Stroke is the third-leading cause of death for women in the U.S., and over twice as many women die of stroke as they do of breast cancer. Women account for over half of all stroke deaths worldwide.
That's why neurologist Sarah Song, MD, MPH, of the Rush Stroke Program says it's essential for women to be savvy when it comes to stroke.
“Women have more strokes and worse outcomes after stroke than men," Song says. "They also have more subarachnoid hemorrhages, a less common type of stroke, than men, and are more likely to suffer from post-stroke depression.
Understanding your risks empowers you to take steps to prevent a stroke. And being aware of the symptoms will enable you to get treatment faster — when every second counts.
Stroke symptoms in women
Generally, women and men experience many of the same stroke symptoms.
When symptoms appear, they come on suddenly. The following are commonly identified symptoms of stroke in both men and women:
- Numbness on one side of the body and/or face
- Weakness on one side of the body and/or face
- Loss of vision in one or both eyes
- Double vision
- Vertigo, or room-spinning
- Slurred speech
- Difficulty speaking or understanding language
- Difficulty walking
- Severe headache
“Women tend to have more migraines than men, and extended migraines, particularly migraines with aura — loss of vision and flashing lights,” Song says. “These can portend a stroke, especially when combined with other symptoms.”
If you notice any of these symptoms in yourself or another person, call 911 immediately, even if they don't cause pain or go away.
Remember that "time is brain." If it is a stroke, the sooner you get treatment, the better your chance of surviving. Prompt treatment also improves your chances for successful rehabilitation and recovery.
Transient ischemic attack is a warning sign
A transient ischemic attack, also known as a TIA, causes the same symptoms as a stroke but lasts only minutes to a few hours. It's often called a “mini-stroke,” but that can be misleading.
“TIAs put all people, not just women, at greater risk for stroke,” Song says. “TIAs should not be considered 'mini-strokes' or less serious than strokes but should be treated seriously as warning signs, and the risk factors for TIA and stroke are the same.”
Even though there may not be lasting symptoms from a TIA, you should still seek immediate medical help. That includes going to the emergency room to be evaluated right away when symptoms occur. It also means talking to your doctor about how to prevent a full-blown stroke and look for stroke risks that could be better controlled.
The good news: With early management and appropriate behavioral changes and other interventions, much of your stroke risk may be lowered.
“A TIA is an opportunity to prevent a stroke through careful diagnostic workup, including brain and vessel imaging, heart echocardiography and bloodwork, as well as starting appropriate medications,” Song says.
Migraine aura and stroke risk
Migraines with aura are intense, chronic headaches where a person experiences flashes of light, light or noise sensitivity, tingling in the hands or face, partial loss of vision or other symptoms.
These crippling headaches — more common in women than men — have been associated with an increased risk of stroke.
The reasons for this association between migraines and stroke are not well understood. But from what we do know, an aura usually needs to be associated with a headache to increase stroke risk. It may also be associated with hormonal changes.
The American Stroke Association says women who experience migraines with aura are twice as likely to have strokes, depending on their other risks. Smoking and using oral contraceptives, in particular, can increase your risk significantly.
“There are also some older medications to treat migraines that have been seen to be associated with increased risk of stroke,” Song says.
Causes of stroke in young women
It's true that strokes most often strike older women — and men. But the World Stroke Organization reports that 16% of all strokes — and over 5% of all stroke-related deaths — occur in people under age 49.
One potential reason is thought to be the increase in obesity among younger women. While obesity is a stroke risk on its own, it also contributes to other significant risks, including high blood pressure, Type 2 diabetes and heart disease — all of which are increasingly common in women today.
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Some of the most common factors that cause or contribute to stroke risk in young women include the following:
- High blood pressure
- Type 2 diabetes
- Kidney disease
- Heart and vascular disease and disorders
- Migraines
- Pregnancy
- Smoking
- Obesity
- Oral contraceptives
- Sickle-cell anemia
- Recreational drugs, especially cocaine or methamphetamine
- Alcohol abuse
Birth control and stroke risk
The American Stroke Association reports that women who take birth control pills may be almost twice as likely to have a stroke as those who don't. The risk of stroke related to oral contraceptives also increases with age.
“However, it should be noted that pregnancy, as opposed to oral contraceptives, is the bigger risk factor for stroke,” Song says.
And because the stroke risk for healthy young women is low to begin with, you don't necessarily have to forgo the pill. Your doctor can help determine whether oral contraceptives or another form of birth control is best for you.
"Oral contraceptive pills that contain estrogen do increase the risk for stroke,” Song says. “But it’s important to note that the progestin-only pill has not been seen to increase the risk for stroke.”
Why does birth control increase stroke risk?
Birth control pills can cause blood clots to develop. In some cases, blood clots can possibly travel to the brain, causing a stroke or heart attack.
“When women who take oral contraceptives also smoke cigarettes or have migraines or hypertension, this can further compound the risk of stroke,” Song says. “For women who smoke cigarettes, have migraines and are older, alternatives to oral contraceptives containing estrogen should be considered.”
How common are strokes from birth control?
Studies show that, among women without high blood pressure and who don’t smoke, about 8.5 per 100,000 who take oral birth control have strokes.
This is close to double the risk for women in the same group who don’t take the pill. They have strokes at a rate of about 4.4 per 100,000 women.
But even with the elevated risk of stroke that comes with the pill, the risk of stroke that comes with pregnancy is still much higher. According to the National Heart, Lung, and Blood Institute, stroke occurs in about 30 of every 100,000 pregnancies.
Pregnancy and stroke risk
Some studies say that the incidence rate of stroke in pregnant women is three times the rate in non-pregnant women, and stroke risk is elevated for postpartum women, too.
