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Background Chest pain is the hallmark symptom in patients with angina with non-obstructive coronary arteries (ANOCA), yet little is known about how symptoms may be influenced by women’s hormonal milestones. This study aims to explore the impact of menstruation and menopause on angina among women with ANOCA.Methods In collaboration with The International Heart Spasms Alliance, this study launched an ongoing web-based survey programme for patients with ANOCA. This survey was distributed internationally via social media platforms and clinician networks.Results To date, 744 women responded (mean age of 57 ± 11 years). Participants were predominantly of a Caucasian ethnicity (92%), and most resided in North America (42%), Europe (41%) or Australia/Oceania (16%). The responsible underlying ANOCA mechanisms included large vessel spasm (33%), coronary microvascular dysfunction (21%), both (32%), or unknown (13%). The average age of chest pain onset was 48 ± 12 years, with 329 (46%, 41 ± 12 years) experiencing pre-menopausal pain-onset and 380 (54%, 53 ± 9 years) peri/post-menopausal pain onset. Chest pain onset was unknown in 35 participants. In those with pre-menopausal pain-onset, 110 (33%) experienced catamenial angina, typically with frequent and intense symptoms in the pre-menstrual period. In those with pain onset during menopause, almost half reported more intense and more frequent angina symptoms over time. Among the 239 women using hormone replacement therapy or menopausal hormone therapy, most reported no change in chest pain intensity (74%) or frequency (70%) with treatment.Conclusion This is the largest study to evaluate the relationship between angina symptoms and hormonal milestones in a women’s ANOCA cohort. Approximately a third of women with pre-menopausal pain-onset experienced catamenial angina, and almost half of those with peri-/post-menopausal pain-onset had more intense symptoms over time. The study highlights that the menstrual history may impact chest pain symptoms in women with ANOCA and should be ascertained during clinical evaluation.