October 18, 2018
Doctor talking to a patient.

Women-Only Stroke Risk Factors

by Stephanie Watson

Gender is no barrier to strokes, which occur when blood flow to the brain is blocked (an ischemic stroke) or damage is caused by bleeding in the brain (a hemorrhagic stroke). But there are some gender differences when it comes to stroke: On average, women tend to have strokes later in life than men do, women have worse outcomes after a stroke, and some stroke risks for women are different from those of men.

Stroke is the fourth leading cause of death in women in the United States, according to the latest statistics from the Centers for Disease Control and Prevention. It’s the fifth leading cause in men. About 55,000 more women than men have a stroke each year, at least partly because of their longer life expectancy.

Many stroke risk factors—including high blood pressure, high cholesterol, smoking, and obesity—affect both genders similarly. Other risks—like atrial fibrillation (an abnormal heart rhythm), diabetes, or migraines with visual disturbances (aura)—affect both men and women, but they affect women differently. Women who have these risk factors have a higher chance of stroke than men do, and the strokes are often more severe in women.

Stroke risks specific to women

A few risks are exclusive to women, according to an analysis by researchers at Brigham and Women’s Hospital in Boston and their colleagues in a study in the March 2018 issue of Stroke. They point out that the risk factors—only a few of which can be controlled—are common in women, and just “a fraction of women” who have them will develop a stroke. Still, women should be aware of the following risk factors and try to implement healthy lifestyle behaviors to lower their stroke risk:

  • Hormone use. Prescription hormones used by women for contraception and menopausal hormone therapy, or MHT (sometimes referred to as hormone replacement therapy), elevate stroke risk. The same might hold true for feminizing (transgender) hormone therapy, but more research is needed in that area. The Women’s Health Initiative (a large, long-term national study) found that MHT increased stroke risk by about a third. The risk increases further when women who use hormones also smoke; are obese; or have diabetes, high blood pressure, or migraines with aura.
  • Age at menstruation. If you had your first period before age 11, you might have an increased risk of stroke later in life, according to some studies that have shown an association between the two.
  • Age at menopause. Going into menopause early (before age 45) has been linked to increased stroke risk. Experts believe the loss of estrogen may contribute to higher cholesterol levels and an increase in cardiovascular disease risk.
  • A history of pregnancy complications. A woman’s stroke risk increases during her pregnancy—especially if she has complications like pregnancy-induced high blood pressure (gestational hypertension), preeclampsia or eclampsia (serious conditions characterized by hypertension and protein in the urine), or gestational diabetes. That threat doesn’t disappear with time. Women with a history of preeclampsia or eclampsia continue to have an 80 percent higher stroke risk later in life than women with no preeclampsia or eclampsia history.

Gender inequalities

Though women face more stroke risks than men, they’re less likely to be screened or treated for them. A larger percentage of men than women take statins to lower their cholesterol or blood thinners to prevent strokes from atrial fibrillation. Men undergo procedures to treat atrial fibrillation at a higher rate than women do.

Time is of the essence when it comes to treating a stroke. To be effective, clot-busting drugs must be given within four and a half hours after a stroke. Women take longer to get to the hospital than men—a delay that could prove disastrous.

Possibly because of these disparities, women fare worse compared with men when they have a stroke. A separate study in Stroke looked at gender disparities after a stroke. The researchers found that women have more activity limitations, poorer quality of life, and more depression. The authors surmised that these negative outcomes may reflect women’s older age at the time of a stroke and the loneliness and lack of social support (older women are twice as likely as older men to live alone) sometimes associated with aging.

This article first appeared in the August 2018 issue of UC Berkeley Health After 50.

9 Strategies for Preventing Stroke

To reduce your likelihood of having a stroke, follow these strategies.