Stroke is the third-leading cause of death in women.
Stroke is a big problem for all Americans, but statistics suggest it may especially affect American women: Stroke is the third-leading cause among women, but it’s the fifth-leading cause of death for men, according to the National Stroke Association.
“Approximately 55,000 more strokes occur in women [than in men] each year,” says Carolyn Brockington, MD, a neurologist at Mount Sinai Hospital in New York City. “So the question is, why are women having more strokes?”
Risk Factors for Stroke in Women
Women experience many of the same stroke risk factors as men do:
High blood pressure
In fact, the biggest risk factor for both ischemic and hemorrhagic strokes is high blood pressure (or hypertension). About 77 percent of people having a stroke for the first time have a BP higher than 140/90 mm Hg, according to the American Heart Association (AHA). Find out what your blood pressure numbers mean here.
Although men and women have similar rates of hypertension from ages 45 to 64, a higher percentage of women than men have elevated BP after age 65. Among those 75 and older, 80 percent of women have high blood pressure, compared to 72 percent of men, according to the AHA.
But there are other stroke risk factors that are unique to women. Two prime examples: migraines and hormones.
Women comprise about 75 percent of people who get migraines. And stroke is three times more common in women who suffer from frequent migraines than in women who do not, according to the American Migraine Association. In particular, having migraines with aura—seeing sparks or dots, or feeling tingling sensations—are linked to a higher risk of stroke.
Women also experience more hormonal changes throughout the life cycle, such as during pregnancy and menopause or while taking birth control or hormone replacement therapy. “It produces what we call a relative hypercoagulable state,” says Dr. Brockington.
When your body is in a hypercoagulable state, you have an elevated tendency to form blood clots. If the fluctuating hormones cause more blood clots, one could potentially travel to the brain and cause blood clots. This is one possible reason women’s risk of stroke increases after menopause.
Symptoms of Stroke in Women
During a stroke, women may have similar symptoms as men do. These are the common symptoms of stroke, according to Dr. Brockington.
Weakness on one side, such as a drooping arm
Numbness on one side, such as lack of facial expression
Problems with speech, such as slurring or not understanding what people are saying
Problems with vision
Problems with walking and coordination
However, women’s symptoms of stroke may stray from these classic signs. “The presentation can be a little bit different,” says Dr. Brockington. “Sometimes the symptoms are a little bit subtle.”
In other words, the stroke symptoms may not be debilitating, and they may not catch the attention of others. That poses a problem, since women are more likely to prioritize others and downplay their own needs and concerns. Even worse, women’s pain is also less likely to be taken seriously by others.
“If suddenly something happens to you, you really need to go to the emergency room,” says Dr. Brockington. “If you’re not being taken seriously, you know your body. You know something’s wrong.”
Dr. Brockington is a neurologist and director of the Stroke Center at Mount Sinai St. Luke’s and Mount Sinai West Hospital in New York City.
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A stroke is the third leading
cause of death in women, and
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the fifth leading cause of death in men.
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And we know that approximately 55,000
more strokes occur in women each year.
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And so, the next question is,
why are women having more strokes?
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We know high blood pressure's
the number one risk factor, diabetes,
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But there are unique stroke
risk factors to women, and
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they center primarily around blood,
and also headache.
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So headache has to do with migraine.
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We know that migraines are more
common in women than men.
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And migraine with aura, so
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when you have a little bit of a warning
before you get the actual headache.
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Where the migraine headache has
been associated with stroke,
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increasing as a risk factor.
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What's interesting about women, is that
we all go through these hormonal changes,
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through menopause, and sometimes,
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if we take supplemental hormones.
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And the reason why is it produces what we
call this relative hypercoagulable state.
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Hyper means elevated, coagulate, to clot.
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With the changes in hormones,
this hypercoagulable state can develop.
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Blood clots can develop in the body and
go to the brain.
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And I think the important
thing that women should know,
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is that the presentation can
be a little bit different.
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Sometimes, the symptoms
are little bit subtle.
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They can be weakness on one side,
numbness on one side,
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problems with speech, problems with
vision, problems with walking where almost
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they're walking as if they're drunk, so
we want people to realize that if suddenly
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something happens to you, that you
really need to go to the emergency room.
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But if you're not being taken seriously,
you know your body, you know
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something is wrong, I would want women
to push forward, and to get the answer.
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Migraine. Washington, DC: U.S. Office on Women’s Health. (Accessed on April 20, 2021 at https://www.womenshealth.gov/a-z-topics/migraine.)
Migraine, stroke, and heart disease. Mount Royal, NJ: American Migraine Foundation. (Accessed on April 20, 2021 at https://americanmigrainefoundation.org/understanding-migraine/migraine-stroke-and-heart-disease/.)
Statistical fact sheet: 2013 update. Dallas, TX: American Heart Association & American Stroke Association. (Accessed on July 26, 2018 at https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf.)
Stroke facts. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on April 20, 2021 at https://www.cdc.gov/stroke/facts.htm.)
Symptoms of a stroke. Dallas, TX: American Heart Association, Go Red for Women. (Accessed on July 26, 2018 at https://www.goredforwomen.org/about-heart-disease/symptoms_of_heart_disease_in_women/symptoms-of-a-stroke/.)
Understanding migraine with aura. Mount Royal, NJ: American Migraine Foundation, 2017. (Accessed on April 20, 2021 at https://americanmigrainefoundation.org/understanding-migraine/understanding-migraine-aura/.)
Women and stroke. Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on July 26, 2018 at https://www.cdc.gov/stroke/docs/women_stroke_factsheet.pdf.)
Women and stroke. Centennial, CO: National Stroke Association. (Accessed on July 26, 2018 at http://www.stroke.org/understand-stroke/impact-stroke/women-and-stroke.)