Bengaluru neurologist explains why menopausal women are at a high stroke risk, reveals 5 signs: ‘Unexplained headache…’
On the eve of World Stroke Day, which is observed on October 29, let’s look at one of the natural risk factors that increases the chances of stroke in women.
Stroke is a life-threatening condition that occurs when the blood supply to the brain is disrupted, causing death of brain cells due to a lack of oxygen. The consequences can be severe, ranging from death or if survived, then long-term disability.
This is why stroke awareness conversations aim to draw attention to both categories of risk factors. Modifiable factors, the ones which are within your control, such as quitting smoking or having a healthy lifestyle, and non-modifiable factors, which are beyond your control, like genetics, sex and age. For non-modifiable factors, one needs to be more cautious and double down on modifiable ones; making healthy lifestyle changes can help take some of the load off.
Menopause, a natural biological process in every woman’s life, falls in the category of non-modifiable risk because it is inevitable. Menopause is basically when a woman’s period stops, along with her reproductive abilities. But this drives up stroke risks significantly.
The Centre for Disease Control and Prevention, in a May 2024 report, revealed that stroke is one of the leading causes of death in women. Even more concerning is that the condition is seen more frequently in those going through or after menopause. In the United States, the CDC estimated that one in five women between the ages of 55 and 75 will face a stroke. The average age of menopause is between 45 to 55 years, as per the WHO. So the upper limit of menopausal age overlaps with the age bracket stroke risk also begins to rise.
This is why menopausal women need to be alert, as menopause is a big non-modifiable risk factor.
To understand why menopause may trigger the predisposition of strokes in women, HT Lifestyle spoke to Dr Prof. Suryanarayana Sharma P M, senior consultant neurologist and stroke specialist, department of neurology at Apollo Hospitals, Bannerghatta Road, Bangalore.
The stroke specialist flagged menopause to be a ‘hidden health concern.’ “ The hormonal shifts, particularly the decline in estrogen, play a key role in this connection,” Dr Suryanarayana shed light on one of the primary triggers. Moreover, those who had early menopause are at a higher risk. The stroke specialist identified that those women who had menopause before 40 may have 1.62 times more risk of getting a stroke. But the risk factors are limited only to one type of stroke, which the stroke specialist clarified, “The increased risk is restricted to ischemic strokes (due to blood clot) and not due to hemorrhagic strokes.”
Not only stroke, but menopause also increases heart attack.
ALSO READ: Cardiologist warns of high heart attack risks after menopause; shares 5 signs: Neck pain, irregular heartbeats and more
Why does menopause increase stroke risks?
1. Estrogen drops
Menopause sees major hormonal changes, with the biggest change being the drop in estrogen level. Estrogen also has several protective benefits for cardiovascular functions. The neurologist explained, “Declining estrogen level reduces nitric oxide production, causing endothelial dysfunction, arterial stiffness, and hypertension, major contributors to stroke risk.”
2. Good cholesterol dips, bad cholesterol spikes
The stroke specialist also noted that while good cholesterol goes down, bad cholesterol levels go up. This imbalance can be very damaging to the arteries. “The postmenopausal period is associated with an increase in total cholesterol and LDL, along with reduced HDL. This results in accelerated atherosclerosis and cerebral arterial narrowing, predisposing to ischemic stroke,” he described.
3. High inflammation
Low estrogen levels trigger inflammation, and like a domino effect, trigger a chain reaction, leading to severe results like clot formation.
“Lower estrogen enhances platelet aggregation, raises fibrinogen levels, and promotes systemic inflammation, creating a tendency for clot formation,” Dr Suryanarayana told.
4. Insulin resistance
During menopause, metabolic changes are also seen. “Menopause is linked with central obesity, insulin resistance, and type 2 diabetes,” he added. “This further damages blood vessels and impairs cerebral blood flow.”
5. Hypertension
As the reproductive years come to an end, estrogen levels in the body decline. This deficiency, however, shows up in various ways. One of them is elevated blood pressure levels.
The neurologist explained this, “Estrogen deficiency activates the renin–angiotensin–aldosterone system (RAAS), leading to sodium retention and hypertension—a key predictor of both ischemic and hemorrhagic stroke.”
Warning signs of stroke
Stroke is a medical emergency, and Dr Suryanarayana emphasised giving the patient urgent medical attention within the ‘golden hour.’ “The patient should be shifted to a stroke-ready hospital in golden hour for advanced stroke treatment,” he said.
The neurologist also listed out 4 noticeable signs which are indicative of a potential stroke:
- Sudden onset weakness or numbness of the face, arm, or leg (especially on one side of the body)
- Difficulty speaking or understanding speech
- Loss of balance
- Vision problems
- Severe, unexplained headache
Preventive measures
Menopause is natural, but the health risk it brings still remains. The way forward is to stay vigilant and work towards a healthy lifestyle. In fact, lifestyle has such an important role that most of the stroke risks are preventable.
“To reduce stroke risk during and after menopause, certain lifestyle modifications are recommended. 90% of the strokes are preventable,” Dr Suryanarayana clarified.
Here are the five lifestyle changes that help to mitigate stroke risks:
- Controlling BP, sugar, and cholesterol is vital.
- Maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins helps control blood pressure and cholesterol.
- Regular physical activity, at least 30 minutes most days, supports vascular health and weight management.
- Avoiding smoking and limiting alcohol intake are equally vital.
- Regular health check-ups, including monitoring blood pressure, blood sugar, and lipid levels, can help detect issues early.
Does hormone replacement therapy help?
So, if estrogen deficiency in the body triggers a chain reaction that may lead to stroke, is Hormone Replacement Therapy (HRT) an option? HRT is essentially hormonal supplements, like estrogen, to balance hormone levels.
The stroke specialist weighed in on this and said, “Hormone replacement therapy may reduce the risk of stroke, but it is associated with other side effects. Consult experts before initiating hormone therapy.”
So yes, while it may alleviate menopausal symptoms and somewhat reduce stroke risks, HRT still poses other side effects. The decision has to be under medical guidance, by understanding the pros and cons.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
