Did you know that signs of a stroke can be different in women than men? This, plus risk factors you may not know about, make stroke a leading killer of women. Here’s the info you need.
Why symptoms are different
If you’re at risk for a stroke, one acronym could save your life: FAST, developed by the American Stroke Association (ASA), which stands for face drooping, arm weakness, speech difficulty, and time to call 911. But these aren’t the only or even most obvious stroke symptoms in women, says Cheryl D. Bushnell, MD, professor of neurology at Wake Forest Baptist Health in Winston-Salem, NC. “We have no idea why the stroke symptoms might be different for women. We need research on this topic.” Women also have unique risk factors—their hormones can play a role—making stroke the third leading cause of death in women.
1. Fainting or seizures
You might be tempted to minimize a fainting spell, but it could be a stroke: Women tend to suffer strokes to the back of the brain more often than men, says Diana Greene-Chandos, MD, assistant professor of neurosurgery and neurology at The Ohio State University Wexner Medical Center in Columbus, Ohio. Known as posterior circulation strokes, they cut off “blood flow to the occipital lobes, brainstem, cerebellum, and part of the temporal lobe. The top of the brainstem is where the consciousness center lies,” Dr. Greene-Chandos explains, and cutting blood flow to this part of the brain can lead to fainting. She notes that fainting “could also be related to a hyperventilation response to any type of stroke, as a fear response,” and that seizures, another of the stroke symptoms in women, can also be confused with a loss of consciousness.
2. Difficulty breathing
Although women would think chest pain and shortness of breath are signs of a heart attack, it could be a stroke. “This is consistent again with posterior circulation problems from the bottom of the brainstem where the respiratory drive centers lie,” says Dr. Greene-Chandos. Early recognition of stroke signs is crucial, says Kathryn M. Rexrode, MD, chief of the Division of Women’s Health at Brigham and Women’s Hospital and an associate professor of medicine at Harvard Medical School in Boston. “It is important to get prompt emergency care if you are experiencing stroke symptoms since some strokes can be stopped by use of thrombolytic, or clot-busting, drugs,” she adds.
According to a survey from Dr. Greene-Chandos and colleagues at The Ohio State University Wexner Medical Center, just 10 percent of women surveyed knew that hiccups, combined with atypical chest pain, are among the early stroke symptoms in women. “Hiccups are consistent with posterior circulation problems from the brainstem,” Dr. Greene-Chandos says. “The brainstem holds swallowing and the drive to breathe,” along with other functions. Keep in mind that this is an extremely rare symptom of stroke. There’s no need to run to the emergency room every time you hiccup!
4. Sudden behavioral changes or agitation
A shift in mental state may be a unique sign of stroke for women, according to the National Stroke Association. Dr. Greene-Chandos believes this could be consistent with a posterior circulation stroke, which could target areas responsible for memory and personality. However, the frontal lobe is also tied to personality, so behavior changes “could be due to a frontal lobe stroke as well,” she says.
5. Nausea or vomiting
A stroke in the cerebellum can also lead to dizziness, nausea, and vomiting, Dr. Greene-Chandos says. “This is consistent with posterior circulation problems from either the brainstem or the cerebellum.” It can also be seen in intracranial hemorrhage-type of strokes as well, she says, in which a bulging blood vessel (an aneurysm) bursts and causes bleeding into the brain.
While changes in your vision are a relatively common sign, according to the National Stroke Association, women’s visual symptoms may include hallucinations. Your occipital lobes—”the powerhouse of interpretation of visual input,” Dr. Greene-Chandos says—can be damaged by posterior circulation problems
7. Taking birth control pills or HRT
In Dr. Greene-Chandos’ study, only 11 percent of women surveyed knew that taking hormones like the birth control pills or hormone replacement therapy (HRT) could raise stroke risk. According to the American Stroke Association, the pill can double your chances of having a stroke. New research by Dr. Rexrode looked at why these hormonal treatments are problematic. “Oral estrogens tend to increase clotting factors made by the liver, leading to higher risk of blood clots,” Dr. Rexrode says. Some women also see their blood pressure rise on oral contraceptive pills. Your doctor should take your blood pressure before prescribing the pills and watch for changes. If you already have high blood pressure, make sure to tell your doctor before taking the pill or HRT. Taking birth control pills is a stroke risk factor you can control.
8. Early menopause or early menstruation
Starting either one of these life changes ahead of schedule can alter a woman’s risk, according to Dr. Rexrode’s research. Starting menstruation before ten years of age or menopause before a woman turns 45 can put her at a higher risk of a stroke. “During the years that woman is menstruating, she produces higher levels of estrogen and other hormones,” Dr. Rexrode says, and it may be that the shortened exposure to these hormones bumps up risk—though researchers are still searching for the reason.
9. Some pregnancy complications
Preeclampsia—dangerously high blood pressure during pregnancy—can raise your stroke risk later on in life. (These are the silent signs of preeclampsia every woman should know.) So can the pregnancy complication of gestational diabetes. Preeclampsia is a sign of stress on the circulatory system, and it can predict the risk of developing high blood pressure later in life, explains Dr. Bushnell. “Also, gestational diabetes is associated with an increased risk of diabetes—both hypertension and diabetes are very important stroke risk factors.” That’s why the ASA’s new stroke guidelines for women, authored by Dr. Bushnell, recommend that doctors consider a patient’s health during pregnancy. Dr. Rexrode notes that pregnancy itself also boosts stroke risk.
10. Multiple miscarriages
Unfortunately, unsuccessful pregnancies may also be a predictor of stroke risk, if the miscarriages were due to a clotting disorder, according to the American Stroke Association. “The clotting factors increase the risk of developing clots in the heart or in the blood vessels of the brain, both of which can lead to stroke,” Dr. Bushnell says. Another sign of a clotting disorder is a history of clots in the legs, also called deep vein thrombosis (DVT).
11. Low levels of a key hormone
Dr. Rexrode’s research identified another stroke risk in women: low levels of DHEA (dehydroepiandrosterone). “DHEA, a hormone made by the adrenal glands, is used in the manufacture of other hormones including estrogens and androgens [male hormones],” she says. “It is not entirely clear whether low DHEA levels reflect some other underlying problem, or whether the effect on risk of stroke is through their influence on other hormone levels.”
12. Migraines with aura
These vicious headaches are more common in women. According to the American College of Cardiology, having migraines with the visual disturbances known as auras is a risk factor for stroke. Dr. Greene-Chandos points out that migraines are known to constrict brain blood vessels, and that could contribute to cutting off blood supply to the brain. “This increases the risk of stroke,” she says.
13. Autoimmune disease
Women are also more likely than men to have autoimmune conditions like lupus, Dr. Greene-Chandos says. Recent research out of Spain shows that autoimmune diseases can raise the risk of stroke and cardiovascular disease. The link may be inflammation, says Dr. Green-Chandos: “Autoimmune inflammatory conditions put women at risk for inflammation of the cerebral vasculature [blood vessels].”
14. Mental health problems
Although the connection between mental health and stroke isn’t clear, scientists do know that stress is a risk factor for high blood pressure and cardiovascular problems—and women may be uniquely susceptible to stress, says Dr. Bushnell. A preliminary study from Harvard found that heightened activity in the amygdala, the area of the brain involved in the stress response, was associated with a greater risk of stroke.
15. Irregular heartbeat
Officially known as atrial fibrillation (AFib), this symptom is particularly concerning as women age. According to the American Heart Association (AHA), women with untreated AFib have five times the risk of stroke. “Atrial fibrillation leads to blood clot formation in the heart, which can then break off and lodge in a blood vessel in the brain,” Dr. Bushnell says.