Neurology and Neurosurgery

Find out why women have a higher risk for stroke

Multiracial women sitting in front of a laptop discussing stroke risk.


Pregnancy, reproductive hormones, migraine, irregular heartbeat and smoking increase stroke risk for women.


Did you know women are at higher risk of ischemic stroke than men are? According to the American Stroke Association, about 55,000 more women than men have a stroke every year. Further, 1 in 5 women will have a stroke, and this “brain attack” is the third leading cause of death among women.


Ischemic stroke occurs when a clot in a blood vessel stops blood flow to the brain and deprives it of oxygen and nutrients. Women have unique risk factors for this type of stroke related to their reproductive health. Women with migraines, atrial fibrillation or who smoke are also at higher risk for stroke.


Here is what you need to know about stroke risk in women and how to lower your risk.



How does pregnancy increase stroke risk for women?


Most women will have healthy pregnancies and birthing experiences. However, if you are pregnant or planning to be, it is important to know about stroke risk so you can manage it. Pregnancy can put stress on the body and cause conditions such as poor blood circulation, high blood pressure and preeclampsia that increase stroke risk.



“Pregnancy can cause swelling and reduce blood flow to parts of the body, especially the lower legs. In turn, poor circulation can cause the blood to clot,” said Dr. Elizabeth Lucal, an OB/GYN and the system vice chair of Women’s Health Services at Nuvance Health. “Also, toward the end of pregnancy, the body makes more of a substance that helps the blood to clot to prevent a woman from bleeding too much when she gives birth.”


Some women can develop high blood pressure when they are pregnant or might have had it before they were. Preeclampsia is a type of high blood pressure that only occurs during pregnancy. High blood pressure or hypertension increases stroke risk because the heart must work harder to pump blood, which can weaken arteries.


“If you are pregnant or planning to be, your gynecologist will monitor and help you manage your blood pressure. You can keep your blood pressure in check during pregnancy by eating a healthy, low-sodium diet and doing regular aerobic exercise, such as walking,” Dr. Lucal said.



How do birth control pills increase stroke risk for women?


Women who take birth control pills may be at increased risk of stroke. 


“Some birth control pills contain hormones that can increase the risk of blood clots,” Dr. Lucal said. “Speak with your gynecologist before starting birth control. Your doctor may recommend other birth control options that might be safer for you if you are at increased risk for stroke because of your personal or family health history, diet, weight or because you smoke.”


How does hormone replacement therapy increase stroke risk for women?


Similarly, women who take hormone replacement therapy (HRT) to treat menopause symptoms may be at increased risk of stroke. HRT contains hormones that can increase the risk of blood clots. 


“Talk with your doctor about your stroke risk and if hormone replacement therapy is safe for you. Your doctor can also discuss other possible ways to manage menopause symptoms,” Dr. Lucal said.


Why does migraine with aura increase stroke risk for women?


Migraines affect women more than men and can occur more frequently during menstrual cycles due to changes in estrogen levels. Migraines with aura have been linked to an increased risk of stroke given the propensity for clots to form in narrowed arteries. Aura can cause visual disturbances, as well as stroke-like symptoms including problems with speech and numbness or tingling in the body. Aura symptoms are temporary and usually occur before a migraine strikes.



“Migraines alter the blood vessels in the brain, which may be why they can increase stroke risk. But it’s a relative risk and a healthy lifestyle such as stopping smoking decreases stroke risk,” said Dr. Hida Nierenburg, a neurologist and the director of headache medicine at Nuvance Health. 


“A headache specialist can help you manage migraine triggers and develop a treatment plan to reduce your migraine days,” says Dr. Nierenburg. “As a neurologist, a headache specialist can also help you determine your overall stroke risk and help you lower it.”



Why does atrial fibrillation increase stroke risk for women?


Women with atrial fibrillation (AFib) are at increased risk of stroke. AFib causes about 1 in 7 strokes, according to the U.S. Centers for Disease Control and Prevention.


“AFib is an irregular heartbeat that can cause blood clots to form in the heart. If a blood clot travels to the brain, it can cause a stroke,” said Dr. Latha Subramaniam, a cardiologist at Nuvance Health.


“Common risk factors for AFib include high blood pressure, diabetes, obesity, excessive alcohol use and smoking. Medications and healthy lifestyle choices can help you manage AFib,” Dr. Subramaniam said.



How does smoking increase stroke risk for women?


Smoking is a major risk factor for stroke in women. Smoking can damage blood vessels and increase the risk of blood clots.


“If you currently smoke, please quit now. If you need help quitting, talk with your primary care doctor, who can connect you with support services,” said Dr. Paul Wright, a neurologist and stroke specialist, and the senior vice president and system chair of the Neuroscience Institute at Nuvance Health.



“Many people may not know that about 80% of strokes can be prevented through lifestyle choices. It is never too late to lower your stroke risk by eating a healthy diet, getting regular exercise, not drinking alcohol in excess and not smoking,” Dr. Wright said.



The bottom line: Be there for all the moments that matter most to you by managing the unique risk factors for stroke in women. You may have a higher risk of stroke if you are pregnant, take birth control pills or hormone replacement therapy, experience migraine with aura, have an irregular heartbeat or smoke. The first step is to determine your stroke risk with your doctor and find ways to lower it.