Gender Differences in Stroke Symptoms and Treatment

It’s not a pretty picture when it comes to women and stroke. Hormonal changes put women at greater risk for stroke at certain times in their lives and statistics reveal that stroke generally proves more disabling for women than men. The good news is these gender disparities have been the focus of ongoing research in the field of stroke prevention and treatment, and the efforts are paying off as new findings from several recent studies may improve stroke prevention and treatment for women and, it’s hoped, deliver a far better prognosis in the future. I discussed this research with Lynda D. Lisabeth, PhD, MPH, an assistant professor of epidemiology at the University of Michigan School of Public Health in Ann Arbor, where she and her colleagues have been looking into the issue.


Women are at elevated risk of blood clots and stroke when they take (or used to take) birth control pills or are pregnant and new research points to elevated risk for those with early menopause as well. Dr. Lisabeth and her research team analyzed 22 years of data from the Framingham Heart Study, finding that 234 of 1,430 women had an ischemic stroke (a type of stroke caused by a blood clot that blocks blood flow to the brain and is responsible for 80% of all strokes) over that time. After factoring in variables such as age, blood pressure, diabetes, smoking and heart disease, researchers found that women who experienced menopause before age 42 were twice as likely to have had a stroke. Though further study is required, these findings suggest that decreasing estrogen levels after menopause may play a role in stroke risk.


Good public awareness campaigns have made many more people familiar with the classic signs of a stroke — sudden severe headache… numbness or weakness on one side of the body… paralysis of face, arm or leg on one side of the body… dizziness or confusion… loss of balance or coordination… trouble speaking or understanding… visual changes, such as blurred or double vision. That list may need to be expanded to include a variety of other symptoms as well — in a different study, Dr. Lisabeth’s team examined records of 461 ischemic stroke or TIA patients, male and female, and found more non-traditional symptoms in women than men. For instance, women were far more likely to have an alteration in mental status, including disorientation or loss of consciousness. Failing to recognize this as a possible sign of stroke may delay life-saving and brain cell-saving treatment.

Yet other studies showed that when women with stroke arrive at the hospital, they typically wait longer for care. Michigan State University researchers found that women are 30% less likely than men to receive treatment with tissue Plasminogen Activator (tPA), the only FDA-approved clot-busting (thrombolytic) drug to limit brain damage after stroke. It must be delivered within four and a half hours of the onset of symptoms. The study found that women waited 12% longer to see a physician and 16% longer for brain imaging procedures, which may have affected their ability to receive this beneficial treatment.


Now, finally — one bit of very good news. It appears that in women, a transient ischemic attack (TIA) is less likely to lead to more severe stroke in the near future. Men who’ve had one or more TIAs, considered “warning strokes” or “mini strokes,” have a greater risk of stroke to follow. Researchers at Yale University and the University of Alabama at Birmingham found that 30 days post-TIA, women are 30% less likely than men to experience a full stroke, 14% less likely to have heart problems and 26% less likely to die.

All this information is important whether you are female or just happen to spend time in the company of women — by which I mean, anyone and everyone should understand the many and varied symptoms of stroke. Stroke is a medical emergency in which time is of the essence. If you suspect stroke happening to yourself or someone you are with, Dr. Lisabeth advises calling 9-1-1 immediately for help, adding that patients who are transported to the hospital via ambulance typically receive faster care.

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