Stroke is the third leading cause of death and disability in Canada, with approximately 50,000 new cases each year. But women face unique risk factors that are often overlooked or ignored, making heart disease and stroke the leading causes of premature death in Canadian women.
And in addition to these unique factors, women often don’t present the way we’ve been taught. Signs of a stroke in women can follow the script we’ve been taught, but often these more obvious symptoms come later.
Signs of a Stroke in Women
You may know, and in fact we’ve written about the acronym, FAST to describe how to identity a stroke:
Signs of a stroke in women can be a little different. While women can and do experience these symptoms, often, they first present a bit differently, with more vague signs such as feeling dizzy, nauseous, overly tired, or just inexplicably “off”.
As a woman, waiting until you present with the classic symptoms could mean waiting too long. According to the CDC, “The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these treatments if they don’t arrive at the hospital in time.” That means that women must be alert to a wider array of symptoms that are not limited to FAST in order to ensure they can access proper treatment in time to make a difference.
How A Woman’s Risk Changes Throughout Her Lifetime
Estrogen can have a protective effect on the brain. The way the hormone fluctuates throughout a woman’s lifetime can change her risk. 89 per cent of Canadian women don’t know what their unique risk factors are, so let’s break it down.
Reproductive Years – Estrogen Fluctuations and Age of Menarche
Your reproductive years are the years between your first period and when you start to experience perimenopause. During this time, your body typically produces a large amount of estrogen, which can help to protect the heart. But fluctuations – which can be seen through irregular periods, etc. – can be dangerous.
Your age when you get your first period is associated with your risk – if you start menstruating before the age of 12 or after the age of 14, your risk of developing a heart condition or a stroke earlier in life is increased.
Contraceptives – Too Much Estrogen is a Risk
While estrogen is a protective factor for the heart, too much estrogen is not a good thing.
Hormonal birth control can significantly raise your risk of stroke. Hormonal birth control often raises your blood pressure, and after age 35 being on hormonal birth control increases the likelihood of developing a clot.
Oral contraceptives typically have a lower associated heart risk than internal methods like a NuvaRing or IUD.
Pregnancy and High Blood Pressure – It’s More Common Than You Might Think
Pregnancy can also impact your heart because it has to work harder during this time. According to the Heart and Stroke Foundation, women can develop several conditions that put them at a significantly higher risk of stroke:
- chronic high blood pressure: before 20 weeks,
- gestational high blood pressure: after 20 weeks,
- preeclampsia: high blood pressure, presence of protein in urine, headaches, changes in vision,
- eclampsia: when a pregnant or newly postpartum woman experiences seizures or loss of consciousness, typically following signs of preeclampsia.
The Heart and Stroke Foundation continues that “Women who experience high blood pressure during pregnancy are two to three times more likely to develop heart conditions or stroke and two times more likely to die from heart conditions or stroke before age 70.”
There is also pregnancy-related stroke, which is relatively rare, but it can happen. The highest risk period is during birth and the first few months after delivery. It is usually the result of an underlying problem such as a pre-existing blood vessel malformation or eclampsia.
You may have heard of the case of Adriana Smith, a nurse in Georgia who suffered from a stroke while pregnant. According to The Independent, Smith originally went to the hospital complaining of a headache. She was given medication and released.
It’s unclear what type of care she received in the hospital or if the stroke was related to her pregnancy, but it underlines a concerning trend. Women, especially racialized women, often complain that their pain and their concerns are not taken seriously by the medical community.
Perimenopause and Menopause – Estrogen Levels Drop Quickly
During this time, your estrogen levels often plummet, leaving your heart open to new threats. Research suggests that menopausal hormonal therapy could help reduce women’s risk of heart disease and stroke, though the area of research is relatively new and needs to be further explored.
Similar to the significance of age of your first period, your age at perimenopause can also impact your risk. If you start experiencing symptoms of perimenopause before age 45, you are deemed to be at higher risk because you will be maintaining lower estrogen levels for an extended period of time..
Sometimes menopause is accompanied by high blood pressure, increasing your risk of heart conditions.
Age is also a risk factor. After age 55, your risk of stroke doubles every 10 years.
Post Menopausal – Age is a Risk Factor
By this point in life, the increased risk of heart disease and stroke are not unique to women. Age itself is a major risk factor for both sexes.
Women should still be aware of how early risks (i.e. age of first period, complications during pregnancy) can impact them. Additionally, women are disproportionately affected by high blood pressure, atrial fibrillation and depression, all of which raise your risk.
Know Your Risk – And Advocate for Your Care
Understanding a woman’s risk of stroke means zooming out and looking at your whole life—not just your symptoms at a given point in time. And it means knowing that signs of a stroke in women may not be what you’d first expect.
From the timing of your first period, to complications in pregnancy, to high blood pressure, to the hormonal shifts of menopause, stroke risk in women is shaped by experiences that are often invisible to the healthcare system.
The risk is real. But so is the opportunity to catch it early, to treat it quickly, and to give women the care they require and deserve—through every stage of life.
So if something feels off, don’t wait. Don’t second-guess. Know the signs of stroke in women. Know your history. And advocate for your health—because no one else lives in your body, and no one else knows it better than you do.
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