Five things to know about how stroke differs in women

A stroke can be devastating for anyone. But the risks and symptoms of stroke are not always the same in women and men.

The American Heart Association (AHA) asked experts to explain some of the most significant differences and what women can do to protect themselves.

Women have a higher risk of stroke with hypertension

Dr. Tracey Madsen, assistant professor of emergency medicine and epidemiology at Brown University in Providence, Rhode Island, noted that women and men share many risk factors for stroke, such as high blood pressure, diabetes and atrial fibrillation. p>

Of all the risk factors, high blood pressure has the greatest influence on the risk of stroke. And "at a certain level of high blood pressure, the risk of stroke may be higher in women than in men," Madsen said.

According to guidelines from the American Heart Association and the American College of Cardiology, high blood pressure is defined as a systolic (top number) of 130 or higher or a diastolic (bottom number) of 80 or higher. A reading below 120/80 is considered normal.

Studies have shown that a woman with a systolic blood pressure of 120 to 129 - the range defined as high blood pressure - has the same risk of stroke as a man with a systolic reading of 140 to 149, said Dr. Cheryl Bushnell, professor of neurology and vice chair. For research at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

“I think this raises a lot of questions about whether men and women should be treated differently for high blood pressure,” she said.

Complications during pregnancy can pose a lifelong risk

Some risk factors apply only to women. "Probably one of the most important is pregnancy," Bushnell said.

Pregnancy is often compared to a stress test for the heart. Blood volume and cardiac output increase by approximately 45% compared to pre-pregnancy levels.

Complications during pregnancy can increase your risk of stroke. Preeclampsia, a condition that causes high blood pressure and organ dysfunction, can lead to immediate stroke. It also increases a woman's lifetime risk of stroke.

About one in five pregnant women experience problems such as preterm birth, gestational diabetes and other conditions that are considered adverse pregnancy outcomes. All of these conditions can increase your risk of stroke in the future. This includes an ischemic stroke, in which a blood clot blocks blood flow to the brain, or a hemorrhagic stroke, in which a blood vessel in the brain ruptures and bleeds.

Early menopause is another risk unique to women, Bushnell said. A woman who stops menstruating before age 45, and especially before age 40, has a higher risk of stroke than a woman who reaches menopause at the usual age of 50 to 54.

A 2020 study published in Stroke magazine suggests that the risk of stroke is higher in young women ages 25 to 44 compared to their male peers. “It's certainly not lower,” said Madsen, co-author of the study. The key message, she said, is that “stroke does happen in this age group, and people should be aware of their risk factors and warning signs.”

Stroke may present differently in women

The classic symptoms of stroke are the same for women and men and can be remembered using the acronym FAST: "F" - facial drooping; "A" - weakness in the hand; "S" - speech disorder; "T" - time to call an ambulance.

But women are more likely to experience additional symptoms, including nausea, loss of consciousness or confusion.

Women are also more likely to have migraines, which may double the risk of stroke caused by a blood clot, according to a 2023 review of studies in the Journal of Stroke, which Bushnell co-authored. She noted that migraines with aura are especially associated with an increased risk of stroke and can include flashes of light or even vision loss.

Such symptoms of migraine with aura, along with numbness or weakness, can overlap with stroke symptoms, Madsen said, which “can make diagnosis difficult and lead to possible delays in diagnosis.”

What happens after a stroke?

Stroke is the fourth leading cause of death for women in 2021, according to the National Center for Health Statistics. Among men, he was in fifth place.

Because women live longer than men, they are more likely to experience a stroke during their lifetime. "Women tend to be six years older at the time of their first stroke compared to men," Madsen said. "This may be part of the reason why stroke is more devastating in women."

Studies have shown that after a stroke, women have a lower quality of life than men, and they are less likely to fully recover their abilities.

How can women protect themselves?

Women need to know their blood pressure and, if it is high, be sure to work with their doctor to control it, Madsen said.

She and Bushnell both emphasized that the best way to prevent stroke is to follow the AHA's "Life's Essential 8," which includes quitting smoking, maintaining a healthy weight, physical activity, eating a healthy diet, getting enough sleep and maintaining normal blood pressure, glucose and cholesterol levels.

Pregnant women should be especially vigilant about their risk of high blood pressure, Bushnell said, and work with their gynecologist for monitoring and, if necessary, treatment.

“Some women may not want to take medication due to concerns for the baby, which I completely understand,” she said. “But there are safe medications.” And, Bushnell emphasized, the risks associated with high blood pressure during pregnancy do not disappear after childbirth.

“There is a lot that we don’t know”

Women have been underrepresented in stroke research, Bushnell said, but scientists are working to improve that.

"There's a lot of active work going on now to study the reasons for these sex differences," Madsen said, such as the role of hormones in stroke risk. “There is a lot that we don't know. But the stroke research community is working hard on this.”