'I got out of bed and fell over — it began to dawn on me that my legs wouldn't work'

Cardiovascular disease affects females as much as males, with their risk increasing around the time of menopause due to hormone changes in the body

Rachel Corbally and her grandson Finn, 4 months. Photograph Moya Nolan

LIFE changed forever for Rachel Corbally in January 2017. “I was so healthy back then,” the 53-year-old former building contractor from Naas, Co Kildare says.

“My diet couldn’t have been better. I spent hours at the gym, three or four times a week, working out on the treadmill and rowing machine before doing weights, resistance training and swimming 30 laps of the pool. I felt strong and looked amazing.”

That Monday morning, the then 47-year-old woke up feeling groggy.

“My head was fuzzy, and I had a headache, like a hangover, except that I hadn’t had anything to drink the night before,” she says.

She received a text message and started to reply, only to realise she couldn’t type properly. “Then I got a sudden urge to pee, so I got out of bed and promptly fell over,” she says. “It began to dawn on me that my legs wouldn’t work.”

Confused and frightened, Corbally called out for her adult son in the next room. “He lifted me up, noticed my face was starting to drop and told me he thought I was having a stroke.”

She was rushed by ambulance to Naas General Hospital, where her stroke was confirmed, and from there to Beaumont Hospital for a thrombectomy. This procedure involves removing the clot in the brain causing the stroke. Corbally credits it with saving her life.

“I woke up at 4.20pm that afternoon with my two kids at my bedside worrying that I’d been left disabled, paralysed or unable to talk,” she says. “But apart from feeling tired, hungry and a bit weak in my left leg, my stroke left no lasting physical effects. I left hospital five days later.”

Cardiovascular conditions such as heart disease and stroke are often seen as conditions that primarily affect men. But Corbally’s story disproves this notion and so do the statistics.

“There’s a false belief that cardiovascular disease (CVD) is a man’s disease but one in four women die from heart disease and stroke each year, which is the same as men,” director of health promotion with the Irish Heart Foundation (IHF) Janis Morrissey says.

In Morrissey’s experience, women are far more aware of their breast cancer risk than CVD risk.

Yet they are six times more likely to die of the latter than the former.

The 2021 Lancet Women and Cardiovascular Disease Commission report explains the reasons for this disconnect. “It found that heart disease and stroke in women had been under-researched, under-diagnosed and under-treated,” Morrissey says.

The lack of research is because women have traditionally been excluded from clinical trials.

Take the Harvard Physician’s Health Study of the 1980s as an example. Not one of its 22,000 participants was a woman. The reasons given were women’s fluctuating hormone levels and the fear of foetal exposure to drugs in women of childbearing age.

Because women weren’t studied, the fact that their bodies might present differently or respond differently to drugs wasn’t considered. This could explain why a 2016 University of Leeds study found that women presenting with a heart attack were 50% more likely to be misdiagnosed than men.

This September, the IHF hopes to raise awareness of the risk of heart disease and stroke in women with its Her Heart Matters campaign.

“We want to help women look after their hearts and advocate for themselves,” Morrissey says.

“Women typically have busy lives, juggling professional and caring responsibilities. IPSOS polling conducted for the IHF found that 30% of women say they don’t have enough time each day to focus on their health.

“We understand that life can leave them short of time and energy but this September, we’re calling on the women of Ireland to take a little time to put themselves first and make their heart health a priority.”

Consider the risk

Dr Susan Connolly is a consultant cardiologist at Galway University Hospital and a National Institute for Prevention and Cardiovascular Health fellow. She wants women to understand that their heart disease and stroke risk increases as they approach menopause.

“Because of a focus on men in heart studies historically, many women do not consider their risk of CVD as part of their overall health status,” she says. “It’s true that younger women are relatively protected but from around the time of menopause, women’s risk can start to significantly increase.”

The average woman in Ireland experiences menopause at age 51, but hormonal changes, mainly falling levels of oestrogen, typically precede it during perimenopause. It’s this change in hormone levels that causes the increased risk.

“Cholesterol levels go up rapidly due to these hormonal changes, which can also cause weight gain, typically around the middle, and result in high blood pressure as well as insulin resistance and type 2 diabetes,” Dr Connolly says.

Additional risk factors include smoking, a family history of heart disease and stroke, an inactive lifestyle and poor diet.

Women’s gynaecological history is another factor. “It’s one that’s often overlooked,” Dr Connolly says.

“But a history of pre-term delivery, pre-eclampsia and early menopause has been associated with an increased risk of CVD in later life.

