Stroke remains one of the world’s most debilitating health threats, imposing a profound toll on families, health services and entire societies.
Once largely associated with older age, it is increasingly striking people at their most economically and socially active stages of life, disrupting careers, family responsibilities and long-term wellbeing.
In the United States, women experience roughly 55,000 more strokes each year than men—a pattern partly explained by women’s longer life expectancy, yet this does not tell the whole story.
Women tend to have poorer recovery outcomes and a reduced quality of life following a stroke, and internationally, stroke is more common in females than males below the age of 25.
A woman’s stroke risk is shaped throughout her reproductive life by biology and hormonal changes. High blood pressure disorders of pregnancy—such as gestational hypertension and pre-eclampsia—are among the most significant contributors.
Pre-eclampsia, usually developing after 20 weeks, involves elevated blood pressure and signs of organ damage, typically affecting the kidneys or liver. These conditions increase the likelihood of stroke during pregnancy and later in life because persistently raised blood pressure can damage vessels supplying the brain.
Hormonal contraception can also play a role. The concern centres mainly on combined oral contraceptives containing both oestrogen and progesterone, which can raise blood pressure and increase the tendency for blood to clot.
The risk becomes more pronounced in women who smoke, are over 35 or experience migraines with aura. Progesterone-only methods do not show the same level of association. Globally, around 248 million women rely on hormonal contraception, according to the World Health Organization.
Menopause introduces another shift. Falling oestrogen levels reduce the hormone’s natural protective effects on blood vessel integrity and cholesterol balance, making vessels stiffer and more vulnerable to damage.
Some forms of hormone replacement therapy, particularly those containing oestrogen, are linked to a modest increase in stroke risk—especially when started many years after menopause or used by older women.
Women are also more prone to migraines, notably those accompanied by aura, which involve temporary disturbances in blood flow within the brain and are associated with higher stroke risk. Autoimmune conditions such as lupus and rheumatoid arthritis—which disproportionately affect women—create chronic inflammation that weakens and narrows blood vessels, adding yet another layer of vulnerability.
A growing body of research highlights reproductive factors, hormonal exposure and immune system differences as key drivers of women’s elevated stroke risk.
Stroke during pregnancy and after childbirth
Pregnancy places extraordinary demands on the cardiovascular system: blood volume increases, hormones shift and the blood becomes more inclined to clot. As a result, pregnant women and those who have recently given birth face roughly triple the stroke risk of their non-pregnant peers, a finding well-established in research from the American Heart and Stroke Association.
Stroke is also a major cause of severe maternal illness and death, and stark inequalities persist. In England, Black women are four times more likely to die from pregnancy-related causes than white women, while Asian and mixed-ethnicity women also face disproportionately higher risks, according to the long-running MBRRACE-UK audit of maternity care.
In the US, Black women die from pregnancy-related complications at nearly twice the rate of white women, with stroke among the critical contributors. These disparities stem from delayed diagnosis, unequal access to care and higher rates of conditions such as hypertension, obesity and pre-eclampsia.
Women from minority ethnic communities are also more likely to live with underlying risk factors—including diabetes and uncontrolled high blood pressure—and to face barriers to high-quality antenatal services.
Why women’s strokes are often missed
Stroke symptoms in women are more likely to be misinterpreted. While classic signs—facial drooping, arm weakness and speech difficulties—appear in both sexes, women more often report additional symptoms such as headache, nausea, fatigue or confusion.
These are frequently dismissed as stress, migraine or anxiety. Paramedics and clinicians are statistically more likely to categorise a woman’s presentation as a “stroke mimic”, delaying lifesaving treatment and increasing the risk of long-term disability or death.
Subarachnoid haemorrhage—bleeding around the brain, usually caused by a ruptured aneurysm—is also more common in women.
It typically presents as a sudden, agonising headache that does not improve with pain relief. Lower oestrogen levels after menopause are thought to weaken artery walls in the brain, making ruptures more likely.
Women who enter menopause early, before the age of 42, face an even higher risk.
Closing the gap
Women carry a disproportionate share of the global stroke burden. Biological, hormonal and social factors intersect throughout their lives, while women from minority ethnic backgrounds often confront additional barriers linked to unequal care, delayed diagnosis and higher rates of underlying health conditions.
Despite this, major gaps remain: many female-specific risk factors are still poorly understood, and women remain underrepresented in clinical research, leaving treatment guidelines shaped largely by male-centred data.
Reducing this burden will require prevention strategies that take account of women’s lived realities—across adolescence, reproductive years, menopause and later life.
Improving awareness, ensuring timely recognition of symptoms and guaranteeing equitable access to healthcare are essential to narrowing the gender divide and mitigating the global impact of stroke.
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