Certain well-known stroke symptoms — such as facial drooping, one-sided weakness and sudden speech slurring — are similar for men and women. “The worst headache I’ve had in my life” is what many stroke patients also describe.
In women, however, other signs of a stroke, also called a brain attack, aren’t always clear-cut. Unfortunately, this can lead to delays in seeking medical help. When it comes to starting stroke treatment, every second counts for preserving brain function.
Below, experts point out better-known and less obvious signs that could mean stroke in women. In addition, they touch on women’s additional risk factors and stroke-prevention strategies for women and men alike.
[See: 17 Ways Heart Health Varies in Women and Men.]
Stroke Symptoms to Know
These are more-familiar warning signs of a possible stroke for men and women:
— One-sided weakness or numbness of the face, an arm or a leg.
— Facial drooping.
— Speech problems: sudden slurring or trouble understanding others’ speech.
— Vision changes: difficulty seeing with one or both eyes.
— Sudden, excruciating headache of unknown cause.
Women, in particular, may experience more subtle signs of stroke:
— Sleepiness or confusion (altered mental status).
— Fatigue.
— Malaise and nausea.
— Vague sense of “feeling funny.”
— Tingling sensation or numbness in any part of the body.
— Weakness of any part of the body.
— Dizziness.
— Balance, walking or coordination problems.
— Behavior changes.
— Memory loss.
Don’t try to guess what these symptoms could mean. Instead, let health professionals help sort them out.
Getting Treatment
As people get older, their risk of stroke rises. “When you look across all age groups, (stroke incidence) is a little bit higher in men compared to women,” says Dr. Cheryl Bushnell, a professor of neurology, vice chair of research and director of the Comprehensive Stroke Center at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. “But the main thing to keep in mind is that women live longer. So if you look at the lifetime risk of a stroke, it’s higher in women than men.”
A blood clot that forms in the vascular system, where it may block circulation to the brain, is called a thrombus. A powerful medication called tPA, or tissue plasminogen activator, can dissolve blood clots that cause ischemic stroke and restore blood flow to the brain. Medication therapy to break down a thrombus is called thrombolysis.
“It’s equally effective in men and women,” says Bushnell, the author of an evidence review of studies that examined sex differences in evaluating and treating ischemic stroke, published in the July 2018 issue of The Lancet Neurology.
Surgical procedures also help minimize the damage from a stroke. “In addition to the tPA medicine given through an IV, we have the ability to pull the clot out with thrombectomy,” Bushnell says. “That’s the process of surgically removing the clot and that is beneficial to both men and women.”
Time is of the essence for stroke treatment. “We want to make sure we recognize the stroke quickly, and that patients or people on the street recognize the stroke and call 911 and get help as quickly as possible,” Bushnell says. “Because there is a short window for those medicines.”
Research included in the 2018 evidence review doesn’t necessarily show definitive gender differences in stroke treatments and outcomes. Treatment delays can involve longer times for women to receive imaging tests such as CT scans or MRIs needed to diagnose a stroke. With less clear-cut symptoms in some cases, it may take clinicians longer to consider the possibility of a stroke. In addition, women are more apt to have certain conditions that can mimic stroke, like migraines, that must be ruled out.
“If you have symptoms that are more vague, it’s more difficult to figure out what to do in the emergency department,” Bushnell says. “But once the stroke is recognized, generally women and men are treated about the same in terms of timing.”
Bushnell’s evidence review found no significant differences in use of emergency medical services, stroke knowledge, eligibility for or access to thrombolysis or thrombectomy, or outcomes of either therapy.
“The most common tPA exclusion criteria for women and men is delayed hospital arrival, and the proportion of women compared with men who arrive outside the tPA window (3 to 4.5 hours) appears to be similar in some, but not all, studies of tPA eligibility,” the evidence review found.
The higher prevalence of older women living alone was identified as a risk factor for late hospital arrival and not receiving thrombolysis treatment.
[See: 7 Ways Pain Is Sometimes Misdiagnosed.]
Recognizing Stroke Risk
Nearly 60 percent of stroke deaths occur in women, according to the Centers for Disease Control and Prevention. “Women don’t realize that you’re twice as likely to have problems with a stroke as you are to have breast cancer,” says Dr. Barbara McAneny, president of the American Medical Association.