“When women are being assessed for their cardiovascular risk, these factors must be asked about and considered.” Corbally didn’t realise it in 2017 but despite her outwardly healthy appearance, being perimenopausal increased her risk of stroke. “I’d started having night sweats and mood swings,” she says. “But apart from that, I had no other risk factors.

“My stroke came completely out of the blue.”

Rachel Corbally and her grandson Finn, 4 months. Photograph Moya Nolan

While Corbally may not have been physically impaired by her stroke, it has taken a psychological toll.

“I went back to work too soon and struggled on for three years, finding it hard to concentrate and worrying about making mistakes. I’d be terrified falling asleep at night, fearing it would happen again. One night, I woke up and my arm had gone numb. I called out to my son in a panic, convinced I was having another stroke.”

Her elderly parents’ ill health further exacerbated her situation. “They were living in Spain, and as I couldn’t cope with the stress of working in construction anymore, I stopped working and moved to Spain to look after them,” she says.

Her parents’ health improved and she has recently returned home after two years of living abroad. “I’ve been back for a few months now and am considering my next chapter in life.”

Corbally’s experience has led her to believe there aren’t enough supports for stroke patients.

“I had no choice but to return to work as a single woman with a mortgage to pay,” she says.“People who have had a stroke or similar should have the option of receiving disability benefit for a year. They need that time to deal with what happened and to mind their physical and mental health.”

According to an IHF patient survey report from June 2023, it’s not just stroke services that are lacking.

Some 26.9% of heart failure patients felt abandoned post diagnosis and 74% didn’t have access to adequate psychological support.

“Their struggles can have a hugely negative impact on their ability to stay well post-discharge,” Morrissey says.

Rachel Corbally and her grandson Finn, 4 months. Photograph Moya Nolan

Replacing lost oestrogen

While it’s vital that women are aware of their increased risk of CVD as they approach menopause, Morrissey also wants them to know that there are steps they can take to prevent it.

“The good news is that 80% of premature heart disease and stroke is preventable through healthy lifestyles,” she says.

“Taking steps like stopping smoking, increasing exercise, and adopting a cardioprotective diet can all make a big difference,” Dr Connolly says. Replacing lost oestrogen through hormone replacement therapy (HRT) could also help.

“HRT reduces menopausal symptoms and protects bone health in women,” Dr Connolly says. “Older studies associated it with an increased risk of heart attack and stroke, but they used older generation HRT treatment in women who were more than ten years past menopause. More recent data shows that modern HRT, which is lower in strength and in patch form, can protect cardiovascular health if started close to menopause.

“The data is not yet robust enough for us to formally recommend it to reduce risk. The best thing is to chat it over with your GP.”

It’s also a good idea to ask your GP for a cardiovascular checkup. “This should include things like getting your cholesterol levels and blood pressure checked,” says Dr Connolly.

“Assess your lifestyle and activity levels as well as your family history. Women shouldn’t put their heads in the sand. Knowledge is power.”

Corbally is planning to put her knowledge into practice.

“I’ve just had my first grandchild and it’s made me realise how lucky I am to be here to meet him,” she says.

“If I want to stay here, I have to start looking after myself. That would be my advice to all women: Stop rushing around looking after everyone else. Take time for yourself.”

Rachel Corbally and her grandson Finn, 4 months. Photograph Moya Nolan

Minimise the risk

The Irish Heart Foundation’s director of health promotion, Janis Morrissey and cardiologist Dr Susan Connolly share tips on how women can minimise their risk of heart disease and stroke.

1. Get checked annually. Ask your GP to measure your blood pressure and heart rate and test for cholesterol and diabetes.

2. View menopause as a time to take stock of your health. “Go to www.irishheart.ie to complete our free online self-assessment tool to identify the changes you’d like to make to your life and our self-care and wellbeing journal that will help you get into the right mindset to make those changes,” says Morrissey. “You can also sign up for our free women’s heart health webinar on September 29.” 

3. Be aware of risk factors, including high blood pressure, high cholesterol, diabetes, and a family history of heart disease and stroke.

4. Stop smoking. Studies show it reduces your risk of heart attack or stroke by 50% within a year.

5. Eat a balanced diet. “The Mediterranean diet is best,” says Dr Connolly. “This means fish once or twice a week, red meat twice at most, and lots of fruit, vegetables, nuts and pulses. Cook with olive oil. Keep your alcohol intake within the recommended range. And avoid processed foods.”

6. Get active. At least 150 minutes of moderate-intensity weekly activity is recommended for good health.

7. Manage your stress levels. “Many women juggle multiple demands,” says Morrissey. “To minimise stress, try to keep a regular sleep routine, be physically active and stay connected with family and friends.”