Stroke In Women

Stroke is the fifth leading cause of death for men but the third leading cause for women, and with the aging of the population, numbers continue to rise.

How our society adapts to the anticipated increase in stroke prevalence in women is vitally important. Now more than ever, it is critical to identify women at higher risk for stroke and initiate the appropriate prevention strategies.

There are certain risk factors for stroke are unique to women, such as pregnancy, use of oral contraceptives, and hormone replacement therapy. Some medical conditions increase stroke risk are much more common in women. These include migraine with aura and cerebral vein thrombosis. So we really need to take gender into account when assessing stroke risk.


Pre-eclampsia during pregnancy is associated with a doubling in the risk of stroke later in life, even if blood pressure returns to normal after delivery. Something happens to the vasculature when pre-eclampsia occurs that doesn't return to normal at the end of pregnancy.

So it is important to ask older women when assessing their stroke risk whether they had pre-eclampsia during pregnancy, even if this was 30, 40, or even 50 years ago. If they did, then they are at higher stroke risk so will need to be screened for blood pressure and other risks more often, or they may need to start screening earlier.

Preventing Pre-eclampsia

One of the new recommendations is that women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to decrease pre-eclampsia risks.

Pregnant women with moderately high blood pressure (150 to 159 mmHg/100 to 109 mmHg) may be considered for blood pressure medication, whereas expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.

Screening women for high blood pressure before they begin taking birth control pills is needed because the combination raises stroke risk. Women with migraine headaches with aura should also be encouraged to stop smoking in order to avoid increased risk.
At the other end of the age spectrum screening for atrial fibrillation (AF) in women older than age 75 years is a must.

Women over the age of 75 have a higher risk than men of having AF. But sometimes they are completely asymptomatic. We need to screen these older women more aggressively.