The Stroke-Hormone Link: What Women Should Know

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[4 MIN READ]

In this article:

  • Stroke is the fifth leading cause of death among women.

  • Women account for 60% of stroke deaths each year.

  • Changes in hormone levels can increase the risk of stroke in women.

When you hear the word “stroke”, if you immediately suspect that a man is affected, you should reconsider your decision. It’s true, more women than men will experience a stroke in their lifetime. In fact, stroke is the fifth leading cause of death among women. It is twice as common for women aged 20 to 39 to have a stroke as men of that age, and it occurs in more women than men over the age of 85. Women are also more likely to have another stroke within five years of their first event.

Men and women share many of the same risk factors. However, there is a factor that is specific to women. It is increasingly understood that if you have taken hormones as part of fertility treatments to have a baby, taken a contraceptive containing estrogen, or used hormone replacement therapy to control menopausal symptoms, your risk of stroke is higher. If you have taken or are considering taking these treatments, it is important to know why the risk exists and what you should discuss with your doctor.

What is a stroke?

A stroke happens when something blocks the flow of blood to your brain or when blood vessels in your brain burst. Without the oxygen carried in your blood, your brain cells die, damaging your brain functions. As a result, you may lose the ability to move, speak, remember, think clearly, eat, or control many bodily functions. In the United States, a person suffers a stroke every 40 seconds and a person dies from it every three and a half minutes. Roughly 795,000 people suffer a stroke each year, with women accounting for 60% of deaths.

There are two types of hits:

ischemic: This trait is the most common type. During this event, a major blood vessel in your brain is blocked by a blood clot or a buildup of fat or cholesterol, also called plaque. It accounts for about 87% of strokes.

Hemorrhagic: This stroke occurs when blood vessels in your brain burst, exposing your brain to blood. As the bleeding continues, pressure builds up on your brain tissue, causing progressively more damage.

These symptoms are common to everyone if you have had a stroke:

  • Weakness or numbness in the face, arm, leg, or one side of the body
  • Difficulty speaking and understanding
  • Dizziness and problems with balance or coordination
  • Loss of vision or darkness
  • Fainting or seizure

Women may experience additional subtle signs:

  • Bad headaches usually without cause
  • brain fog
  • Exhaustion
  • Nausea and vomiting

What roles do hormonal treatments and hormone replacement therapy play?

The increased risk of stroke associated with hormone treatments and hormone replacement therapy comes down to one thing: they cause changes in your hormone levels. These changes can occur both with fertility treatments as well as with birth control and therapies to reduce your menopausal symptoms.

Although rare, certain drugs used to increase fertility or prepare your body for in vitro fertilization (IVF) can increase your risk of stroke. Two hormones called gonadotropins – follicle-stimulating hormone and luteinizing hormone – are frequently injected to help your body produce more eggs for an IVF cycle. In about a third of cases, they can cause swelling of the ovaries, called ovarian hyperstimulation syndrome. This condition can potentially cause blood clots. Contraceptives that contain estrogen: Women who use forms of birth control that contain only estrogen are twice as likely to have a stroke as women who don’t. Although estrogen offers some protection against strokes, such as lowering your cholesterol levels, it can also raise your blood pressure and thicken your blood. This makes blood clots more likely. Pills that contain higher levels of estrogen increase your risk the most.

Your risk of stroke may be even higher if you have any of these additional risks:

  • Smoking
  • High blood pressure
  • History of stroke or blood clots
  • Overweight
  • Taking certain medications, including certain antibiotics and treatment for epilepsy, tuberculosis or HIV
  • Severe migraines, especially with aura
  • Complicated diabetes
  • Heart abnormality or disease
  • Hormone replacement therapy (HRT)

Using HRT to control your menopausal symptoms, such as hot flashes and night sweats, is a bit mixed when it comes to your risk of stroke. The impact of treatment on your risk of stroke depends on when you start taking it. If you start within five years of menopause, your risk remains the same as that of women who have never used HRT. However, if you start HRT 10 years or more after the onset of menopause, your risk of ischemic stroke increases. Given these potential problems, doctors now recommend limiting HRT to the lowest dose you need and using it for the shortest time possible.

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This information is not intended to replace professional medical care. Always follow the instructions of your healthcare professional.

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