Many of the same things cause strokes in women and men, but there are some important differences as well. Some of these differences are due to lifestyle factors, and some are due to the differences between male and female bodies.
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
Using the contraceptive pill is very safe, but some types do carry an increased risk of stroke for some people. That’s why your risk of stroke should be carefully checked before you are given hormone contraceptives.
If you are taking the pill and are worried about having a stroke, 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
The combi pill contains both oestrogen and progestogen. Treatments including oestrogen can increase the risk of blood clots and stroke in some people. 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.
If you do not have any other risk factors for stroke, then you should be able to use the combined oral contraceptive pill or contraceptive patch safely.
Who can’t use the combi pill
You may not be able to use these contraceptives if you have any of the risks:
Progestogen-only treatments are unlikely to raise your stroke risk, but may not be suitable if you have had a stroke or heart disease before.
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.
Stroke and pregnancy
Although the overall risk of stroke in younger women is low, pregnancy does increase your risk of a stroke. But all pregnant women should have regular appointments to check for high blood pressure and diabetes, which aim to avoid problems during pregnancy and birth.
If you are pregnant and have existing high blood pressure or other risk factors for stroke and heart disease, you should be closely monitored during your pregnancy.
One reason for the risk of stroke in pregnancy is the high levels of hormones causing changes in the blood vessels and the make-up of the blood. This makes a blood clot more likely, with the highest risk being just after you have had your baby.
During pregnancy your blood pressure can rise, causing a higher risk of stroke.
Pre-eclampsia can affect any pregnancy, and one of the main signs is high blood pressure. Other signs of pre-eclampsia include protein in your urine, 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 women become diabetic during pregnancy, known as gestational diabetes. This stops after the birth, but you can be more likely to develop diabetes later in life.
Gestational diabetes makes you more likely to develop pre-eclampsia, which raises your stroke risk. If you have diabetes you should be given treatment and advice to help lower the chances of any problems during pregnancy and birth.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is a treatment that tops up hormone levels. It’s often used to help symptoms of the menopause, such as hot flushes, vaginal dryness and mood swings.
There are different types of HRT which can 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.
Fertility drugs and IVF treatment (in vitro fertilisation)
The hormones used to increase fertility or to prepare for 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.
Stroke risk and migraine in women
Migraine is a complex condition with a variety of symptoms, and it affects more women than men.
It is thought that female hormones are closely linked to migraine in women. Many women report having a migraine attack around the time of their period, known as a ‘menstrual migraine’. Some women also find that their migraines may get worse as they approach the menopause, but may improve after the menopause.
Studies show that people with migraine, particularly with aura, have roughly twice the risk of an ischaemic stroke (a stroke caused by a blockage). Because of this link, women who have migraine with aura are advised not to take the combined contraceptive pill.
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.