Causes, Risk Factors, and Warning Signs

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On May 13, 2025

Many stroke risk factors are common to both men and women, but certain risks are unique to or at least more common in women.

In 2024, the American Heart Association and the American Stroke Association released amended guidelines and screening recommendations for women, specifically for those who:

Have been diagnosed with endometriosis
Experienced menopause before age 45
Experienced hypertension during their pregnancies
Lost ovarian function before age 40

The association recommends that healthcare providers screen for these conditions as part of their evaluation of a woman’s risk for stroke.

Estrogen

The estrogen naturally produced in the body has a protective effect on cardiovascular health, including on stroke risk.

But when estrogen is taken in oral contraceptives, as part of postmenopausal hormone therapy, or for any other reason, it increases the clotting factors in blood, which can increase the risk of an ischemic stroke. While for most women the use of oral contraceptives containing estrogen is safe, those who have migraine with aura, are older than 35, smoke cigarettes, or have other stroke risk factors, may be at higher risk for stroke and should discuss the safety of using oral contraceptives with their doctor.

In postmenopausal women, the normal drop in estrogen levels is associated with a rise in cardiovascular risk, including risk for stroke.

Pregnancy

Pregnant women are three times more likely than women of the same age who are not pregnant to have a stroke, because of the increased risk of high blood pressure and blood clots during pregnancy.

Serious complications of pregnancy, gestational diabetes and preeclampsia — which causes severe high blood pressure — also raise stroke risk significantly.

Autoimmune Conditions

Autoimmune diseases disproportionately affect women, and some of those diseases can increase stroke risk, due to the fact that they cause inflammation, which in turn causes plaque buildup in the arteries, narrowing blood vessels and blocking blood flow. Some conditions may also increase the risk of blood clots.

Autoimmune conditions that can raise the risk of stroke include:

Migraine With Aura

Migraine is another condition that affects more women than men, and migraine with aura, in particular, is associated with a slightly higher risk of stroke, although scientists do not know exactly why.

Experts recommend that women who have migraine with aura make an effort to lower any other stroke risk factors they may have, including smoking, high blood pressure, and obesity.

Race

Race may raise stroke risk for some women.

Research has shown that Black women may be at a higher risk of stroke than white women of the same age. In a recent study, Black women who were diagnosed with high blood pressure before the age of 45 had twice the risk of stroke. Additionally, the findings showed that Black women with high blood pressure before age 35 had three times the risk of a stroke.