There are many health issues that affect men and women differently — and stroke is an important, potentially life-altering one.
“Women have unique health care challenges ranging from having different risk factors for stroke, to having different symptoms of stroke, to responding differently to treatments for stroke, and sometimes being treated differently by health care providers,” says Cynthia Kenmuir, M.D., Ph.D.
Read on for Dr. Kenmuir’s insight into stroke and women from the Mayo Clinic Press book Taking Care of You: The Empowered Woman’s Guide to Better Health.
What is a stroke?
A stroke occurs when the blood supply to your brain is suddenly disrupted, preventing brain tissue from getting oxygen and resulting in brain cells dying. This injury to the brain causes a neurologic deficit (impaired functioning, such as an inability to speak or walk normally).
There are two forms of stroke:
- Ischemic stroke. This type of stroke is caused by a blockage in one of the blood vessels to the brain. The blockage starves the brain of needed oxygen and nutrients, causing brain cells to die. Approximately 85% of strokes are ischemic.
- Hemorrhagic stroke. This less common type of stroke occurs when there is bleeding into the brain caused by a broken blood vessel. Only 15% of strokes are hemorrhagic.
Stroke is a medical emergency. Both types of stroke can cause permanent disability or even death if left untreated. Brain cells die quickly — approximately 2 million brain cells are lost each minute during a stroke. However, it’s very important to know that in many cases brain cells can recover (and stroke symptoms can improve) if blood flow is quickly restored by removing the blockage causing the stroke. When recognized early, strokes can be treated and result in good outcomes.
Common symptoms of stroke include:
- Weakness or numbness on one side of the face, arm or leg
- Trouble speaking or understanding
- Loss of vision
Sometimes a blood vessel is blocked only briefly and symptoms are temporary. This is referred to as a transient ischemic attack. A transient ischemic attack still requires medical attention because it may be a warning that you could have a more serious stroke in the future.
Why does stroke matter to women?
There are several reasons why stroke matters to women.
Women are more likely than men to have a stroke.
One in five women will have a stroke in her lifetime. Among women, Black women have the highest chance of having a stroke. Women tend to be older than men are at the time of stroke and are 20% more likely to have significant disability from a stroke. Stroke kills more women than men and is the number four cause of death in women, killing over 80,000 women each year.
Women may present with nontraditional stroke symptoms.
Compared with men, women more often report less-specific symptoms of stroke, including headache, lightheadedness or passing out, fatigue or generalized weakness, a “funny” feeling that’s difficult to describe, chest pain, racing heart or shortness of breath, sudden behavior change, such as confusion, agitation or hallucinations, and nausea or vomiting. These less-specific symptoms can often be missed or misdiagnosed by both women and clinicians, resulting in treatment delays and worse outcomes.
Some risk factors are specific to women.
Pregnancy changes can thicken the blood, increasing the risk of a blood clot forming and causing a stroke. Stroke risk is highest around the time of childbirth and normalizes by six weeks after giving birth. Women who develop pregnancy-specific high blood pressure (including preeclampsia and eclampsia) have two to five times the stroke risk later in life compared with women who don’t have high blood pressure during pregnancy.
Hormones, including oral birth control pills and non-oral hormones such as Nuvaring, can increase the risk of blood clots that can cause stroke. These medications should be used with caution prior to age 35, and only after a discussion with your clinician that includes your individual stroke risk. Similarly, taking hormones later in life (more than 10 years from menopause) increases stroke risk. The age of menopause may also be a risk factor, with some studies suggesting that the earlier a woman reaches menopause, the greater her risk of stroke may be. However, not all experts agree and more research is needed.
Women are less likely to be treated for stroke.
After a stroke, women are less likely to be prescribed appropriate blood thinners and medications intended to lower blood sugar and cholesterol. They are less likely to be treated with emergency IV thrombolytic medication for their stroke, possibly related to delayed recognition of less typical symptoms by clinicians. Studies have shown that women are more prone to depression after a stroke and report a poorer quality of life after a stroke.
To sum up
Listen to your body. If something doesn’t feel right, it probably isn’t. Women can have more subtle symptoms of a stroke, especially in the early phases, when the stroke is often treatable with a good possible outcome. Women are less likely to have their stroke symptoms recognized as a stroke, less likely to be seen by a stroke specialist and less likely to have the standard medical evaluation after a stroke.
Time is brain! If you’re concerned that you or someone else is having a stroke, please call 911 immediately. Please do not call your neighbor, child or friend for a second opinion or try to drive yourself to the hospital. Strokes can worsen quickly, and you could miss your opportunity to get help, leaving you with permanent disability. Strokes can be treated, sometimes with complete recovery, if you get medical help quickly.
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