Young adults represent a small proportion of all stroke victims. Only about 15% of strokes occur in individuals younger than 50 years of age. In this demographic, young women are at a greater risk of stroke than young men.

A meta-analysis of 70,000 young adults (18-45 years of age) revealed that women under 35 were 44% more likely to experience an ischemic stroke (stroke caused by a blocked artery) than men who were the same age. After age 35, the risk was the same for men and women. In another study, young women from the age groups of 25-34 and 35-44 were found to be more likely to have strokes than men the same age, though they found no difference in the likelihood of stroke between men and women in the 15-24 age group.

The reasons for the increased stroke risk in young women are not yet known. However, some risk factors for stroke uniquely or disproportionately affect young women.

1. Lopsided effect of obesity on young women

Being obese or overweight is one of the major risk factors for stroke in young people. But the risk of stroke due to obesity is different for men and women.

Research shows that women who were obese as teenagers have a greater risk of an ischemic stroke before they hit 55, even if they lost weight later. According to this study:

• Women who were obese as teenagers were 87% more likely to suffer an ischemic stroke or transient ischemic attack (TIA).
• Women who were obese at age 31 were 167% more likely to have an ischemic stroke than other women in the same age group who had normal weight at 31.

Obese men in the same age groups did not have an increased likelihood of ischemic stroke or TIA. However, men who were obese at 31 were more likely to have a hemorrhagic stroke (stroke caused by bleeding in the brain) than obese women in the same age group.

2. Antiphospholipid syndrome

Antiphospholipid syndrome is an autoimmune condition in which the body’s immune system attacks healthy tissues. It can result in the formation of blood clots in blood vessels which can interrupt blood flow. If blood flow to the brain is obstructed, it can cause a stroke. Between 10-20% of stroke victims under the age of 50 have antiphospholipid syndrome. The disorder occurs 5 times more often in young women than men.

3. Pregnancy and postpartum period

Pregnancy and the postpartum period increase the risk of stroke in women. The greatest risk starts a month before delivery and lasts until 6 weeks after birth. During this period, the women’s risk of stroke is about 3 times greater than that of non-pregnant women of comparable age. Complications during pregnancy such as preeclampsia and gestational diabetes further increase the risk of stroke.

4. Oral contraceptives

Millions of women use oral contraceptives (birth control pills) to take care of their reproductive health. Research shows that contraceptive pills with high estrogen content are associated with an increased risk of stroke.

A large study that followed over 2 million women found that estrogen pills increased the risk of both ischemic and hemorrhagic strokes. The risk was dose-dependent- higher doses of estrogen carried a higher risk of stroke. Stopping the pills was associated with reduced risk for both types of strokes. The risk is compounded in the presence of other risk factors such as obesity, cigarette smoking, and uncontrolled high blood pressure.

Non-hormonal birth control or progestin-only birth control has not shown an association with stroke.

5. Migraines

Migraines are severe throbbing or pulsing headaches accompanied by nausea and sensitivity to light and sound. Severe pain can continue for hours or even days making it a disabling experience. Migraines are said to have an aura when the patient starts experiencing symptoms such as visual disturbances, tingling in the hands or face, difficulty speaking, etc., usually before the migraine strikes.

Women are more likely than men to suffer migraines. The number of women who have migraines is 3 times greater than men. The condition is estimated to afflict 18-25% of women.

Migraines are a risk factor for both ischemic and hemorrhagic strokes in young adults. People who have migraines have double the risk of experiencing an ischemic stroke. The risk increases even more in those who have migraines with aura. The risk goes up when someone smokes tobacco or uses birth control pills, with the latter having a more dramatic effect. 

How to avoid strokes

It is not known why women get more migraines, experience antiphospholipid syndrome more often, or get affected by obesity differently. But they can still take steps to reduce their chances of getting a stroke.

Young women can avoid getting a stroke by carefully controlling the preventable risk factors for strokes. These include:

• Carefully selecting oral contraceptives. Speak to your doctor about non-hormonal or progestin-only birth control methods.
• Carefully controlling high blood pressure. Take your blood pressure medicine routinely as prescribed by your doctor. 
• Quitting smoking tobacco products. Avoid the use of cigarettes as well as vapes.
• Avoiding obesity. Use a good diet with plenty of exercise to maintain a healthy body weight in the normal BMI range.
• Accessing prenatal and post-natal medical care.  Regular visits with your ob-gyn can help in the timely detection of complications such as preeclampsia, and gestational diabetes.