Some aspects of women’s lives can increase our risk of a stroke, like the contraceptive pill, pregnancy and having migraines. But for most women, taking care of your health and managing your risk factors will help you avoid a stroke. For example, if you are a younger woman who doesn’t smoke and is physically active, your risk of stroke will probably be very low.
When you are seeking contraception or having a baby, doctors check if you have any risk factors for stroke. The aim is to spot in advance if you are more likely to have a blood clot or stroke and avoid it happening if possible.
The main risk factors affecting women include the contraceptive pill with oestrogen, HRT and fertility drugs, as well as hormones used for gender transition. We also look at the risks associated with pregnancy, and the link with pre-eclampsia. Some health conditions more common in women can affect your risk of stroke, such as migraine with aura, and lupus.
Why do more women have strokes?
Overall, more women than men have strokes in the UK. Women live longer than men, so they have more chance of having a stroke in their lifetime. They also tend to have strokes at a later age. This could be due to lifestyle, and being less likely to have medical conditions like high blood pressure. However, women are more likely to die of a stroke. This could be because of their older age when they have a stroke.
Women’s risk factors
On the whole, the biggest impact on women’s health comes from the main risk factors like smoking, obesity, high blood pressure and atrial fibrillation. But there are some things that affect mainly women including:
Stroke and hormone contraceptives
Overall, the risk of stroke from using contraception is low. Some types of hormone-based contraception do carry an increased risk of stroke. However, your risk of stroke should be carefully checked before you are given any of these treatments by the doctor. So if you are worried, don’t stop any treatment until you can talk to your GP or nurse. Ask them about your own risk, and the best contraception for you.
Combined oral contraceptive (combi) pill and contraceptive patch
These contain both oestrogen and progestogen. Treatments including oestrogen can increase the risk of serious problems such as stroke, heart attacks, and blood clots. So if you have any of the risk factors for stroke such as high blood pressure or smoking, you may not be able to use it.
So if you have any of the risk factors for stroke such as high blood pressure, smoking or being overweight, you may not be able to use these types of contraceptive. This also applies if you have had a stroke or blood clot before, or have migraine with aura.
A plastic T-shaped device that is placed in your womb and releases a small amount of progestogen into the uterus. It may not be suitable if you have a history of serious heart disease or stroke.
Your GP or your local sexual health clinic can advise you on the different contraceptive options that are available, and what is suitable for you.
You can find more information on all types of contraception and alternatives to the pill on the NHS website.
Stroke and pregnancy
Although the overall risk of stroke in a younger woman is very low, pregnancy and childbirth do slightly increase your risk of a stroke. Stroke is still very rare among pregnant women, but you can help to have a healthy pregnancy by attending all pre- and post-birth appointments.
One reason for the higher risk is that pregnancy makes your blood become more ‘sticky’ and likely to form clots. This may be the body’s way of protecting you from bleeding during birth. Your blood pressure may rise, and you should have your blood pressure measured at ante-natal appointments to spot the signs of pre-eclampsia.
Because of your age, your overall risk of a stroke is likely to be very low. But you can help to have a safe pregnancy by staying active and keeping your circulation healthy. Having a good diet, staying a healthy weight and stopping smoking will all cut your risk of a blood clot or stroke. If you have any existing health problems like diabetes or high blood pressure, make sure your GP and midwife know. You may need to change medications or get extra monitoring.
The chance of a stroke or blood clot is higher all through pregnancy, but the most risky time is the first few weeks after birth. So keep an eye out for the stroke FAST signs, and blood clots. Signs of a blood clot in your lungs include chest pain and difficulty breathing.
Pregnancy after stroke
If you have had a stroke or blood clot before, you may be taking blood-thinning medication. However, you can’t take most type of anticoagulant (blood-thinning) tablets while you’re pregnant. So if you are pregnant or planning to have a baby, speak to your GP or midwife about this as soon as possible. You'll need help to manage your risk of a stroke or blood clots while pregnant. This can include having an injectable anticoagulant such as heparin.
Pre-eclampsia can affect any pregnancy, and one of the main signs is high blood pressure. All pregnant women should have their blood pressure checked regularly to help spot the early signs of pre-eclampsia.
Signs of pre-eclampsia include headaches, abdominal pain just below the ribs, visual disturbances, nausea and vomiting, and swollen hands and feet.
If you have any signs of pre-eclampsia you need to get medical help straight away. If the symptoms are mild, you may be able to return home and have your blood pressure closely monitored. You can have medication to treat the high blood pressure. If you are diagnosed with pre-eclampsia, you’ll be monitored carefully until it’s possible to deliver the baby.
Diabetes during pregnancy
Some pregnant women develop gestational diabetes, which stops after you give birth. Having gestational diabetes makes you more likely to develop pre-eclampsia, so it’s linked to a slightly increased stroke risk. You will get advice about controlling your blood sugar and any treatment you might need. You have an increased risk of developing diabetes in later life, but having a healthy lifestyle can help you stay well for longer.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) tops up your levels of hormones to control menopausal symptoms such as hot flushes, vaginal dryness and mood swings.
