If you’re a healthy, young, active woman who doesn’t smoke, chances are you probably haven’t given a whole lot of thought to whether or not you’re at risk of a stroke. Strokes are more common in older people, smokers, and people who are obese and/or have a metabolic syndrome. So if you’re none of these things, it’s understandable not to be constantly worried about the danger of strokes. But that doesn’t mean you shouldn’t think about it, ever, at all. You should. And here’s why.
The National Stroke Association puts it best when they say, “Stroke can happen to anyone at any time.” A stroke occurs when blood flow to the brain is blocked, leading to cell death. Though they are more common in people aged 65 and older (the likelihood just about doubles for each decade of life after 55), they happen to young people, too. Take 34-year-old model Katie May, who died from a stroke earlier this year; Merideth Gilmor, a Connecticut mom who had a sudden stroke at 38; or 32-year-old Louise Palfreyman, a single mother in the U.K. who was left partially paralyzed after a stroke last year, according to the Daily Mail. And consider that there’s actually something called beauty parlor stroke syndrome, which can arise in people after they have their hair washed at the salon.
Not only is stroke extremely common—someone has a stroke every 40 seconds in this country—but it’s more common in women than in men. And more deadly. It is the fifth leading cause of death in the U.S., and about 60 percent of the people who die from strokes are women.
Many of the things that increase your chances of stroke are the same across the sexes, such as cardiovascular disease, physical inactivity, obesity, diet, and smoking. But there are some things that have a stronger effect entirely unique to women.
Andrew Russman, M.D., a vascular neurologist and stroke specialist at Cleveland Clinic, states that it was only in 2014 that experts realized the need to highlight the variables that affect women differently than men and drew up guidelines that for the first time specifically addressed stroke prevention in women. In the same vein, it’s important that women know their family histories and pay attention to health and lifestyle risk factors that may impact their chance of having a stroke at any point in their lives.
While having a stroke in your 20s or 30s is rare, Russman says there is good reason for even young women to be aware of their potential risk. “It’s enough of an issue that women should be thinking about these things.” Prevention and awareness while women are young can help lower stroke rates.
Here are seven things that increase stroke risk in women:
1. Being on the Pill
Oral contraceptives cause your red blood cells to clot which can cause strokes. Women who smoke are advised not to take birth control pills, and those who have a family history of stroke should also avoid the Pill, since it can increase your chance of having a stroke. Hormone replacement therapy after menopause also raises clot risk.
High levels of estrogen, as seen in pregnancy, increase blood-clotting factors, which in turn increase stroke risk—especially a type caused by a clot in a vein that drains blood from the head. Russman advises women who are or want to become pregnant to find out whether there is a history of cerebral venous thrombosis in their family. “It’s important for family planning,” he says. Knowing there’s a higher risk means you can go on blood thinners preemptively when you get pregnant, or be ready to act fast if the need arises.
3. Migraine with aura
Women are three times more likely than men to have migraines. And though migraines with aura (a particular type of migraine headache that is accompanied by visual or other sensory disturbances) are associated with a higher risk of stroke in both men and women, that association is stronger among women. That doesn’t mean if you have migraine with aura you’re going to have a stroke. But you should definitely be aware of the connection.
4. High blood pressure
Again, high blood pressure is a classic risk factor that affects both men and women. However, the effect is stronger in women—a fact that is all the more concerning when you add in birth control pills. Russman points out that women can start to see high blood pressure in their 20s, and if that happens it’s crucial to get checked out, review your family history, and keep on top of it.
Preeclampsia is a condition marked by high blood pressure that can set in after 20 weeks of pregnancy. In addition to its effect on stroke risk (amplified by increased clotting during pregnancy), it can be life threatening for both mother and baby. Preeclampsia is sometimes brought on by gestational diabetes, a form of the disease that can come on suddenly in the middle of pregnancy.
6. Atrial fibrillation
This erratic fluttering of the top chambers of the heart impedes movement of blood into the lower chambers, which pump it to the rest of the body. The blood can collect in the atria, and still blood can clot. It is a strong risk factor for stroke that effects both sexes, but is more concerning in women.
7. Loneliness and depression
Depression and “psycho-social stress,” such as social isolation, work stress, or discrimination, are associated with high blood pressure, one of the biggest risk factors for stroke—and they impact women’s risk more than men’s. (Research has also shown that figurative heartache can become a literal heart attack, especially among older women.) Though it can be difficult to address issues of mental health and loneliness, it’s crucial not just for your psychological well-being, but for your physical health as well.
If you think you may be having a stroke, call 911 immediately, even if the symptoms seem to go away. The acronym F.A.S.T. describes the three telltale signs of stroke: face drooping, arm weakness, and speech difficulty. The T stands for “Time to call 911.”