What do pregnancy, birth control pills, and migraine headaches with aura have in common? They are among several factors that influence stroke risk in women.

Women face a higher risk of stroke than men, mainly because they tend to live longer. But  now new guidelines, released jointly by the American Heart Association (AHA) and the American Stroke Association (ASA), offer new guidance that can help to lower that risk.

Many risk factors for stroke are shared by men and women. However, women’s risk is also influenced by hormones, reproductive health, pregnancy, childbirth, and other gender-specific factors, according to Cheryl Bushnell, MD, a co-author of the new statement published in the AHA/ASA journal Stroke.

According to both associations, about 55,000 more women than men suffer strokes each year. Stroke is the third leading cause of death for women; for men, it’s the fourth. One in five women has a stroke at some point in her life. And about three out of 10,000 pregnant women have a stroke during pregnancy.

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Among the new guidelines is a recommendation that women with a history of high blood pressure before pregnancy be considered for low-dose aspirin and or calcium supplement therapy. This can help lower their risk for preeclampsia.

Preeclampsia is a blood pressure disorder that can occur during pregnancy. It can cause serious complications. Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.

To reduce the risk of stroke in women, the AHA and ASA also recommend that:

  • Pregnant women with moderately high blood pressure (150-159mmHg/100-109mmHg) be considered for blood pressure medication, and expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
  • Women should not smoke, and they should also be aware that smoking and the use of oral contraceptives increases the risk of stroke.
  • Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
  • Hormone replacement therapy should not be used, to prevent stroke in postmenopausal women.
  • All women over age 75 should be screened for atrial fibrillation risks, due to a link to higher stroke risk.

Bushnell said that more studies are needed to develop female-specific criteria to help identify women at risk for stroke. In the meantime, she reiterated that high blood pressure, migraine with aura, atrial fibrillation, diabetes, depression, and emotional stress are stroke risk factors that tend to be stronger or more common in women than in men.

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