The stroke-hormone link: What women should know

July 7, 2022

Providence Heart & Vascular Team

[4 MIN READ]

When you hear the word “stroke,” if you immediately envision a man being affected, you should reconsider. That’s right — more women than men will experience a stroke during their lifetime. In fact, stroke is the fifth leading cause of death among women. It’s twice as common for women between ages 20 and 39 to have a stroke than men that age, and it occurs in more women than men over age 85. Women are also more likely to have another stroke within five years of their first event.

Men and women do share many of the same risk factors. However, there is one factor that’s unique to women. There’s a growing understanding that if you’ve taken hormones as part of infertility treatments to have a baby, taken estrogen-containing birth control or used hormone replacement therapy to control symptoms of menopause, your risk of stroke is higher. If you’ve taken or are considering taking these treatments, it’s important to know more about why the risk exists and what you should discuss with your doctor.

What is a stroke?

A stroke happens when something blocks the flow of blood to your brain or when blood vessels in your brain burst. Without the oxygen carried in your blood, your brain cells die, damaging your brain’s functions. As a result, you may lose the ability to move, speak, remember, think clearly, eat or control many bodily functions. In the United States, someone experiences a stroke every 40 seconds, and someone dies from the event every three-and-a-half minutes. Roughly 795,000 people have a stroke annually, with women accounting for 60% of deaths.

There are two types of strokes:

Ischemic: This stroke is the most common type. During this event, a major blood vessel in your brain is blocked by a blood clot or build-up of fat or cholesterol, also called plaque. It accounts for approximately 87% of strokes.

Hemorrhagic: This stroke happens when your brain’s blood vessels burst, exposing your brain to blood. As the bleeding continues, pressure builds up on your brain tissue, progressively causing more damage.

These symptoms are common for everyone if you’ve had a stroke:

Weakness or numbness in your face, arm, leg or one side of your body
Difficulty speaking and understanding
Dizziness and balance or coordination problems
Vision loss or dimness
Fainting or seizure

Women can experience additional subtle signs:

Bad headaches typically without a cause
Brain fog
Exhaustion
Nausea and vomiting

What roles do hormone treatments and hormone replacement therapy play?

The increased stroke risk associated with hormone treatments and hormone replacement therapy boils down to one thing — they cause changes in your hormone levels. These changes can happen both with fertility treatments as well as with birth control and therapies to reduce your symptoms of menopause.

Although it’s rare, some medications used to either increase fertility or prepare your body for in vitro fertilization (IVF) can raise your chances of a stroke. Two hormones called gonadotropins — follicle-stimulating hormone and luteinizing hormone — are frequently injected to help your body produce more eggs for an IVF cycle. In roughly one-third of cases, they can create swelling in the ovaries, called ovarian hyperstimulation syndrome. This condition can potentially cause blood clots. Estrogen-containing birth control: Women who use forms of birth control that contain only estrogen are twice as likely to have a stroke as women who don’t. Although estrogen offers some protection from stroke, such as lowering your cholesterol levels, it can also increase your blood pressure and can thicken your blood. That makes blood clots more likely. Pills that contain higher levels of estrogen boost your risk the most.

Your stroke risk may be elevated even more if you have any of these additional risks:

Smoking
High blood pressure
History of stroke or blood clots
Overweight
Taking certain medications, including some antibiotics and treatment for epilepsy, tuberculosis or HIV
Severe migraines, especially with aura
Complicated diabetes
Heart abnormality or disease
Hormone Replacement Therapy (HRT)

Using HRT to control your symptoms of menopause, such as hot flashes and night sweats, is a bit of a mixed bag when it comes to your stroke risk. Whether the treatment impacts your stroke risk depends on when you start taking it. If you start within five years of menopause, your risk stays the same as women who’ve never used HRT. However, if you begin HRT 10 or more years after menopause begins, your risk for an ischemic stroke does rise. Given these potential problems, doctors now recommend limiting HRT to the lowest dose you need and using it for the shortest time possible.

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