Women who are pregnant or postpartum can have both ischemic strokes from blood clots and hemorrhagic strokes from bleeding. Most maternal strokes happen within the first few weeks after birth, triggered by blood loss or hormonal changes.
There are a few reasons for this increased risk.
“There is an increase in blood volume during pregnancy,” Song says. “The heart works harder than it does when not pregnant, and this can increase the risk of blood clots forming in the heart. There is also an increased risk of blood clots throughout the entire body, especially as the pregnant body grows, due to the blood being thicker than usual."
During the first trimester of pregnancy, the body enters a pro-inflammatory state that helps the body repair cells, remove dead cells and adapt to the fetus. The body enters this state again during the third trimester to prepare for labor, contractions and birth.
While this state is important for pregnancy, it increases the risk of stroke.
Women who have high blood pressure during pregnancy, whether they had high blood pressure before getting pregnant or not, have a higher risk of stroke as well. They also have a higher risk of preterm birth and seizures.
“There are some vessel pathologies that can develop as a result of stroke as well, such as a small tear in the vessel wall, known as arterial dissection,” Song says.
Stroke is also associated with certain complications of pregnancy, including infections and preeclampsia, which is elevated blood pressure during pregnancy.
If you are pregnant or plan to be pregnant and have other risks for stroke, including a history of smoking, obesity, high blood pressure or diabetes, then it’s important to talk to your doctor. They can help you manage your risks and monitor your health.
Menopause and stroke risk
Menopause also can affect women’s risk of stroke.
“There is some evidence that women who undergo premature and early menopause may have a higher risk of stroke than those who have menopause in their 50s,” Song says.
Women who have a shorter reproductive lifespan — the time between their first menstrual cycle and menopause — have a higher risk of stroke than those with a longer reproductive life span.
Song also notes that hormone replacement therapy, sometimes taken by women to relieve symptoms of menopause like hot flashes and vaginal discomfort, may increase the risk of ischemic stroke. "Although, transdermal therapy has been seen to have a lower risk for stroke than oral therapy,” she says.
Obesity and stroke risk
Studies have shown that women who are obese or have gained more than 44 pounds since age 18 are about 2.5 times more likely to have a stroke than women who maintain a healthy weight.
Studies have also shown that postmenopausal women with a waist measuring more than 35.2 inches and a triglyceride (blood fat) level higher than 128 mg/dL have five times the risk of stroke.
And there are other serious health risks associated with an "apple" body shape in women, including heart disease and diabetes.
“Women are more likely to be affected by obesity than men, and that may increase stroke risk,” Song says. “New research has shown that women who were overweight in adolescence or young adulthood may have an increased risk of stroke, particularly ischemic stroke, regardless of their body-mass-index at earlier or later time points."
There are some stroke risk factors you can't control, like your family history, ethnicity, race and age. So it’s helpful instead to focus on the behaviors you can change.
That includes making time to exercise and eating a diet rich in fruits, vegetables and whole grains. Adopting a healthy lifestyle may help prevent stroke in women, especially if you have other stroke risk factors.
Higher stroke risk for Black and Hispanic women
“There are significant stroke disparities in race and ethnicity, particularly in older women, for Black and Hispanic women," Song says. “Research suggests that education and insurance status or socioeconomic status could play a role in increased stroke risk, particularly in Hispanic women.”
According to the Office of Minority Health, part of the U.S. Department of Health and Human Services, Black women are twice as likely to have a stroke as white women — and more likely to die from a stroke than either white women or Hispanic women.
One reason? High blood pressure, diabetes and obesity — three of the biggest risk factors for stroke — are all more common in Black women than white women.
A lesser-known risk factor: sickle cell disease, a genetic disease common in Black Americans. Around 1 in 365 Black Americans is born with it. Twenty-five percent of adults with sickle cell disease will have a stroke by the age of 45.
Hispanic women, too, experience high blood pressure, diabetes and obesity at higher rates than non-Hispanic white women, putting them at increased risk of both stroke and stroke-related deaths.
Protecting yourself from stroke
While you cannot change certain things that increase your risk for stroke, there are steps you can take to lower your risk.
Working to improve your weight, blood pressure and cholesterol with lifestyle changes and medications can help reduce the risk not only of stroke, but of heart disease and cancer.
Avoiding smoking and excessive alcohol use will also help. And controlling other conditions that contribute to strokes, including diabetes, heart and vascular disease and kidney disease can lower your risk.
Another way to protect yourself, and others, from the worst outcomes of stroke is to know the symptoms.
“Women should know and understand their stroke risk," Song says. “However, it is of paramount importance than all people be able to recognize acute stroke symptoms and to get to the hospital for potential treatment.”
The acronym FAST is an easy way to remember signs of stroke and what to do if you think you or someone else is having one. It stands for the following:
- Face and head: Symptoms may be numbness or weakness in their face, drooping of the face, inability smile, dizziness, confusion, vision trouble or headache.
- Arms and legs: Symptoms may be numbness or weakness in the arms or legs, especially on one side of the body, trouble walking or loss of coordination.
- Speech: The person may have difficulty speaking or understanding speech.
- Time: It's important to call 911 or get to an emergency room or stroke center immediately for treatment.
“There are highly effective treatments for stroke, but they can only be given if people recognize stroke and get treated appropriately,” Song says. “Calling 911 is incredibly important because it guides you to the ER at the right hospital with the stroke treatments you need.”
If you’d like to learn more about the care Rush provides for patients who have stroke or need follow-up care such as rehabilitation and help with lifestyle changes, visit our Stroke Care page.