In her oncologist role, McAneny is CEO of the New Mexico Cancer Center in Albuquerque and Gallup, New Mexico. “All the women I talk to as a cancer doctor are very focused on their breast cancer risk,” she says. “But women also need to focus on their stroke risk.”
Stroke doesn’t affect everyone equally, McAneny says. Stroke is more common in women, she notes, and it’s more common and more likely to be fatal in African-Americans.
Pay attention to any of these symptoms, McAneny emphasizes: “One-sided weakness of your face, or your arm or your leg is certainly a risk of stroke,” she says. “But (also), a sudden onset of confusion, or you can’t speak, or you can’t find the words or you can’t understand, or visual changes can be a sign of stroke. A sudden bad headache can be a sign of stroke. And sometimes just dizziness or loss of balance.”
Call 911 or your community’s emergency number right away if stroke is a possibility, McAneny advises. “These days, if the stroke is caused by a blood clot, we have many stroke centers across the country, which can give medications to dissolve these blood clots and let the blood go freely back to the brain so that the brain can recover,” she says. “If you wait too long, that piece of the brain dies and it’s very hard to get all of your function back.”
Blood Pressure Factor
Doctors would much rather prevent strokes than treat them, McAneny points out. That means controlling high blood pressure, a major stroke contributor. “So check your blood pressure and make sure it’s in the normal range,” she says. “Get on a treatment regimen if it’s not in the normal range.”
The AMA has joined with the American Heart Association in the Target: BP initiative to reduce uncontrolled blood pressure nationwide. “So many people have high blood pressure and don’t even know it,” McAneny says. “And the longer you have high blood pressure, the more it beats up the tiny blood vessels in the brain and the more likely you are to have damage to those vessels, which is one of the causes of stroke.”
[See: 13 Ways Social Determinants Affect Health.]
Pregnancy, Birth Control and Stroke
Younger women have different stroke risks to consider, including pregnancy. “Women who are pregnant have a higher risk of stroke than women who are not pregnant during those childbearing years,” Bushnell says. “Women have blood clotting that is a natural evolution to prevent hemorrhage, or bleeding with delivery. So your blood clots a little easier when you’re pregnant. That’s thought to be one of the reasons why it can also increase the risk of stroke.” Stroke risk is only elevated during the pregnancy and for about six weeks following delivery, she adds.
Taking birth control pills raises stroke risk for women, but that has to be put into context. “If you just do a large population study, birth control does increase the risk by about twofold — so it doubles the risk,” Bushnell says. However, she adds, the absolute risk remains small.
“The risk of a 25-year-old woman having stroke is about maybe 5 to 10 per 100,000 women,” Bushnell explains. “So, when you double that, you’re talking about 10 to 20 per 100,000. That’s still a very, very small percentage of women who would be affected.”
When stroke risk factors are combined, however, the picture changes. “If a woman is using birth control — if she smokes, has high blood pressure, has diabetes, high cholesterol or is obese, that risk of a stroke with use of oral contraceptives increases dramatically,” Bushnell says.
Menopause, in itself, is probably not a risk factor for stroke. “What actually is concerning is when menopause occurs early,” Bushnell says. When women in their late 30s or early 40s develop premature menopause, she says, that can be associated with a risk of stroke in the future. Various health factors may play a role, she adds, such as smoking or other diseases women might have that lead to early menopause.
Healthier Anti-Stroke Lifestyle
Lifestyle and self-management matter for reducing stroke risk. Along with keeping blood pressure controlled, managing diabetes and cholesterol are important, Bushnell says. “Physical activity is critical,” she says. “It’s not just losing weight. There are so many benefits: for the brain, blood vessels, heart and lungs. Our sedentary lifestyle is killing us — it’s causing strokes.”
By maintaining a healthy weight and staying active, you can help prevent diabetes, high blood pressure and high cholesterol from ever developing, Bushnell says. The DASH and Mediterranean diets are both good for prevention, she adds: “Start with physical activity, healthy diet and healthy weight and you could then prevent the risk factors that set you up for a stroke later in life.”
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What Are Stroke Symptoms in Women? originally appeared on usnews.com
