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In this article:
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Stroke is the third leading cause of death for women in the U.S., and more women die from stroke than men.
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Women have a unique risk factor for stroke that men don’t. Exposure to changing hormone levels through birth control, fertility treatments, pregnancy and menopause can increase the chance of having a stroke. But more research is necessary.
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To reduce the risk of stroke, women can maintain a healthy lifestyle, see their doctor regularly and talk to their doctor about hormone use.
The stroke-hormone link: What women should know
Did you know that someone has a stroke every 40 seconds in the United States? That amounts to 795,000 people each year.
Among women, stroke is the third leading cause of death and a leading cause of disability. Women have a unique risk factor that men don’t: exposure to changing hormone levels from birth control and fertility treatments or during pregnancy and menopause.
Here we examine the link between stroke and hormones in women.
What causes a stroke?
A stroke happens when something blocks blood flow to your brain or when blood vessels in your brain burst. Without the oxygen from your blood, your brain cells die quickly. As a result, you may lose the ability to move, speak, remember, think clearly, eat or control many bodily functions.
There are two types of strokes:
- Ischemic: This is the most common type, accounting for about 87% of strokes. A blood clot or build-up of fat or cholesterol (called plaque) blocks a blood vessel in your brain.
- Hemorrhagic: This is when a blood vessel in your brain bursts. Pressure builds up on your brain tissue, which progressively causes damage.
“Someone dies from stroke every three minutes, and women account for 57% of deaths,” says John Zurasky, M.D., a neurologist specializing in stroke and neurocritical care at Providence St. Vincent Medical Center. “More women than men will experience a stroke during their lifetime.”
Recognizing the signs of a stroke
A stroke can come on quickly and unexpectedly. Know the symptoms so you can act right away.
The BE FAST Method
To know the signs of a stroke, remember the acronym BE FAST:
Balance: Loss of balance or coordination
Eyes: Blurred vision or loss of vision
Face: One side of the face droops
Arm: Weakness or numbness in your arm, leg, face or one side of your body
Speech: Difficulty speaking
Time: Call 911 immediately
Women also may have other stroke symptoms. These may include:
- Fainting or seizure
- Fatigue
- Headache
- Lightheadedness
- Nausea and vomiting
If you think you or someone else may be having a stroke, this is a life-threatening emergency. Call 911 or get medical attention immediately.
Risk factors for stroke
Understanding stroke and its risk factors is important. For men and women, specific conditions can increase the chances of having a stroke. These include:
- Certain medications, including some antibiotics and treatment for epilepsy, tuberculosis or
- HIV
- Diabetes
- Early age of menses (periods before age 10)
- Family history of stroke or blood clots
- Heart abnormality or cardiovascular disease
- Heavy alcohol use
- High blood pressure
- Overweight or obesity
- Severe migraines, especially with aura
- Smoking
“People can manage some risks themselves, and those at high risk should talk with their doctor about ways to lower their risk for stroke,” Dr. Zurasky says.
How hormones affect stroke risk
There are some unique stroke risks for women. Hormones in birth control, fertility treatments and hormone replacement therapy (HRT) alter natural hormone levels. These changes have been associated with an increased risk of stroke.
The role of estrogen
Estrogen is a primary female hormone. It has several roles in the body. They include:
- Influences lactation
- Regulates menstruation and ovulation
- Supports pregnancy
Estrogen also improves blood flow, helps dilate blood vessels and lowers cholesterol levels. Research shows that this can reduce the risk of heart disease and ischemic stroke.
However, other evidence suggests that women who have prolonged exposure to high amounts of estrogen have a greater stroke risk. This is likely due to the role of estrogen in blood clotting. Supplementing estrogen (in birth control or HRT, for instance) can increase proteins that promote blood clotting and reduce proteins that prevent blood clots.
“Researchers continue to study the relationship between estrogen and stroke,” Dr. Zurasky says.
Birth control and stroke risk
Some birth control combines estrogen and progesterone (another sex hormone). Other contraceptives contain only progesterone, and some have estrogen only.
Some studies show that hormonal birth control can increase the risk of stroke — particularly pills with higher estrogen levels. Although estrogen improves blood flow, it can also raise your blood pressure and thicken your blood. That makes blood clots more likely, which can increase your risk of stroke.
But studies aren’t conclusive. More research on hormones and stroke may clarify the risk.
Fertility treatments
Although it’s rare, some medications to boost fertility or prepare your body for in vitro fertilization (IVF) can raise your chances of a stroke.
In IVF, you or your doctor injects follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to help your body produce more eggs. About one-third of the time, FSH and LH can create swelling in the ovaries. This may cause blood clots.
Pregnancy and stroke: What to know
Stroke during pregnancy is uncommon. But pregnancy and the period immediately after childbirth (postpartum) are associated with a higher stroke risk compared to young women who aren’t pregnant.
Some conditions during pregnancy can increase blood pressure, which may lead to ischemic or hemorrhagic stroke. These include gestational hypertension, preeclampsia and eclampsia.
Other rare conditions during pregnancy may lead to stroke. These include:
- Amniotic fluid in the bloodstream
- Dissection (tearing) of the neck arteries during labor
- Peripartum cardiomyopathy (weakening of the heart muscle)
For about six weeks after childbirth, women have a higher risk of blood clots. This may cause dural sinus thrombosis, which are clots in the large veins that carry blood from the brain. These clots may lead to a stroke.
Hormone replacement therapy (HRT) and menopause
During menopause, estrogen levels naturally drop. Research shows if you go through menopause before age 40, your risk of stroke increases compared to women who have menopause between ages 50 and 54. This may be due to the loss of estrogen’s protective effects on the blood vessels.
If you use HRT for menopausal symptoms like hot flashes or night sweats, your risk of stroke may increase. If you start within five years of menopause, your risk stays the same as women who’ve never used HRT.
But if you begin HRT 10 or more years after menopause begins, your risk for an ischemic stroke rises. Many doctors recommend limiting HRT to the lowest dose you need for the shortest time possible.
Lowering your stroke risk
Seeing your doctor regularly and making healthy lifestyle choices can help reduce your risk of stroke. Lifestyle changes that help include:
- Abstaining from alcohol or using in moderation
- Avoiding smoking and tobacco products
- Eating a balanced diet full of fruits and vegetables
- Exercising regularly
- Maintaining a healthy weight
- Managing chronic health issues such as high blood pressure, high cholesterol, diabetes and obesity
“Be proactive in taking charge of your health, and know when to talk to your doctor,” Dr. Zurasky suggests. “Schedule a visit when you don’t feel well, or at least once a year to identify any issues.”
Expert Insights on women’s stroke prevention
The experts at Providence can assess your risk of stroke and recommend specific ways to reduce it. Regular checkups can help identify any concerns early.
And if you have a stroke, Providence offers leading-edge, compassionate stroke care across our network. Our multidisciplinary teams develop a personalized treatment plan with advanced therapies and offer a variety of support services to help you recover.
Contributing caregiver
John F. Zurasky, M.D., is a neurologist specializing in stroke and neurocritical care at Providence St. Vincent Medical Center in Portland, Oregon.
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Related resources
Ask an expert: Recognizing stroke symptoms
Providence TeleStroke program redefines rural stroke care
Hypertension: Why it's known as a silent killer
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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