Menopause and the Risk of Stroke

When women reach the age of 45, they hit a statistical marker. That is the age when the risk of stroke begins to climb for women. And the reason you should pay attention to this is that most women don’t even think about the possibility of stroke until they are much older — when it may be too late.

Older couple jogging in the park
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As we move into the menopause years and estrogen is no longer protecting us the way it once did, we begin to have more and more risk of both heart disease and stroke. By the age of 65, we catch up with men, and those intervening years are ones when we need to be vigilant. Women don’t have quite as many strokes as men in those middle years, but we are much more likely to die if we do have one. The reasons for this are not exactly clear, but they have to do with not getting the same treatment as men, and with not recovering as well as men do.

Risks Factors You Can't Change

Some of the risks you have for stroke are in the hand that you are dealt, and you can’t really do too much about them. Some of those irreversible risk factors include:

  • Your Age: There has been a notable increase in strokes among women aged 45 to 55. Researchers are sorting out why this is the case, but one thing you can’t change is your age. And after 55 your risk climbs, and a third of strokes occur in women before the age of 65.
  • Your Ethnicity: African-American and Hispanic women are more likely to have a stroke than Caucasian women. You are at highest risk if you are an African-American woman since almost half of the African-American women will die of stroke and heart disease.
  • Your Family History: If there is someone in your immediate family who has suffered a stroke, you have twice the risk of a woman who does not have a family history of stroke.
  • Personal History of Stroke: If you have already had a stroke or a trans ischemic attack (TIA), which is a “mini-stroke,” you have a much higher chance of having another stroke.

Risks You Can Change

While it’s true that there are many risk factors for stroke that you cannot change, there are many measures you can take to lower or eliminate altogether. Once you realize that women are more likely to die from a stroke if they have one, it can be a wake-up call to make changes the following if they apply to you:

  • Smoking: If you need one more reason to quit smoking, the risk of stroke is a good one. Quitting is really difficult, and most people need help to make such a big behavior shift. It’s not a matter of willpower alone — it’s a strong, compelling addiction and you will need support and resources to quit smoking successfully.
  • Weight Gain: Being in the obese range is a major risk factor for stroke, especially for women. In particular, if you have “central obesity,” marked by a waist circumference of more than 35 inches (40 inches for men) you are at greater risk for a stroke. If you have obesity as a risk factor, weight loss should go to the top of your list.
  • Drinking Alcohol: Women who drink more than 2 drinks a day increase their risk of stroke by 50%.
  • High Blood Pressure: Do you know your blood pressure? Many women are surprised when they go in for an annual exam and find that their blood pressure has crept up into the danger area. A woman’s blood pressure can climb as much as 8 to 10 points a year in middle age. If you don’t know your blood pressure reading for some time in the last 6 months, have it taken. And if you know it is high, get it treated. There are many treatments for high blood pressure, and keeping it down lowers your risk of stroke.
  • Exercise: Being even moderately fit can reduce your risk significantly, and women who are very fit can reduce their risk of stroke by as much as 43% over women who have low fitness levels.
  • High Cholesterol: Like blood pressure, cholesterol can begin to rise in your 40s. Be sure that you have a cholesterol screen when you have your annual exam, and then keep track of it. If it gets into the treatable range, it is a sign that you are at risk for stroke.

Learn the Signs

Many women are unaware of what the signs of a stroke are. They delay getting care or calling 911 until some damage has already been done. Don’t dismiss the symptoms of stroke, and don’t hesitate to get help if you have any of the following:

  • Sudden weakness or numbness in your arm, leg or face — especially if it is one-sided.
  • Confusion, difficulty understanding what others are saying, or problems speaking
  • Loss of coordination, balance or ability to walk.
  • Double or blurred vision
  • Sudden unexplained, unusual headache

Women Have Different Symptoms Than Men

Women present with nontraditional symptoms of stroke 62% of the time, much more frequently than men. This means that our symptoms are more likely to be missed or misunderstood and precious time can be lost because we don’t associate our symptoms with stroke. So in addition to the more traditional signs of stroke listed above, be aware of the following as symptoms that women experience:

  • Pain. Women are more likely to report pain as a symptom of their stroke, including chest pain, and sudden face or limb pain.
  • More Generalized Symptoms Women also report general sensations such as weakness, fatigue, shortness of breath and nausea more often than men do.
  • Other Unusual Symptoms. Women may experience hiccups and heart palpitations during a stroke, which are rare in their male counterparts.

It’s easy to see that the unique stroke symptoms that women have might be easily misinterpreted or ignored. Be aware of these unusual symptoms so that you don’t dismiss them. And if you notice any warning signs or symptoms of a stroke, don’t talk yourself out of them. Quick treatment makes all the difference, so get help right away. When in doubt, call 911. Better to be embarrassed than to suffer a stroke without medical attention.

Realize that women have strokes too and that we are much more likely to die of them than men are. Pay attention to your risk factors, and work with your medical provider to keep your chances as low as possible of having a midlife stroke.

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