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7 Stroke Risk Factors Women Should Know

Each year, 55,000 more women have a stroke than men. Learn the reasons why—and what you can do.

Medically reviewed in May 2021

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Not only do women have a higher lifetime risk of stroke, but more women die from strokes each year than men. And while risk factors such as smoking, diabetes and being obese don’t discriminate against age or sex, some lesser-known risks may be more likely to affect women. Find out your stroke risk, as well as ways to prevent or reduce your chance of stroke.

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Hypertension

Approximately 77 percent of people who have a stroke for the first time also have high blood pressure, also known as hypertension. Rates of high blood pressure tend to be lower in premenopausal women compared to men of roughly the same age. But those numbers shift dramatically as women get older, and particularly after menopause, which occurs on average around age 51. Rates of high blood pressure are higher in women over age 65 than in men of that age group, and approximately 75 percent of postmenopausal women have high blood pressure.

Often called the silent killer, high blood pressure has no signs or symptoms. That’s why it’s important to get your blood pressure checked at least every year. Hypertension can be controlled—and even eliminated—by practicing heart-healthy habits such as controlling your weight, exercising, reducing stress and eating a healthy diet. In some cases, medications may be required to keep blood pressure levels in check.

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Birth Control Pills

Over the years, birth control pills have become safer in terms of their relationship to stroke risk. That said, women who take the pill and have other stroke risk factors may be more likely to have a stroke than those who don’t use oral contraception. “Birth control pills can cause a stroke by triggering a clot in the blood vessel system,” says Phaniraj lyengar, MD, medical director of the Sunrise Comprehensive Stroke Center at Sunrise Hospital in Las Vegas.

Talk to your healthcare provider (HCP) about what forms of birth control to take, given your health profile and risk factors. For example, you may need to avoid using combination pills (those containing estrogen and progestin) if you’ve had a heart attack, stroke, blood clots, high blood pressure, diabetes, liver disease or breast cancer or if you smoke. If you experience migraine headaches with aura, you’ll likely also need to skip combination pills.

Pills containing progestin only may be recommended for people who shouldn’t use combination pills. But people with breast cancer and certain types of lupus may be advised to avoid progestin-only pills. Your HCP can guide you on what forms of contraception—whether non-estrogen or non-hormonal—would be best for you.

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Pregnancy and Preeclampsia

If you’re pregnant, your chance of having a stroke while you’re expecting is pretty rare. Stroke affects only 2 out of 10,000 U.S. women per year. But preeclampsia, or high blood pressure that occurs during pregnancy, can double your risk for stroke later in life. Women with hypertension before pregnancy or who had it during a previous pregnancy should talk to an HCP about taking low-dose aspirin to lower stroke risk; it’s recommended from 12 weeks through delivery.

Certain women may need to take medications to lower blood pressure, as well. And whether or not you’re expecting a baby, you should keep your blood pressure under control to help reduce your stroke risk. 

If you have a history of preeclampsia, you’ll need to stay in close contact with your HCP about being regularly screened—and treated, if necessary—for heart risk factors such as high blood pressure, high cholesterol, obesity and smoking.

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Menopausal Hormone Therapy

Using menopausal hormone therapy (MHT) may slightly increase the odds of stroke in some women, as it can boost blood clot risk. But MHT is still the leading way to treat menopause symptoms, and its benefits may outweigh the risks for most women who haven’t yet turned 60, or who are within 10 years of menopause. Currently, most experts say it’s safe to take the lowest effective dose for short-term therapy. Talk to your HCP to find out if MHT is safe for you.

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Soda

It’s well known that drinking sugary soda can lead to weight gain, diabetes, hypertension, high cholesterol and even heart disease. But a 2012 study published in the American Journal of Clinical Nutrition was the first to discover the link between sodas and stroke. The study, which analyzed soda consumption in men and women, found that the risk of stroke was 16 percent higher in people who drank one additional sugar-sweetened or diet soda per day, compared to those who drank none.

Even diet soda may be linked to an increased risk of stroke. A 2019 study of almost 82,000 women in the journal Stroke found that those who drank two or more artificially sweetened beverages (such as diet soda or diet fruit drinks) daily had a 23 percent higher risk of stroke than those who drank them never or rarely.

Swap your soda for a sugar-free alternative like sparkling water with a spritz of fresh lime or unsweetened iced tea.

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Migraine with Aura

“Women tend to have higher rates of migraines, which can increase stroke risk,” says Lori Noorollah, MD, a neurologist in Independence, Missouri. More specifically, the risk occurs if the migraine is accompanied by an aura, which could be a visual disturbance, a pins and needles sensation and/or numbness. If you have migraines with aura, you can help lower your stroke risk by keeping your weight in check, controlling your blood pressure, exercising regularly and avoiding smoking.

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Atrial Fibrillation

People who have atrial fibrillation (AFib), a condition in which the top chambers of the heart beat irregularly, have a higher risk of having a stroke. Women tend to develop AFib later than men and are more likely to have a stroke and die because of it. This is a result, in part, of the way in which the hearts of women with AFib don’t pump blood effectively through the body.

“It’s like the edges of a stream or river where the water flow isn’t fast, you can see that it swirls around and becomes more still,” says Charles Joyner, MD, an electrophysiologist in Richmond, Virginia, who treats patients with AFib. When this happens, he explains, the blood can thicken and form a clot, which resides in the atrium, or the upper section of the heart. “That clot can break free and enter other organs, such as the brain, causing a stroke.”

Slideshow sources open slideshow sources

Persky RW, Turtzo LC, McCullough LD. Stroke in women: disparities and outcomes. Curr Cardiol Rep. 2010;12(1):6-13.
Centers for Disease Control and Prevention. Women and Stroke. Page last reviewed August 5, 2020.
American Stroke Association. Women Have a Higher Risk of Stroke. Page last reviewed December 5, 2018
Centers for Disease Control and Prevention. Facts About Hypertension. Page last reviewed: September 8, 2020.
Beth L. Abramson, MD, FACC; Kajenny Srivaratharajah, MD; Leslie L. Davis, NP, PhD, FACC; Biljana Parapid, MD. Women and Hypertension: Beyond the 2017 Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. American College of Cardiology. Jul 27, 2018.
Carlton C, Banks M, Sundararajan S. Oral contraceptives and ischemic stroke risk. Stroke. 2018;49(4):e157-e159.
American Heart Association. “Preeclampsia doubles women's stroke risk, quadruples later high blood pressure risk.”
Bernstein AM, de Koning L, Flint AJ, Rexrode KM, Willett WC. Soda consumption and the risk of stroke in men and women. Am J Clin Nutr. 2012;95(5):1190-1199.
Mossavar-Rahmani Y, Kamensky V, Manson JE, et al. Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative. Stroke. 2019;50(3):555-562.
Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36(6):1115-1119.
Pothineni NV, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, Vallurupalli S, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR. Gender and AF: differences and disparities. US Cardiology Review. 2018;12(2):103.

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