Why do women have more strokes than men? A look into stroke recovery in both sexes

Time to read: 8 min

According to the CDC, about 795,000 Americans have a stroke each year – that’s one every 40 seconds – which makes stroke one of the leading causes of serious long-term disability. Like many health conditions, stroke presents differently in men than in women, plus risk factors and post stroke recovery often differ too. Let’s take a look into why.

Male vs. female stroke: Causes and unique risk factors

Each year, about 55,000 more American women have a stroke than men. In addition to the general risk factors for stroke like family history, smoking, high cholesterol, high blood pressure, being overweight and lack of exercise, women are faced with a set of unique risk factors that could increase their risk of stroke:

• Longer average life span: Women typically live longer than men and stroke risk is strongly associated with advancing age.
• Oral contraceptives: Hormonal birth control pills could increase the risk of stroke, especially when coupled with other high-risk factors like smoking and diabetes.
• Hormone replacement therapy: Some research shows that a combined hormone therapy of progestin and estrogen can increase the risk of stroke for women.
• Migraines: The majority of migraine sufferers in the U.S. are women, and migraines with aura (visual disturbances) can increase a woman’s risk of stroke.
• Atrial fibrillation: Women are diagnosed with atrial fibrillation (irregular heart rhythm) at a higher rate than men. AFib is a major risk factor for large embolic strokes.

How post-stroke recovery differs between men and women

While more research needs to be done to understand how a person’s sex influences their ability to recover after stroke, one 6-month study looked at 459 stroke patients and found that by the end of the study, women were less likely than men to be able to perform daily tasks like feeding, bathing, and dressing, without assistance. Also, by the end of the study, only 18% of female patients were able to independently perform eight of the nine self-care tasks observed, whereas 34% of male patients were able to do so.

After controlling for several factors, the researchers concluded that post-stroke recovery for women could be impacted by two key issues:

1. Women were more likely to be older at the time of stroke and therefore their physical functioning was likely to be poorer before the stroke happened.
2. Women were also more likely to experience depression, which research shows can impair post-stroke rehabilitation.

Male vs. female aphasia

Aphasia is a condition that can happen after an injury to the brain. It’s an impairment of a person’s ability to comprehend words, and is strictly related to language, including speaking, listening, writing, and reading.

According to a 2019 meta-analysis that looked at 25 studies including over 48,000 stroke patients, assumptions that men were more likely to experience post-stroke aphasia due to lateralized language functions (when language is largely controlled by one side of the brain) were wrong. The analysis revealed that in fact, women experience aphasia at higher rates than men. However, while a larger number of women are diagnosed with aphasia, the increased rate could be due to the fact that women are often older when they experience a stroke, which means age could be the defining factor in aphasia diagnosis rates, not sex.

Signs of stroke unique to women

In general, both men and women experience many of the same symptoms at the onset of stroke: vision problems, difficulty with balance, severe headache, confusion and vision problems. However, women have reported experiencing some additional symptoms:

• Difficulty breathing
• Loss of consciousness or fainting
• Hallucinations
• Seizures
• Vomiting or nausea
• General weakness
• Hiccups

Stroke prevention for women

According to the National Stroke Association, it’s important for women to stay on top of their health in a number of ways to help reduce the risk of stroke:

1. Monitor blood pressure at doctor visits, especially when starting a birth control regimen (as this can increase blood pressure).
2. Women over 75 should also be screened for atrial fibrillation (irregular heartbeat).
3. Monitoring blood pressure while pregnant is important because pregnancy increases blood pressure and stress on the heart.
4. Those who experience migraines with aura are advised to quit smoking immediately.

In addition to these preventative measures, it’s also important for both men and women to stay on top of their mental health. According to research, depression can result in a greater impairment to day-to-day living abilities after a stroke, so seeking treatment for depression is an important part of post-stroke recovery.

Want to learn more? Check out these resources:

•  Study: Sex differences in stroke recovery
•  Why are women at higher risk for stroke than men?
•  Stroke Prevention for Women: Start Early
•  Heart attack and stroke: Men vs. women
• 10 Therapy Tasks Practiced Most Frequently By Survivors Of Stroke