Stroke in Women: Women Need to BE More than FAST!

3.25.25

Women suffer more from stroke than men. They are both more likely to have a stroke and less likely to get the kind of timely, high-quality treatment that leads to the best outcomes. Some of that is because women live longer and therefore have strokes at older ages, when it is harder to recover. But women also face additional risks and burdens that men do not.

One in five women will have a stroke before they die, compared to one in six men.

You may have seen public health advice for when to seek care for stroke, usually summarized with the acronym BEFAST for:

  • Balance loss or difficulty walking
  • Eyes – sudden vision changes like blurred or double vision, or vision loss
  • Face droop on one side, or an uneven smile
  • Arm weakness or numbness in one arm
  • Speech problems
  • Time to call 911 if you notice any of these signs

That is a good message as far as it goes. But women are far less likely to have those symptoms, and that causes delays in getting the emergency treatment that is their best shot at limiting the damage to their brains. Women delay three times as long as men in seeking emergency medical care for stroke, according to a 2012 study in Gender Medicine.

Unfortunately, I know this all too well. My stroke started with a terrible headache. I was 55 years old. I just popped a Tylenol and did not worry beyond that even though I was a medical reporter and knew the symptoms of a stroke. Research has found that women are more likely than men to have atypical stroke symptoms like headaches, nausea, and all-over weakness and fatigue. Confusion, hiccups, chest pain or a racing heartbeat are other atypical symptoms of a stroke that women are more likely to experience.

Worse, women are more likely to lose consciousness and not be able to call for help at all, according to a review of studies published by the NIH.

That issue in particular caught my eye because it is what happened to me. Shortly after that headache, I passed out.  I woke up briefly in the ambulance as I was being rushed to the hospital. According to my family, at least three days had passed since I begun experiencing the headache.  (This was during the pandemic, and I was isolating at home alone.) I mention this because it made me feel like I had missed something or messed up in some way.  Reading these studies helped me realize that my experience was not unusual.  I imagine that some of you female stroke survivors feel the same way. I hope this serves as a good reminder to cut yourself some slack.

But there are other reasons women do not get to the hospital on time to get the best outcomes.

  • Women are more likely to live alone. So, there may be no one home to notice the BEFAST symptoms and call 911.
  • Once they do seek care, women face longer wait times to get the imaging they need to diagnose a stroke.

Women also face risks that men don’t.

  • Pregnancy can cause complications like preeclampsia, a spike in blood pressure that can cause an immediate risk of stroke that lingers throughout a woman’s life. Other common pregnancy conditions like gestational diabetes and premature labor have been linked to an elevated risk of stroke later in life.
  • Also, using oral contraceptives, especially in smokers, and having migraine headaches, which are more common in women, increase the risk of stroke as a woman ages.
  • Another risk factor for women is early menopause, before the age of 45. Though women have a lower risk of stroke during midlife, their risk doubles after menopause, according to a study in Lancet Neurology.

Stroke hits women and men at different stages of life. Women have more strokes than men between the ages of 25 and 44. That trend reverses between the ages of 45 and 75, when men have more strokes. Women have more strokes after age 75, according to a 2022 article in the journal Stroke. That is important because the older you are when you have a stroke, the harder it is to recover.  According to a study in the Journal of Stroke, women had worse cognitive impacts after stroke and higher rates of dementia.

Women also tend to recover less mobility and function after stroke. Women faced higher rates of depression and anxiety after stroke. A 2022 study in the journal Circulation Research found that women were more likely to face disability and a lower quality of life after a stroke. That may partly be because women are often older and in worse health at the time of their stroke. Women are also more likely to have more severe strokes.

According to the CDC, someone in the US has a stroke every 40 seconds, and stroke is the leading cause of serious long-term disability in the U.S. Too much of that burden is falling on women.

If you have suffered a stroke, having peer support may significantly help your adjustment to post-stroke life. Stroke support groups can offer this support. Stroke Support Association offers in-person group meetings in Long Beach, California, and online meetings for those who live remotely from this area. Click here to learn how to join our free support groups.

 

By Karen Rafinski

 

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