Health and Wellness

I’m a young, healthy woman – and I’m at risk for stroke?

Written by our friends at Tufts Medical Center

You’re a young adult woman who eats a healthy diet, tries to stay active and generally lives a well-balanced life. The thought that you might be at risk for stroke has probably never crossed your mind, but unfortunately, it’s something you should be aware of! Lester Leung, MD, MSc, Director of the Comprehensive Stroke Center and the Stroke and Young Adults (SAYA) Program at Tufts Medical Center has the answers to your questions about stroke.

Q: I read recently that stroke can affect young people. Is that true? I thought stroke just happens to older people.

A: Yes, stroke can actually affect people of all ages, including young adults, children, and babies. The most common causes of stroke vary across ages, and they can affect people who are otherwise quite healthy. Strokes can be due to a blood clot that blocks a blood vessel in the brain, or it can be due to a rupture of a blood vessel in the brain (causing bleeding).  You can learn more about stroke, its causes, and potential symptoms, and how it is diagnosed on the Tufts MC Comprehensive Stroke Center’s website.

Q: What puts a young woman like me at risk for stroke?

A: Among young adults, stroke actually affects women more often than men. This is because of stroke risk factors unique to women: pregnancy, taking hormonal contraception, and that more women than men have migraines. Unsure how to identify the signs of a stroke? Remember, B.E.F.A.S.T.

Q: Why does having migraines put me at risk for stroke?

A: There are multiple connections between migraines and stroke risk, and some are not well understood. In some cases, migraine may simply be associated with other conditions that can lead to stroke: for example, people with migraine are more likely to have a patent foramen ovale (PFO), a small hole or tunnel between two chambers in the heart. People with a PFO will sometimes have a blood clot travel from the heart to the brain, but in these cases, migraine usually is not involved. However, for other people, migraine itself can be a part of several other mechanisms by which stroke occurs, especially vasospasm (blood vessel constriction). The problem is that these additional mechanisms are not very well understood or commonly recognized.

Q: I have had migraine headaches and have been told I can’t use a hormonal contraceptive. Why?

The problem is that some hormonal contraceptives (those that contain estrogen) can promote increased blood clotting in women with migraines. This includes women with migraine with auras and those with migraine without auras.

Women taking estrogen-containing contraceptives at usual doses alone are not at risk, and women with migraine alone are at a very small amount of increased risk for clot formation. However, when combined, the risk for blood clots – and therefore stroke – is greater than the individual risks. This risk is even greater for women who have migraine, take estrogen-containing contraceptives, and use tobacco.

Q: Do I have other options for contraception, if I cannot take hormonal contraceptives?

A: Telling women with migraines that they cannot use hormonal contraception is a bit oversimplified. Contraceptives that only contain progesterone, especially synthetic progestins (such as levonorgestrel), appear to be relatively safe. Our best studies thus far indicate that levonorgestrel (which is in an intrauterine device/IUD and also in a “mini-pill” form) has no notable increased risk of blood clotting for women with migraine.

Q: Why would pregnancy put me at risk for stroke? Should I be worried?

A: During pregnancy, some women develop high blood pressure or diabetes, both of which can damage blood vessels in the brain or elsewhere in the body. For some women, blood vessels in the head and neck can become more susceptible to injury. One type of blood vessel injury is called dissection which is a tear in the wall of the blood vessel, leading to blood clotting. Finally, in the late third trimester and for the first several weeks after delivery, some women may be at increased risk for blood clotting. Nonetheless, stroke is a rare event during pregnancy and the post-partum period, so most women are not going to have a stroke during or shortly after pregnancy. Nonetheless, if you are concerned, speak with your Obstetrician, primary care physician, or a Vascular Neurologist to determine if you are at increased risk and if you should take any additional precautions.

The multidisciplinary team at the Comprehensive Stroke Center at Tufts Medical Center in downtown Boston treats people with a wide range of cerebrovascular disorders: ischemic strokes, transient ischemic attack, intracerebral hemorrhages, subarachnoid hemorrhages, cerebral venous sinus thrombosis, carotid artery stenosis, and many more. Our clinicians work together to find the best treatment plan for you. To us, every patient is an individual. We strive to treat every patient with compassion and a personal touch. And we’re dedicated to meeting the highest standards for stroke care.

Tufts Medical Center is a renowned not-for-profit academic medical center in downtown Boston and the principal teaching hospitals of Tufts University School of Medicine. Tufts MC offers a full range of services including primary care, OBGYN services in all areas of women’s health and dedicated pediatric and adult emergency rooms.

Disclaimer: The content provided in this post is intended solely for the information of the reader. This information is not medical advice and should not replace a consultation with a medical professional.

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