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Stroke symptoms in women can be different from men

Posted on May. 20, 2019 ( comments)

Stroke, like lots of things, doesn’t play fair.

Women are more likely than men to have a stroke, and 60 percent of all stroke deaths in the United States are women, says Phyllis Smith, director of MultiCare’s stroke program.

“And they have unique stroke symptoms,” she says.  

But by understanding what puts them more at risk, women can take steps to reduce those odds.

Not only do women have a higher lifetime risk of having a stroke, but they also have a higher rate of post-stroke mortality, disability and dementia than men, Smith says.

For elderly women, “a lot of that has to do with the fact that they are more likely to be living alone or in assisted living when a stroke comes on,” she says.

But strokes in women sometimes aren’t recognized as quickly because their symptoms can be different from men’s.

Oftentimes, women’s stroke symptoms come on more gradually than men’s. The “classic” stroke symptoms of sudden one-sided arm weakness, difficulty speaking or drooping facial expressions are typical for both men and women. But women are more likely than men to suffer loss of consciousness, weakness, loss of coordination, vision problems, sudden dizziness, confusion, agitation or hallucinations with a stroke. Nausea, vomiting and even hiccups are stroke symptoms more often seen in women than men.

“A lot of times women won’t call 911 because they don’t recognize it a stroke symptom,” Smith says.

In older women especially, even doctors may believe the symptoms are from a new prescription or even a urinary tract infection. For younger women, stroke is often misdiagnosed as a migraine with aura.

Any noticeable change in someone’s memory or thinking warrants a call to 911, Smith says.

Treatment is available within a small window of time — just a few hours — so getting to the hospital fast is key both to survival and reducing your chance of post-stroke disability.

So what puts women at greater risk than men? It’s probably a combination of hormones and social factors, Smith says. Menopause marks a significant uptick in stroke risk for women.

“The estrogen protection they used to have diminishes,” she says.

Yet hormone replacement therapy hasn’t been shown to decrease stroke risk in menopausal women. If anything, it raises the risk slightly.

Pregnancy also puts women at a higher risk for stroke. Again, hormones are almost certainly the cause.

“Your clotting factors get off,” Smith says. “Your body has to make all these changes to adapt to having another person living in there.”

After giving birth, your stroke risk begins to return to normal.

The good news is that 80 percent of strokes are preventable, Smith says. The keys to preventing strokes are the same ones that prevent heart disease: Maintaining a healthy body weight, eating a healthy diet, exercising and monitoring your blood pressure and cholesterol can stop strokes before they happen.

And of course, if you smoke, you should stop.

Studies show drinking more than one or two sodas a day — even diet sodas — raises your risk of a stroke, Smith adds. Women who experience migraines with aura are also at increased risk for stroke. In fact, most people have at least one risk factor.

What’s most important is how many risk factors you have. The risk factors “add up,” Smith says. While hormonal birth control may elevate your risk only slightly, if you add diabetes or smoking or high blood pressure or high cholesterol, the danger of stroke bumps up with each.

Discuss your risk factors with your provider. Find a primary care provider near you.

If you think you may be experiencing a stroke, Smith emphasizes calling 911 immediately.

“It’s better to be over cautious than under cautious,” she says. “When brain cells are gone they’re gone. Better to have a false alarm than wait and have more disability.”

Learn more about stroke treatment at MultiCare

About The Author

Cheryl Reid-Simons
Cheryl Reid-Simons is a freelance writer and serial community volunteer. In her spare time, she drives a private activities shuttle for her twin sons, healthy graduates of the Tacoma General NICU and interim care nursery. More stories by this author
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