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What Are the Differences in Stroke Symptoms Between Women and Men?

What Women Should Know

When it comes to having a stroke, every minute matters.

“In the last couple of years, our ability to provide acute treatment has changed considerably, but it’s very time dependent. Recognition is one of the best ways of intervening quickly,” says Paul E. Later, MD, a neurologist with Northwestern Medicine.

Could a difference in stroke symptoms cause individuals, particularly women, to ignore their stroke symptoms? Although most people are familiar with the symptoms noted in the acronym F.A.S.T., there are other important symptoms to recognize. What’s more, men and women may experience stroke symptoms differently.

Women Are More Likely to Report Nonspecific Symptoms

The American Stroke Association’s acronym F.A.S.T. refers to face drooping, arm weakness, speech difficulty and time to call 911. These are some of the basic symptoms. However, there are other stroke warning signs. “When a blockage occurs in different areas of the brain, it can cause numbness, weakness, language dysfunction or unsteadiness,” says Dr. Later. “The symptoms will differ based on the different areas of the brain and its functions.”

During a stroke, both men and women typically report these signs appearing suddenly:

  • Numbness or weakness in the face, arm or leg, especially on one side of the body
  • Confusion, trouble speaking or trouble understanding
  • Trouble seeing in one or both eyes
  • Difficulty walking, dizziness, or loss of balance or coordination
  • Severe headache with no known cause

Women, however, may also report these symptoms:

  • Hiccups
  • Nausea
  • Chest pain
  • Fatigue
  • Shortness of breath
  • A racing heartbeat

“Because the types of symptoms some women experience are nonspecific, it often takes longer to recognize that a stroke is happening,” says Dr. Later, referring to the specific list of symptoms women may experience. “Most people don’t immediately associate these symptoms with a stroke.”

Women Have More Risk Factors

There are other factors that add to the complexity regarding the difference in stroke symptoms between men and women. Statistics show women are also more likely to have a stroke. In fact, one in five women in the U.S. will have a stroke in her lifetime.

Risk factors that are relevant to women include:

  • Pregnancy. “During pregnancy, there are changes in the coagulation system that put a woman at increased risk for stroke,” says Dr. Later. This can result in blood clots, which can then restrict blood flow to the brain, causing a stroke to occur.
  • Preeclampsia. Research shows that having a history of preeclampsia, a condition characterized by high blood pressure during pregnancy, doubles a woman's risk of stroke later in life.
  • Birth control pills. Although they are very safe and the risk is small, blood clots can occur as a side effect.
  • Migraine with aura. This is mildly linked to ischemic stroke (when an artery supplying blood to the brain becomes blocked), especially in younger women with other vascular risk factors.
  • Atrial fibrillation. Although an irregular atrial heart rhythm increases the risk for stroke in both men and women, it is more likely to cause stroke and severe complications from stroke in women.

There is some consideration about whether hormone replacement therapy can increase a woman's risk for stroke. Dr. Later adds, “Taking estrogen less than 10 years after menopause can have positive vascular effects, but if it’s taken longer, there may be negative effects.”

Women tend to live longer, so they also may be more likely to live at home alone. “Some symptoms may not be noticed,” says Dr. Later. “If you’re confused and don’t recognize a deficit, it can have significant impact on the time it takes to get help.” This, along with minimizing nonspecific symptoms or discrediting them as something else, could affect how quickly women seek medical attention.

Consequently, Dr. Later stresses the importance of having an established network of family or friends. He also notes the importance of telling someone as quickly as possible if you have a symptom. “Even if your symptoms mimic a stroke, we can sort it out when you arrive at the emergency department. If we miss a window of opportunity, the interventions that are possible are greatly decreased,” he says.

Bottom Line

Early treatment can make a huge difference in recovery after stroke. Knowing and recognizing stroke symptoms can allow you to get proper care faster, which dramatically improves the number of interventions available. Although stroke symptoms will differ based on where the blockage is occurring, it is important to seek help if you exhibit any symptoms.

It's important to recognize that the longer a stroke goes untreated, the more damage can occur. “Our ability to quickly and efficiently remove a blood clot has drastically improved. The key takeaway is that we now have dramatic interventions if the circumstances are right. If we see a patient quickly, our chance of reversing any deficits is dramatically improved,” says Dr. Later.

Remember, every minute matters. If you experience any symptoms, call 911 immediately.

Northwestern Medicine Stroke and Cerebrovascular Care

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Paul E. Later, MD
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