Stroke is the No. 3 cause of death in women, according to the American Stroke Association (ASA).
It’s a statistic that Wendy Price knows all too well. The 70-year-old Carlsbad, California, resident, who was diagnosed with von Willebrand disease at age 45, has multiple risk factors for stroke, including high blood pressure and a family history of cardiovascular disease.
But updated stroke prevention guidelines released by the ASA in 2024 highlighted several additional risk factors for stroke that are unique to women, including pregnancy, taking oral contraceptives, or being on hormone replacement therapy. The guidelines are particularly relevant to women with bleeding disorders since many of them take oral contraceptives to control heavy bleeding, says Annette von Drygalski, M.D., Pharm.D., director of the Center for Bleeding and Clotting Disorders at the University of California San Diego.
“In addition, hemorrhagic strokes, which occur when a blood vessel in or around the brain ruptures and causes bleeding into the brain, can be more severe in women with bleeding disorders,” von Drygalski says.
Ministrokes are a thing, too: Read on to learn how to promptly handle them.
How to Protect Yourself
Here’s what women, girls, and people with the potential to menstruate (WGPPM) can do to lower their risk of stroke:
- Talk to Your Doctor About Estrogen.
Oral contraceptives that contain estrogen (also known as combined hormonal contraception) have been shown to increase the risk of stroke in WGPPM even though the amount of estrogen is lower now than in the past. The risk is even greater if you also smoke. Estrogen replacement during and after menopause can also heighten stroke risks, von Drygalski says.
“If you take oral contraceptives to control heavy bleeding or you’re on hormone replacement for menopause, discuss the pros and cons with your doctor, especially if you have other risks such as advanced age, hypertension, or migraines,” she says.
Other contraception options to consider include progestin-only birth control and intrauterine devices (IUDs). For relief of menopausal symptoms, ask your physician about transdermal patch applications of estrogen. “The risk is decreased if the medication is given through the skin, rather than a pill,” von Drygalski notes.
- Be Proactive. You can help reduce the level of your stroke risk on your own. Exercise moderately in a safe manner for the severity of your disorder; practice good sleep hygiene; follow the Mediterranean diet; and monitor your cholesterol and blood pressure. If you have risk factors, von Drygalski recommends getting evaluated by a cardiologist, even at a young age. Cardiologists should be encouraged to discuss patient-specific stroke risks and prevention strategies with the patient’s hematologist.
To protect herself, Wendy Price now takes a cholesterol-lowering statin plus a blood pressure medication and monitors her levels regularly. She also exercises daily to help keep both those numbers down.