Early Menopause and Stroke Risk: What Every Woman Needs to Know

Menopause affects more than just our hormones. For some women, this stage of life can lead to yet another impactful health shift: an increased risk for stroke.¹ 

In this article, Bonafide Chief Medical Officer, Dr. Alyssa Dweck, defines what a stroke is, explains the potential relationship between stroke and menopause, and cautions who may be most at risk.

What Is a Stroke?

In the medical world, there are two types of stroke: ischemic and hemorrhagic. With an ischemic stroke, the blood supply to a part of the brain is blocked or reduced, often caused by a blood clot.^2,3 During a hemorrhagic stroke, on other hand, a blood vessel within the brain leaks or bursts, causing brain bleeding.⁴ 

Ischemic strokes are more common, accounting for 87% of the more than 795,000 strokes that occur each year; while hemorrhagic strokes are linked with more severe clinical and functional outcomes.^5,6,7 

Both types of strokes are considered medical emergencies.

What You Need to Know About Early Menopause and Stroke Risk

In addition to cardiovascular disease and osteoporosis, an increased risk for stroke is on the list for women in early menopause—especially in women who reach menopause before 40, according to Dr. Dweck.⁸ 

“Early menopause—which denotes 12 months amenorrhea (no period) before age 45—and premature menopause—defined as menopause before age 40—can be associated with an increased risk of cardiovascular disease (CVD) and stroke compared to women where menopause is occurring at the average, natural age of around 51 years old,” she explains.

Research suggests estrogen—a hormone that becomes volatile and then drops during menopause—helps to widen blood vessels, lowering the risk for blood clots in the brain.⁹ As estrogen declines during menopause, women may begin to lose some of that protection, explains Dr. Dweck.

“Estrogen protects against stroke by supporting blood vessel health and blood flow,” adds Dr. Dweck. “On a more cellular level, estrogen promotes dilation of blood vessels (vasodilation) and enhances vascular endothelial health (the inside lining of the blood vessels), inhibiting inflammation and reducing oxidative stress. The decline in estrogen during menopause increases the risk of stroke by increasing aging effects on blood vessels, increasing blood pressure, worsening lipid profiles, and promoting endothelial dysfunction.”

This hypothesis may explain why research has found that women who started menstruation at an early age and experienced delayed menopause may have a lower risk for stroke than their less-estrogen-exposed counterparts.¹⁰

Causes of Strokes in Females

Unfortunately, strokes in women aren’t rare. Strokes are one of the leading causes of death in women, according to the CDC, and nearly one in five will have a stroke between the ages of 55 and 75.^11,12

Risk Factors for Strokes in Women

So, what causes strokes in women?

Along with losing the potentially-protective benefits of estrogen during menopause, other factors play a role in stroke risk, according to Dr. Dweck.

“In addition to declining estrogen’s effect on blood vessels, age in general, genetics, and lifestyle habits significantly influence cardiovascular risk,” she says. “Traditional risk factors for stroke include high blood pressure, adult-onset diabetes, or elevated cholesterol/LDL and obesity due to worsening blood vessel health.”

Other risk factors for stroke in women can include: ^13,14

• High blood pressure
• Smoking
• Certain types of birth control
• Obesity
• Type 2 diabetes
• Kidney disease
• Preexisting heart and vascular disorders
• Pregnancy
• Drug or alcohol use 

“Unfortunately, women who experience early or premature menopause may have a higher risk for some of the above risk factors, like blood pressure and obesity,” cautions Dr. Dweck.

“Women who experience early or premature menopause have a higher prevalence of these specific stroke risk factors,” she continues. “The American Heart Association/American Stroke Association guidelines highlight that early menopause is associated with a rise in blood pressure and adverse changes in lipid profiles. They recommend close monitoring and aggressive management of these risk factors in women with a history of premature or early menopause.”

Stroke Symptoms in Women

The American Stroke Association suggests using the acronym FAST to identify a stroke and when to call for medical attention.¹⁵ 

1. F for Face Drooping—One side of the face may droop or go numb.
2. A for Arm Weakness—One arm may go weak or numb.
3. S for Speech Difficulty—Speech may be slurred.
4. T for Time to Call 911—During a stroke, every minute counts. If you notice the above symptoms, call 911 immediately.

Every Stroke Is an Emergency

If you or someone you know displays symptoms of a stroke, it’s important to seek immediate medical attention. 

Resources

1. https://www.health.harvard.edu/womens-health/early-menopause-linked-to-higher-risk-of-stroke
2. https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113
3. https://www.healthline.com/health/stroke/ischemic-vs-hemorrhagic-stroke
4. https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113
5. https://www.healthline.com/health/stroke/ischemic-vs-hemorrhagic-stroke#seriousness
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC7824133/
7. https://www.cdc.gov/stroke/data-research/facts-stats/index.html
8. https://womenshealth.gov/menopause/menopause-and-your-health
9. https://www.healthline.com/health-news/estrogen-how-lifelong-exposure-may-reduce-the-risk-of-stroke
10. https://pdf.sciencedirectassets.com/277342/1-s2.0-S1873959810X00035/1-s2.0-S187395981070017X/main.pdf?
11. https://www.cdc.gov/stroke/about/women-and-stroke.html
12. https://pubmed.ncbi.nlm.nih.gov/16397184/
13. https://www.cdc.gov/stroke/about/women-and-stroke.html
14. https://www.rush.edu/news/women-and-stroke-symptoms-causes-and-risks
15. https://www.stroke.org/en/fast-experience