
Not because of the question. Because of what it meant that he was asking it.
A few weeks earlier I had learned the word perimenopause. Not from a doctor. From a podcast I went looking for myself, after a year of being told everything looked fine while I watched my body do things I couldn’t explain. So I was already holding that word at arm’s length, the way you do when you’re not sure you want it to apply to you.
And then a cardiologist, in a cardiology office, asked about my cycle.
In a split second my mind wasn’t on my heart at all.
I’m aging.
Am I already too late?
Too late to protect my health?
Too late to have children?
None of that was in his question. I understand that now. He was recognizing something I hadn’t accepted yet, which is that my hormones and my heart were part of the same conversation and always had been.
I didn’t know that. I would have told you I understood heart disease.
My dad had his first stroke at forty-nine. Years later, a triple bypass. Heart disease was never abstract in my family. It was something I had watched up close, in hospital corridors, for most of my life.
What I understood was the event.
The stroke.
The surgery.
The blocked artery.
I didn’t understand the twenty or thirty years that came before any of it.
I thought heart disease was something that happened one day. I didn’t realize it was something that had been happening quietly the whole time, and that the day was only the day we finally noticed.
My cholesterol had been sitting a little outside the normal range for years. Every year the recommendation was the same, and every year I agreed with it.
Eat better.
Move more.
Lose some weight.
Let’s keep watching it.
That seemed completely reasonable to me. It seemed reasonable for about a decade.
Then I ordered more testing than my annual physical had ever included, mostly because I was trying to understand why I no longer felt like myself, and cholesterol turned out not to be one number. It was particle counts and inflammatory markers and a picture nobody had ever shown me.
For the first time my family history stopped being background. Not because it decided anything. Because it changed what I wanted to ask.
Here is the part that actually unsettled me, though, and it wasn’t the numbers.
I felt completely fine.
No chest pain. No shortness of breath. Nothing that would have sent me to a cardiologist if I hadn’t gone looking on my own.
Apparently that’s the point. Arteries don’t wait for symptoms before they start changing. Plaque doesn’t appear on the morning of the heart attack.
Disease often arrives in the medical record long after it has arrived in the body.
So I did what I do, which is decide and push.
Over the next year I lost more than twenty pounds. My insulin improved. My blood sugar improved. Most of the numbers I had been working on moved in the direction I wanted them to move.
Then I repeated the cardiovascular testing.
Some things improved. The ones I cared about most barely moved.
Further testing suggested my liver simply produces more cholesterol than average, and that genetics were doing more of the work here than I had wanted to believe.
I’ll be honest. That scared me.
Not in a dramatic way. In the quiet way that has you reading research papers at eleven at night, trying to understand what your own body is telling you, and wondering how much of this was ever yours to fix.
Somewhere in that same year I heard a cardiologist say, at a conference, that women’s health has largely been treated as reproductive health.
It sounds obvious written down. I haven’t been able to put it down since.
Almost everything I was ever taught about estrogen was organized around periods, pregnancy, fertility, hot flashes. Almost nothing was organized around the fact that estrogen had been quietly holding up my blood vessels, my metabolism, my muscles and my brain that entire time.
Which is why the question in his office landed the way it did.
He wasn’t changing the subject. I just didn’t know it was the same subject.
I used to think prevention meant catching something early.
These days I think it might be closer to staying curious while there’s still nothing to find, which is harder, because there’s no result to react to, and I am much better at reacting than I am at paying attention.
I don’t have this resolved.
I’m still working with my physicians. I’m still deciding whether lifestyle will be enough or whether medication becomes part of this. I’m still trying to rebuild muscle I didn’t know I had lost. Still trying to sleep. Still trying to be less impressed by my own ability to override things.
What has changed is smaller than a plan. I used to think of my heart as an organ I was supposed to protect. Some days now I can think of it as a system I’d like to keep for another forty years, and it turns out those are very different jobs.
But what I keep getting stuck on is the earlier part.
I was in the room for all of it. My father’s stroke, the surgery, the recoveries. I watched the whole thing and somehow decided that watching was the same as understanding.
I don’t know what I would have done differently at thirty-five if someone had explained it to me. Maybe nothing. That might be the part I can’t get past.
So the question I’m sitting with isn’t really which test to order next.
It’s whether I’m capable of paying attention to something that isn’t hurting me yet, or whether I’m going to need it to become an event first.
Paola
Every essay starts with my own life: my experiences, journals, voice notes, questions, and conversations. I write multiple drafts, rethink my assumptions, and revise relentlessly until the piece says what I actually mean. I use AI as an editorial partner to help organize ideas, improve clarity, and challenge my thinking. The experiences are mine. The perspective is mine. The final judgment about every word is mine.
This was great to read- so informative, tangible and relatable! Keep writing, you’re awesome!! ♥️