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Women and Strokes: What You Need to Know

There are ways to reduce risk, but be ready to recognize the signs

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Stroke is a man’s disease, right? Not so fast. It’s true that during middle age men have a higher risk than women. But rates even out in older adults, neurologist Cheryl Bushnell, M.D., stroke division chief at Wake Forest University School of Medicine, wrote in a 2023 review of the research. Among U.S. women, stroke is the fifth leading cause of death, according to the Centers for Disease Control and Prevention. Strokes have been blamed for killing about twice as many women as breast cancer each year.

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Stroke is an emergency that requires fast action. It’s important to know the signs, know what to do and, even better, know how you can try and prevent it.

Cut Your Risk

About 80 percent of strokes are preventable, according to the CDC. There are things women can do to help reduce their risk:

  • Controlling high blood pressure is crucial.
  • Stop smoking. It’s also a good idea to avoid e-cigarettes.
  • Talk to your doctor about your cholesterol levels.
  • Increase physical activity to 30 minutes of moderate activity a day.
  • Eat a healthy DASH or Mediterranean diet.
  • Maintain a healthy weight.
  • Control diabetes. Keep blood sugar under control.
  • Avoid heavy (average three or more drinks per day) alcohol intake.
  • Get good quality sleep. If you have sleep apnea, discuss treatment with your doctor.

There are two main types of strokes that occur in men and women

  • Ischemic stroke is the most common, accounting for about 85 percent of strokes. It happens when a vessel carrying blood to the brain is blocked by a clot or a build-up of fatty plaque.
  • Hemorrhagic stroke is less common, but more severe. It’s caused when a blood vessel in or on the brain leaks or bursts, releasing blood into the brain. The blood itself can damage brain tissue and can cause pressure to build up in the brain, leading to further damage.
  • Don’t forget ministroke, also called a TIA for transient ischemic attack. It’s like a tiny warning stroke. Ministrokes occur when a blood vessel is blocked briefly so symptoms are temporary. People may not even realize they’ve had one because the symptoms can be very mild and don’t last long, sometimes only a few minutes or a day. For this reason, people often dismiss them, not realizing their seriousness. But it’s important to get medical attention right away because a more serious stroke may be in the cards. The risk of stroke or other serious adverse event is about 20 percent in the 90 days after a TIA, if untreated. Symptoms of a ministroke can include weakness or numbness on one side of the body, slurred speech or difficulty understanding others, vision changes in one or both eyes and dizziness.​

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When it comes to stroke, women can face extra challenges. Their symptoms might be harder to recognize and they’re less likely to get quick treatment — often because they don’t seek out treatment. Women are often older when they have a stroke, and therefore may suffer worse effects afterward.

How are stroke symptoms different in women versus men?

The Acronym to Remember Is B.E.F.A.S.T.

​Learn the most common symptoms of stroke and how to respond.

Balance — lack of coordination or difficulty walking​
Eyes — vision changes​
Face — drooping​
Arm — weakness on one side
Speech — slurring, not able to get words out, unable to understand what others are saying
​Time — Do not waste time! Call 911! 

And when calling 911, be ready to say when the stroke began, or when the person was last acting normal, Bushnell says. This will help the emergency responders and the stroke team determine if this person can be treated with life-saving medication or surgical procedures to remove the blood clot. “If the stroke is caused by bleeding, this is also an emergency and there are life-saving treatments for this type of stroke, as well,” she says.

The most common stroke symptoms occur in both men and women at the same rate, but women sometimes have more generalized, less recognizable symptoms that are easier to ignore. These symptoms include confusion, headache and weakness, which may not be initially recognized as a stroke. 

Women face unique risk factors for stroke

Some risks for stroke apply only to women. Stroke risk is higher during pregnancy and childbirth and among women who take oral contraceptives that contain estrogen. Risk is higher in women who go through menopause early or have their ovaries removed before menopause. Risk rises after menopause, as well. Changing estrogen levels play a role. And hormone replacement therapy, which some women take to relieve symptoms of menopause, may increase the risk of stroke.

“For postmenopausal women, most important is to avoid hormone replacement therapy if you are more than five years past the onset of menopause or if any other stroke risk factors are present,” says Bushnell, who coauthored a 2023 review of stroke studies in women, published in the Journal of Stroke. That includes “diabetes, hypertension, high cholesterol, cigarette smoking or obesity.”

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In addition to established recommendations for reducing stroke risk, such as controlling high blood pressure, older women also should be screened for irregular heartbeat, known as atrial fibrillation, Bushnell says. A-fib substantially increases a person’s risk for stroke, and women with A-fib face double the risk of men with the condition. Some people with A-fib have no symptoms, while others experience a racing heart, dizziness or shortness of breath.

“If a woman feels heart palpitations or an irregular rhythm [a sudden racing or abnormally fast or fluttery heartbeat], she should ask her doctor about getting an ECG [electrocardiogram] or longer-term heart monitoring,” Bushnell wrote in an email.


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Recovery challenges are also unique

Women who survive a stroke often face more problems during recovery than do men. Those problems include more depression and more cognitive problems, according to Bushnell’s review of research. Part of the problem may be that women who have a stroke are less likely to get sufficient rehabilitation.

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