There are different types of HRT which use oestrogen and progestogen in different combinations or alone. HRT tablets containing oestrogen cause a small increase in your risk of stroke. However if you use a patch or a gel form of HRT with oestrogen, this does not increase your risk of clots or stroke.
If you have a family history of blood clots, you may need some extra checks before receiving HRT. Like the combined contraceptive pill, the increase in risk from taking HRT tablets is very small, particularly if you are under 60. So provided you are in a low-risk group, or your risk factors are well managed, your overall risk is still very small.
To find out more about your stroke risk and taking HRT, speak to your GP or visit the NHS website.
Fertility drugs and IVF treatment (in vitro fertilisation)
The hormones used to increase fertility or to prepare for in-vitro fertilization (IVF) treatment can have rare complications that may increase the risk of blood clots and stroke.
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome (OHSS), when the ovaries swell, happens in around a third of IVF cycles. Most cases are mild. A very small percentage may lead to serious complications such as pain, breathing difficulties and blood clots in the veins. If you are having IVF it’s important to get help with any symptoms of OHSS as soon as possible.
If you are having or considering having IVF treatment, you can ask your doctor about the effect on your risk of stroke, and what you can do to manage any risk factors you may have.
Hormone treatment for gender transition
Like the hormone treatments used for female contraception, the hormones used for gender transition can slightly increase your risk of stroke. Oestrogen used for transitioning from male to female can raise your risk of a blood clot. It can also raise levels of bad (LDL) cholesterol, which is linked to fatty deposits in your arteries. The hormones used for men and women could make you more likely to develop insulin resistance, which can lead to type 2 diabetes.
There isn’t a large amount of research available on this subject, but doctors will assess your individual risk and discuss the options with you. You can keep your risk of a blood clot and stroke low by having a healthy lifestyle.
Stroke risk and migraine in women
Migraine affects more women than men. There are two types of migraine: migraine with aura and migraine without aura. The aura usually happens at the start of a migraine attack, before a headache begins. It often includes visual changes such as seeing flashing lights or dark patches.
People with migraine, particularly with aura, have roughly twice the risk of an ischaemic stroke (a stroke caused by a clot). Because of this link, women who have migraine with aura are advised not to take the combined contraceptive pill.
It is important to remember that the risk is still very small, particularly if you don’t have many other risk factors for stroke.
Lupus and stroke
Lupus is an autoimmune condition that mainly affects women. It tends to appear more often among people of African, Caribbean and Chinese descent.
Some forms of lupus mainly affect the skin, but it can also cause fatigue and joint pain with irregular flare-ups. The severe form is called systemic lupus erythematosus (SLE). This can cause kidney damage leading to high blood pressure, which makes a stroke more likely.
There is no cure for lupus itself, but you can treat the symptoms such as pain and high blood pressure. If you have SLE, your kidneys should be monitored, and kidney problems can be treated with immunosuppressants. You can also take steps to reduce your risk of a stroke by making healthy lifestyle choices like eating healthily, not smoking and taking plenty of exercise.
Blood thinning medication and women’s health
If you have had blood clots or a stroke before, you may need to take blood-thinning medication. This is usually a long-term treatment, and it’s important to take the medicines as prescribed to help you stay healthy.
Some women find that blood-thinning medication can give them very heavy periods or vaginal bleeding between periods. If this happens to you, tell your GP.
Types of stroke in women
Women tend to have strokes later in life than men. But overall, more women die of stroke than men. This is probably because women live longer than men and tend to have their strokes when they are older. Women can have the same types of stroke as men, caused by a clot or a bleed in the brain. But there is another rare type of stroke which is more common in women, known as cerebral venous thrombosis (CVT).
Cerebral venous thrombosis (CVT)
CVT happens when a blood clot forms in the space between the brain and the skull. This blocks blood draining out of the brain. It can cause stroke symptoms, and sometimes leads to bleeding in the brain.
The main symptom is often a headache, but you can also have signs of stroke such as confusion, seizures and weakness down one side. Symptoms might come on more gradually than a typical stroke. But you should get medical help as soon as possible.
It may be treated with an injection of the anticoagulant heparin, and you might be given blood-thinning medication to reduce the risk of another clot.
How can I stay healthy and avoid a stroke?
As you get older, your stroke risk goes up over the years. But by staying active and having a healthy diet and lifestyle, you can feel good and stay healthy for longer.
Some health conditions are strongly linked to stroke, including high blood pressure, atrial fibrillation, diabetes and high cholesterol. If you have any of these conditions, sticking to any treatment you’re given can significantly cut your risk of a stroke.
Stroke can run in families, so speak to your GP if several close relatives have had a stroke or heart attack. People from some ethnic groups, such as South Asian and African and Caribbean people, have a higher risk of stroke compared to the general population. To find out more about your individual risk of stroke, ask your pharmacist or nurse for a health check and advice.
A stroke can happen to anyone, at any age, but there are many things you can to stay well and active.