Did you know that stroke kills more women than men each year and is a leading cause of death? Yet too few women realize their risk. After 85, nearly twice as many women suffer strokes as men. Even between 20-39, a female’s stroke rate is double that of males.
But why? As we transition from perimenopause into menopause, hormone changes chip away at estrogen’s protective effects against cardiovascular disease. But it’s not just age – the symptoms of stroke also present differently. While men report the typical unilateral one-sided paralysis or weakness that we associated with stroke, women may experience subtler signs like dizziness, visual disturbances, fatigue, and cognitive fuzziness. The delays that come from a late diagnosis make the outcome worse in women.
Yet knowledge is power – and knowing what your risk factors are. Women have some unique risk factors for stroke that you might not be aware of. Let’s look at some of those.
Pregnancy-Related Risk Factors
Did you know that women who have certain conditions during pregnancy are at higher risk of developing a stroke? Here are some pregnancy-related complications that place women at higher risk of stroke:
Preeclampsia and eclampsia: These related conditions involving high blood pressure during pregnancy significantly raise the risk of stroke during the later stages of pregnancy and in the first few weeks after giving birth. The risk seems highest right after delivery. They also increase the long-term risk of stroke and heart disease.
Gestational diabetes: This pregnancy complication also increases stroke risk during pregnancy and after birth. One analysis found women with gestational diabetes had double the risk of ischemic stroke over the year after delivery compared to those without. Gestational diabetes also correlates to a higher lifetime risk of type 2 diabetes, another stroke risk factor.
Plus, women with a history of adverse pregnancy outcomes like preterm delivery, having a small-for-gestational-age baby, miscarriage, and stillbirth seem to have a higher risk of stroke later in life. Researchers think pregnancy serves as a “stress test” that can reveal underlying vascular problems.
Hormonal Factors
Hormonal factors before and after menopause can place you at a higher risk of stroke, especially estrogens. Studies show that estrogen causes slight increases in blood clotting factors. If a clot travels to the brain, it triggers a stroke. So far, this risk seems to mainly happen with estrogen-containing birth control pills, less so with progesterone-only ones.
Now for the bad news – smoking and estrogen meds are a dangerous combo. Together they dramatically increase the chance of forming blood clots that lead to stroke. So, if you smoke, it’s critical to quit if you want to be on the pill or hormone replacement therapy.
Hormone therapy works similarly – higher estrogen levels equal higher stroke risk. One option is to only take estrogen plus progestin instead of estrogen alone. It’s not perfect but can help lower the odds.
The bright side is that for healthy women who don’t smoke, the threat of stroke is still low with these meds. But you can play it extra safe by using the smallest estrogen dose that works for you. Knowledge is power.
Menopause
As if the hot flashes, mood swings, and other “joys” weren’t enough, our risk of stroke goes up with the decline in natural estrogen production. Without enough estrogen floating around in our blood, things get out of balance. Substances that cause blood clotting build up while the good stuff that prevents clots decreases. Not a good combo!
So, this shifting hormone situation makes it more likely that a blood clot could form and eventually travel up to our brain, blocking blood and oxygen. And hello stroke! Even though we picture strokes happening to elderly folks, women as young as 40 or 50 can have them after menopause starts. However, as you see from the news on hormone replacement therapy, taking hormone replacement isn’t necessarily the answer.
Autoimmune Disorders
Autoimmune diseases, where the immune system mistakenly attacks healthy cells affect more women than men. Common examples are rheumatoid arthritis, lupus, and multiple sclerosis. These conditions cause inflammation, or swelling and damage, in body tissues and blood vessels over time.
The inflammation that goes with autoimmune conditions can injure the delicate lining of blood vessel walls, making plaque buildup more likely. Plaque consists of cholesterol, calcium deposits, and cell waste that can narrow vessels and restrict blood flow. This process of hardening arteries is called atherosclerosis.
When blood flow to the brain is reduced, stroke risk goes up. A stroke happens when a blood clot blocks an artery carrying oxygen-rich blood to the brain, or when a blood vessel ruptures. Without enough blood, parts of the brain start dying.
For women with autoimmune diseases, the risk of stroke can be two to three times higher than for other women. Researchers believe persistent inflammation underlies the increased risk. Inflammation damages blood vessels, making them more prone to plaques and clots.
In summary, chronic inflammation from autoimmune disorders can ultimately compromise blood vessels over time. This vessel damage lays the groundwork for plaques, clots, and blocked or burst arteries that trigger strokes. Getting inflammation under control is key for lowering stroke risk among those with autoimmune conditions.
Migraines with Aura
Research suggests that about 3 times more women than men get migraines with these neurological aura symptoms. A migraine aura refers to neurological symptoms that can occur before or during a migraine attack. It’s called an “aura” because the symptoms are often visual disturbances that appear as flickering or shimmering lights, zigzag lines, or blind spots in one’s field of vision. Scientists aren’t sure why there’s such a big gender difference. It might relate to hormone fluctuations, which is why many women find their migraines occur around their menstrual cycles.
Now in terms of stroke risk, some studies indicate that women who experience migraines with aura may be up to twice as likely to have an ischemic stroke compared to those without migraines. That’s the type of stroke caused by a blood clot blocking flow to the brain.
The theory is that people who get auras may have underlying abnormalities in their blood vessels or vascular reactivity that makes small clots more likely to form. So, the same process contributing to the aura may sometimes set the stage for stroke, especially if other risk factors like smoking or high blood pressure are also present.
Conclusion
When it comes to stroke risk, women need to remember that they can face unique challenges compared to men. Working closely with your doctor is important to stay on top of your personal risk factors. Together, you can come up with lifestyle changes, medications, or screening tests tailored to your situation.
Keeping blood pressure under control seems to be especially critical for women to reduce stroke risk. More research focused specifically on gender differences related to prevention and treatment would help the medical community provide better care.
The key is for all women to partner with their healthcare providers to understand their bodies and take a proactive approach. There are many things we can do to lower the likelihood of having a stroke. But we each need to find out what will work best in our individual cases.
References:
“Migraine and Stroke: Reducing Your Risk as a Patient.” 04 Dec. 2017, https://americanmigrainefoundation.org/resource-library/migraine-stroke-reducing-risk/.
“Women and Stroke | cdc.gov.” https://www.cdc.gov/stroke/women.htm.
“Stroke Risk Factors Unique to Women | Stroke – AHA/ASA Journals.” 08 Feb. 2018, https://www.ahajournals.org/doi/10.1161/STROKEAHA.117.018415.
“Inflammation, Autoimmunity, Infection, and Stroke | Stroke.” https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024157.
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