Women account for 60% of all strokes, and researchers are only just beginning to understand why.

When people think of strokes, many imagine a universal risk, but the reality is more complex and serious for women. Women account for over 60% of all strokes, and they tend to suffer more debilitating consequences afterward.

Why Are Women at Greater Risk of Stroke?

While men and women share some common risk factors, like high blood pressure, diabetes, stress, and smoking, women face additional unique stroke risks across their lifespan.

One of the key differences in stroke risk lies in hormonal fluctuations. The estrogen and its derivatives that are produced by your body have a significant protective effect on blood vessels, keeping them flexible and healthy. This translates to a lower risk of cardiovascular disease. But when women go through menopause, the body produces less estrogen, so this is typically when conditions like hypertension or cardiovascular disease develop.

During the first 10 years after menopause, a woman’s risk of stroke more than doubles. The earlier women enter menopause, the higher the risk, especially if it’s before age 40.

The next logical thought would be to replace the estrogen that the body is no longer producing through Hormone Replacement Therapy (HRT). Unfortunately, synthetic estrogen does not have the same protective effect as the estrogen that is produced by your own body. HRT actually increases stroke risk significantly, especially in women who already have other cardiovascular risk factors. This is thought to be caused by estrogen’s tendency to thicken the blood, which increases the risk of blood clots.

Women’s Stroke Type

Women are more prone to hemorrhagic strokes than ischemic strokes. Ischemic strokes are caused by a blockage like a blood clot traveling to the brain and affecting the blood flow to certain regions of the brain. Hemorrhagic strokes occur due to bleeding in the brain, either from trauma or a ruptured blood vessel. The hemorrhagic type of stroke is often caused by high blood pressure, which becomes much more common in women following menopause.

Women are also disproportionately affected by migraines, specifically those with an aura. Having these types of migraines is also associated with much higher stroke risk and peaks during childbearing years. If coupled with another risk factor like smoking or use of hormonal birth control, stroke risk escalates sharply.

Maternal Strokes

Pregnancy changes a lot about a woman’s body; blood volume increases by nearly 50%, blood pressure regulation becomes more complex, and there is a significant increase in estrogen production. These changes can strain the cardiovascular system and make women more susceptible to hypertensive disorders like preeclampsia and eclampsia, both of which are major stroke risk factors.

A woman’s stroke risk increases by three times during pregnancy, with strokes typically occurring in the last trimester or in the 12 weeks following birth. This includes the risk of ischemic stroke as well as hemorrhagic strokes. This is why vigilant prenatal and postnatal care is so important in women with high blood pressure.

How Ethnicity Factors into Stroke Risk

Strokes do not affect all women equally. African American women are nearly twice as likely as caucasian women to experience a stroke, and it is more likely to be fatal. This is partially explained by the prevalence of sickle cell disease, which increases stroke risk but also has to do with social determinants of health.

Social determinants of health include access to care, income level, education, access to healthy food, community safety, and chronic stress from systemic inequities. Chronic conditions like hypertension and diabetes are far more prevalent in Black and Hispanic communities and are often underdiagnosed and undertreated, exacerbating stroke risk.

How to Reduce Your Risk of Stroke

When it comes to your long-term health, prevention is the name of the game. Many stroke risk factors are modifiable with the right lifestyle adjustments. Here are some things you can do to track and reduce your risk of stroke:

• Don’t Skip Your Yearly Checkup - The more information you have about your health, the healthier and more proactive you can be long-term. If you manage your conditions well and catch them early, you are far less likely to experience a stroke.

• Track Your Blood Pressure - High blood pressure is a leading cause of stroke and can be asymptomatic. Monitor it regularly and consult your doctor if your blood pressure is trending upward.

• Discuss Hormonal Risks - If you’re considering estrogen-based birth control or HRT, talk to your doctor about your risk. Your age, family history, clotting factors, and other health conditions should be part of your decision.

• Manage Chronic Conditions - Stay on top of diabetes, high cholesterol, and any cardiac problems with the medications recommended by your doctor.

• Stay Active and Eat Heart-Healthy - Get your body moving for at least 20 minutes per day, and consume a diet rich in fruits, veggies, and whole grains to keep your blood vessels flexible and reduce inflammation.

• Prioritize Mental Health - Depression, anxiety, and chronic stress are associated with a higher stroke risk. Prioritize your emotional well-being as part of your overall health strategy.

• Avoid Highly Processed Foods - Foods that are high in preservatives, unhealthy fats, and sodium all contribute to an increase in systemic inflammation, which is a major driver of chronic diseases.

Differences in Stroke Outcomes

After a stroke, women often face a harder road to recovery. They are more likely than men to experience severe disability, reduced mobility, and lower quality of life after a stroke. This may be due to older age at the time of stroke, less aggressive treatment, higher stroke severity, or fewer social supports during recovery. Women are also more prone to post-stroke depression and cognitive decline, which hinders rehabilitation.

This is why a one-size-fits-all approach doesn’t work when it comes to stroke rehabilitation. At Reunion, we understand that women’s risk factors and recovery journeys are unique. That’s why we create personalized recovery plans for every patient that walks through our doors. We not only address physical rehabilitation but also cognitive, emotional, and social recovery needs. This plan is complete with a discharge packet full of educational materials, directions, and a follow-up schedule, so your recovery can continue when you return home.

Our team includes specialists from different disciplines, like neurology, physical therapy, speech-language pathology, and mental health. They work together to help every woman rebuild strength, regain independence, and return to the life they love fully recovered.

Recovery is personal. At Reunion, it’s also powerful. Choose care that’s built for women, by experts who understand.