The hormonal rollercoaster that marks perimenopause—the often yearslong on-ramp to menopause—is well known to bring some in-your-face symptoms: hot flashes, insomnia, anxiety, joint pain, to name a few. But that same phase of fluctuating and ultimately dropping estrogen levels can also trigger some much less noticeable shifts throughout your body, which may in turn raise your risk for certain health conditions, namely stroke.
Before hitting those perimenopausal years, women generally are less likely than men to have a stroke, which happens when blood flow to your brain is limited due to a blocked (or broken) vessel. But at perimenopause and beyond, women’s stroke risk mirrors or even exceeds that of men, Mollie McDermott, MD, director of the stroke division at Michigan Medicine, tells SELF. In fact, this spike is a big reason why, over the course of a lifetime, women have a higher likelihood of stroke (20%) versus men (roughly 15%).
Read on to learn why the threat of stroke looms large as you approach menopause, and the risk-reducing habits that become ever more critical in this phase of life.
Why stroke risk rises in perimenopause
The dips in estrogen that characterize this stage set off a cascade of changes in your body that could affect blood flow to your brain, many of which feed into or fuel one another. For starters, we know estrogen plays a role in keeping blood vessels supple and pliable, so a lack thereof could make them rigid or stiff, Mindy Goldman, MD, an ob-gyn in San Francisco and chief clinical officer at Midi, a telehealth platform for midlife, tells SELF. These kinds of vessels are, then, more prone to constriction, upping your risk for a blockage.
Narrower, less flexible blood vessels can also elevate your blood pressure, as can other effects of perimenopause, like sleep struggles, stress and anxiety, and metabolic shifts, as well as simply aging. That tends to coincide, too, with changes in lipid (a.k.a. fat) profiles, particularly a rise in “bad” LDL cholesterol and triglycerides, Somi Javaid, MD, a Cincinnati-based ob-gyn, founder of women’s health care platform HerMD, and member of the plusOne wellness collective, tells SELF. After all, a drop-off in estrogen can make your liver less capable of processing and clearing fats. Taken together, these cardiovascular shifts raise your odds of developing sticky plaques in your arteries that can trigger a stroke.
The estrogen deficit of perimenopause can also slow down your metabolism—an outcome of aging as well—and make you less sensitive to the hormone insulin, which can lead to high blood sugar levels and weight gain, particularly in your belly. All of these changes, Dr. Javaid adds, can further pile onto the likelihood of stroke.
One last threat that may emerge in perimenopause is an increase in inflammatory chemicals throughout the body, Dr. Javaid adds. The combo of losing estrogen (which can have an anti-inflammatory effect) and the metabolic changes above may be to blame. The resulting rise in inflammation could explain why menopausal women with severe hot flashes and night sweats are especially vulnerable to events like stroke, Dr. Goldman says: “There’s a theory that greater inflammation worsens menopause symptoms and raises stroke risk.”
How to lower your risk of stroke in perimenopause and beyond
It’s essential to keep up with annual doctor visits in this life stage to stay on top of biomarkers that may go off-kilter, like blood pressure, blood sugar, and cholesterol. These can creep up for a while without generating any symptoms, Dr. McDermott points out.
Elevated levels might warrant further testing; in the case of cholesterol, for instance, your doctor may want to assess the size of those LDL particles to figure out if they’re “the big, fluffy kind or the smaller, denser, stickier type that is more atherosclerotic [and risky],” Dr. Javaid says. Or, if your blood pressure is consistently high, they might do a urine test or an electrocardiogram (EKG), which checks heart function, to explore potential root causes.
Catching any higher-than-normal numbers early gives you more time to intervene before a stroke occurs. That might look like embracing certain lifestyle modifications (more below), getting on medication, or both. (If your numbers are off and you have a family history of heart disease, your doctor may be more likely to jump to meds, Dr. Goldman notes.)
The quicker you recognize and seek help for any signs of stroke, the less likely you are to sustain lasting brain damage. And it’s just as critical to notice even stroke symptoms that are temporary or fleeting in nature; these could be evidence of what’s colloquially called a ministroke (a.k.a. a transient ischemic attack), which occurs when there’s a brief blockage of blood flow to the brain that then resolves typically within a few minutes to an hour. That might seem like NBD, but research suggests that nearly one in five people who have a TIA will go on to have a full-blown stroke within 90 days (and most of those strokes occur within two days), Dr. Javaid points out. So it’s critical to get a workup even for short-lived stroke symptoms to figure out the underlying cause—and a plan to squash it for the future.
Common stroke and ministroke symptoms include:
- Facial drooping
- Weakness, numbness, or tingling in an extremity
- Speech difficulty
- Loss of vision or vision changes
- An intractable headache
- Vertigo (dizziness)
- Balance or coordination problems, or trouble walking
- Confusion
Two other key features to keep in mind: Stroke symptoms tend to start suddenly (not gradually over hours) and usually involve just one side of the body, Dr. McDermott says.
The fact that heading into menopause makes stroke more likely doesn’t mean it’s inevitable. Rather, the same healthy habits that can tamp down stroke risk at any point in life just take on even more significance in this stage, when other factors are working against you.
All the doctors SELF spoke with emphasize not smoking or vaping (that is, quitting if you do or not picking up the habit) and being physically active—in particular, 150 minutes of cardio per week, along with two to three sessions of strength training. It also helps to get at least around seven hours of sleep every night, cut down on (or ideally cut out) alcohol, and follow a Mediterranean-style diet rich in plants and low in salt and saturated fats.
A note on hormone therapy and stroke risk in perimenopause
Hormone therapy (a.k.a. hormone replacement therapy, or HRT), which involves using estrogen to alleviate menopause symptoms, has been shown to slightly increase risk of blood clots, which is why it’s not typically recommended for people who’ve had a heart attack or stroke. Research suggests, however, that this risk is unique to the oral forms and doesn’t apply to the transdermal kind (or, the patches). “When you take something by mouth, it’s processed by your liver, where it can affect clotting profiles,” Dr. Goldman explains. “When you use a patch on your skin, you bypass that metabolism through the liver.”
Evidence of higher stroke risk in HRT users also primarily comes from studies in people over age 60, typically several years postmenopause. Newer data suggests that starting HRT earlier in life, particularly in perimenopause, may be protective against stroke “because it can even out some of the large hormonal swings that occur during this period,” Dr. Javaid says. The theory is, supplying your body with estrogen when you’re in this phase of instability can restore some of its benefits on blood vessels and inflammation levels, lessening the likelihood of plaque buildup and stroke, Dr. Goldman says. (But if you wait until postmenopause, you’re likely to already have plaque in your arteries, and the impact of adding estrogen could be to dislodge some of it and actually prompt a blockage, she says.)
Still, there’s not enough data as of now to suggest women take HRT during perimenopause specifically to prevent stroke. The bottom line is, it’s best to talk to your doctor about the pros and cons of HRT in your personal scenario—it’s possible that it could quell the worst of your menopause symptoms and may be neutral (or even protective) when it comes to stroke.
Related:
- Oh, Fun: Perimenopause Might Be Making Your Migraine Attacks Worse
- Why 30 Isn’t Too Young to Start Thinking About—And Preparing for—Menopause
- My ‘Flu’ Symptoms Turned Out to Be Early Signs of a Stroke
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