Stroke poses a significant health risk to women, with hormonal changes, pregnancy complications and menopause increasing vulnerability. Experts urge women to recognise B.E. F.A.S.T. symptoms and seek immediate medical attention.
Stroke remains widely perceived as an affliction of late age, with traditional prevention campaigns centering predominantly on typical male presentations. But data from the American Stroke Association and recent and international reviews in Stroke reveal the sad reality of stroke as a disease that disproportionately harms women. Stroke ranks as the third leading cause of death in women, with 1 in 5 women having a stroke and female stroke survivors with inferior functional recovery and higher mortality than male stroke survivors.
A central driver behind this disparity lies in the intricate interplay between vascular health and female sex hormones throughout a woman’s lifespan.
The risk curve starts early in the reproductive years. Exogenous estrogens in combined oral contraceptives increase the thrombotic risk associated with migraine with aura, smoking, and/or untreated hypertension. Hemodynamic expansion and physiologic changes in coagulant proteins in pregnancy and the early puerperium increase thrombotic risk by fourfold. Pregnancy outcomes that challenge the maternal vasculature, such as preeclampsia and gestational hypertension, warrant ongoing attention; they are not nebulous, self-limited findings but rather a test of the vasculature that is played out over a lifetime and ultimately doubles the risk of stroke.
The other important vulnerable interval is the menopause transition years later. Endogenous estrogen serves as the natural endothelial protector, leading to vasodilation and lipid homeostasis. Arterial stiffening, hypertension, and certain metabolic dysfunctions increase in women in the face of declining estrogen. On PubMed, prominent work reveals that women with premature or early menopause (< 45 years of age) have a higher cerebrovascular disease burden. National, large prospective studies have found that systemic hormone replacement therapy (HRT) fail to lower the risk of stroke; indeed, late-onset oral estrogens may pose elevated thromboembolic risk.
The burden of embolic stroke is also more pronounced in women than men and will increase with the more severe and disabling type of embolic stroke and atrial fibrillation in older age.
Proactive, personalized care is essential in reducing this burden. Clinicians should routinely incorporate reproductive history (e.g., complications of pregnancy, contraception, timing of menopause) into a vascular examination. Stay Aware At Home. Memorize the B.E. F.A.S.T. (Balance problems, Eyesight loss, Facial drooping, Arm weakness, Speech problems) that can mean the difference between permanent disability and full recovery. If you experience symptoms, it’s an emergency: call your emergency medical services and don’t sleep it off.
(Authored by Dr. Lakshmi Krishna V, Consultant – Neurology, Manipal Hospital Electronics City)