Women & Stroke: Risk Factors and Prevention

Eating right, getting regular physical activity, and not smoking are well-known prevention strategies for healthy living, but they’re not enough for women who want to reduce their risk of having a stroke for the first time, according to the American Heart Association (AHA).

This is because there are gender- and sex-specific factors, like oral contraceptive use, pregnancy complications, and menopause timing, that can increase women’s risk of having a stroke.

A stroke occurs when blood flow to part of the brain is blocked by a clot, cutting off oxygen-rich blood and causing brain cells to die within minutes. A stroke also occurs when a blood vessel in the brain bursts or leaks. A stroke can lead to permanent disability or death. Stroke is the fourth leading cause of death in the United States, according to the AHA’s 2026 statistics.

For the first time, the AHA’s updated guidelines noted specific stroke risk factors that may apply only to certain people, including those who:

“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke, referred to as primary prevention,” said Dr. Cheryl Bushnell, the lead author of the guidelines and a neurology professor at Wake Forest University School of Medicine in Winston-Salem, North Carolina, in a statement about the updated guidelines.

Women have unique risk factors for stroke because they use contraceptives and get pregnant, two of the leading contributors to strokes in young women in particular, according to Dr. Joshua Willey, an associate professor of neurology at the Columbia University Vagelos College of Physicians and Surgeons and the medical director of the New York-Presbyterian Columbia Comprehensive Stroke Center.

“Since a high proportion of young women will use contraceptives, or are planning or will plan a pregnancy, specific guidelines for a large segment of the population are important and had not been previously specifically addressed,” Dr. Willey, who wasn’t involved in writing the guidelines, told Everyday Health.

The following are the five factors that increase first-time stroke risk:

1. Oral Contraceptives

People using oral contraceptives with higher estrogen levels have twice the risk of stroke later in life compared to those using pills with little or no estrogen.

For those with other stroke risk factors, like being over 35, having high blood pressure, or smoking, the guidelines suggest using progestin-only birth control pills or non-hormonal contraceptives.

2. Pregnancy Complications

The guidelines specify several stroke risk factors that may occur during pregnancy, including:

• Preeclampsia—dangerously high blood pressure that can even damage other organs.

• Postpartum high blood pressure that develops or persists after childbirth.

In addition to different types of hypertension, other pregnancy complications that the guidelines say are associated with stroke risk include:

To lower the risk of stroke during pregnancy, it’s recommended for women to get screened and treated for high blood pressure, manage blood sugar, and address any underlying medical conditions that could lead to other complications.

3. Endometriosis

Endometriosis, a chronic gynecological condition where endometrial tissue grows outside the uterus, is linked to up to a 34 percent increased risk of stroke, according to the guidelines.

4. Menopause

The guidelines indicate that women who experience menopause before age 45 or have severe, recurring vasomotor symptoms such as hot flashes and night sweats are at increased risk of stroke.

Also facing a higher risk of first stroke while managing menopause symptoms are women over 60 or those who have used hormone replacement therapy for more than 10 years after menopause.

5. Gender-Affirming Estrogen Therapy

Transgender women and gender-diverse individuals using estrogens for gender-affirming treatment might face a higher risk of stroke. However, there isn’t enough data to determine how much of a risk they may have for a first stroke or how different types or durations of estrogen treatment could affect their risk.

Because of this, the guidelines advise that these individuals follow widely recognized stroke prevention measures, like avoiding smoking and getting screened and treated for high blood pressure if needed.

Further Recommendations From the Guidelines

For people who are overweight, have obesity, and have type 2 diabetes, the guidelines suggest exploring new GLP-1 drugs, such as Ozempic and Wegovy, which might help them lose weight and improve their blood sugar levels. Obesity and high blood sugar are both risk factors for a first stroke.

In addition, the guidelines highlight a range of “non-medical factors” that can affect stroke risk, such as:

Understanding that these factors, along with gender- and sex-specific risks, can impact stroke risk helps women to make informed choices throughout their lives to manage their risk, Dr. Michael Hill, a neurology professor at the University of Calgary in Alberta, who wasn’t involved in updating the guidelines.

“Sex differences in stroke risk exist and are relevant throughout the phases of life,” Dr. Hill told Everyday Health. “These phases of life are different for men and for women and interact with choices taken in those phases. Emphasizing this is important.”

Story Links:

https://www.everydayhealth.com/heart-health/what-women-need-to-know-about-preventing-a-first-stroke/
https://www.heart.org/en/news/2026/01/21/what-the-latest-heart-disease-and-stroke-numbers-mean-for-your-health