Stroke Prevention for Women: What You Need to Know

Every year, stroke claims thousands of lives in the United States, ranking as the fifth leading cause of death and a major contributor to long-term disability. Many people may not realize that women face a higher risk of stroke than men, driven by unique biological factors and a longer average lifespan.

An estimated 795,000 people have a stroke each year in the U.S.—a figure that includes about 55,000 more women than men, according to the American Heart Association. Black women have the highest prevalence of stroke.

Fortunately, many strokes are preventable, and there are steps women can take to reduce their chances of having one, health experts say. In October 2024, the American Heart Association and the American Stroke Association published new guidelines—for the first time in 10 years—outlining ways to prevent a first stroke. Published in the journal Stroke, the guidelines emphasize the importance of preventing a first stroke, because once someone has one stroke, they are at higher risk of having subsequent strokes.

The updated guidelines are for men and women, but include female-specific considerations. For example, premature childbirth and conditions such as endometriosis, early menopause (before age 45), premature ovarian failure (when the ovaries stop functioning before age 40), and the use of oral contraceptives can all raise the risk of stroke in women.

Additionally, Black women are twice as likely to have a stroke as non-Hispanic white women, and they also have higher rates of pregnancy complications due to higher rates of pre-existing hypertension (high blood pressure).

“Unfortunately, I don’t think many women are aware of all the increased risks they face,” says Rachel Forman, MD, a Yale Medicine stroke neurologist. “And many of these are associated with conditions that can occur during pregnancy, which is a normal part of life.”

The two main types of stroke are ischemic, which occurs when a blockage—typically a blood clot—reduces or stops blood flow to part of the brain, and hemorrhagic, which happens when a blood vessel ruptures and causes bleeding in or around the brain. All types of stroke cause damage that can be disabling, including difficulty thinking, talking, and walking.

“Educating women about stroke empowers them to take precautions that can improve their overall health and decrease their stroke risk,” points out Meghana Rao Brito, MD, a Yale Medicine cardiologist. This includes managing conditions such as high blood pressure, high cholesterol, and diabetes, all of which can cause plaque to build up in the arteries (atherosclerosis), narrowing them and restricting blood flow. These factors increase the chance of blood clots, which can lead to stroke.

Since damage to the arteries can take years to develop, it’s important for women to take preventive steps early and to be aware of their risk factors.

There is much medical researchers don’t understand about women’s higher stroke risk, but certain differences stand out. For example, women live longer than men, on average, and the risk of stroke increases with age. Furthermore, pregnancy, childbirth, and menopause involve significant hormonal changes that can impact cardiovascular health. Many heart conditions raise the risk of stroke.

Certain pregnancy-related complications, such as gestational hypertension, small-for-gestational-age infants, and especially preeclampsia (more on these below) raise a women’s lifetime risk of stroke by up to 20% to 30%, Dr. Forman says.

Here are conditions that raise a woman’s stroke risk during and after pregnancy:

• Gestational hypertension: high blood pressure that develops after 20 weeks of pregnancy in a woman who previously had normal blood pressure
• Preeclampsia: High blood pressure after 20 weeks of pregnancy, accompanied by additional, symptoms such as severe headache, vision problems, and abdominal pain
• Gestational diabetes: high blood sugar levels in a pregnant woman
• Recurrent pregnancy loss: two or more miscarriages before 20 weeks of gestation
• Having a baby that is small for gestational age: birth weight is below the 10th percentile for their gestational age

Outside of pregnancy, these factors, in addition to ones mentioned earlier, are associated with an increased stroke risk in women:

• High blood pressure: This is a leading cause of stroke, and women over age 65 are more likely than men to develop it. Elevated blood pressure also raises the lifetime risk of atrial fibrillation (irregular heart rhythm), which significantly increases stroke risk.
• Smoking: Smoking contributes to plaque buildup in the arteries, narrowing them and reducing blood flow to the brain, potentially leading to a stroke. In women, smoking can interact with estrogen, further increasing the risk of stroke.
• Obesity: Excess weight increases the workload on the heart and can lead to high blood pressure.
• Sleep apnea: This can cause intermittent high blood pressure during sleep, increasing stroke risk.
• Oral contraceptives and hormone replacement therapy: Using these, especially in women who smoke or have other risk factors including high blood pressure or migraine with aura (sensory disturbances including flashes of light, blind spots, numbness, tingling), raises stroke risk.

These risks do not mean a woman should forgo oral contraceptives or hormone replacement therapy, but Dr. Rao Brito suggests they are reasons to ask a medical provider for a personalized risk-benefit analysis.

It’s also important for women to tell all their health care professionals about their risk factors, Dr. Forman notes. “Immediately after pregnancy, we follow up with women who had issues, but 10, 20 years down the road, if she’s well past it and seeing a different provider, her provider may not know,” she says.

One of the most important steps a woman can take to prevent stroke is to “know your numbers,” says Dr. Forman.

For example, the numbers she is referring to in adults are:

• Blood pressure: Normal blood pressure is typically systolic pressure (top number) below 120 mm Hg and diastolic pressure (bottom number) below 80 mm Hg.
• Cholesterol: This takes into account readings including HDL (high-density lipoprotein) and LDL (low-density lipoprotein). A healthy HDL level for women is 50 mg/dL or higher; for LDL, it is less than 100 mg/dL.
• Blood sugar: For fasting (not eating for at least 8 hours), a blood glucose level of 100 mg/dL or lower is normal. For two hours after starting a meal, a level of less than 140 mg/dL is normal.

If any of these numbers are outside the normal range, women should work with a medical provider to manage them through medication or lifestyle changes.

Some women may benefit from medications for certain conditions, but managing lifestyle behaviors, including diet and exercise, also goes a long way to reduce stroke risk. The guidelines recommend a Mediterranean-style diet, which emphasizes whole grains, fruits, vegetables, healthy fats (like olive oil), lean protein (primarily fish), legumes, nuts and herbs, while minimizing processed foods and red meat.

The guidelines also encourage health care providers to screen patients for sedentary behavior, a confirmed risk factor for stroke, and to promote regular physical activity. According to federal guidelines, adults should get at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week.

“These guidelines lean into the importance of how you live your life from childhood through adulthood, and emphasize appropriate nutrition and exercise, which I think is great,” says Dr. Rao Brito.

Finally, medical experts encourage people to know the abbreviation FAST (face drooping, arm weakness, speech difficulty, time to call 911) to identify signs of a stroke.