Hormones and Stroke Risk: Pregnancy, Menopause, and More
Women’s HealthJuly 02, 2026
9 Min Read
Reviewed by
Neurology
Stroke is the third-leading cause of death in women. And along with traditional risk factors like high blood pressure, sex hormones can also put women at risk of stroke
Naturally occurring hormones and hormones taken at certain life points can increase women’s stroke risk. It’s important to know your individual risk factors to lower your risk
“Women have an overall higher lifetime risk of stroke than men,” says Eliza Miller, MD, MS, FAHA, chief, Women’s Neurology, UPMC. “Part of that is just that they live longer in general, but that’s not all of it. And some of these risks are related to these hormonal factors. It’s under-studied, it’s under-discussed, and it absolutely should be part of the conversation.”
Learn more about hormone changes and stroke risk for women . Discover which women are most at risk and learn proactive brain-heart wellness habits to lower your risk
How Do Hormones Affect Women’s Stroke Risk?
Sex hormones, including estrogen and progesterone, can increase a woman’s risk of blood clots. That’s true for both hormones produced naturally (endogenous hormones) or hormones taken from outside the body (exogenous hormones)
Dr. Miller points to three situations when women are at greater risk for stroke due to sex hormones:
- During pregnancy and postpartum.
- When taking hormonal contraceptives.
- When taking hormone therapy for menopause symptoms.
Stroke risk during pregnancy and postpartum
Women are at greater risk of stroke during pregnancy and the postpartum period. According to the American Society of Hematology (ASH):
- The risk of developing a blood clot quadruples during pregnancy.
- The risk increases to 20 times more likely in the postpartum period. It’s 100 times more likely in the first week after birth.
Various factors raise a woman’s stroke risk during this time, such as pregnancy-related high blood pressure. But hormonal fluctuations can also play a part
Many different hormones rise during pregnancy, including estrogen and progesterone
Close to birth, the body makes more of a substance that helps the blood clot. This substance reduces the risk of bleeding emergencies during childbirth. However, it also raises the risk of clotting disorders, including stroke
“The bottom line is that women who are pregnant are at increased risk for all kinds of clotting events,” Dr. Miller says. “And actually, the highest risk time period for that is in the early postpartum period.”
The increased stroke risk extends to about 12 weeks after birth, Dr. Miller adds
Hormonal contraception and stroke risk
The use of certain birth control methods containing estrogen and progestin can increase a woman’s stroke risk
The overall risk is low, Dr. Miller says. But people with other risk factors may be at higher risk. These hormonal birth control and stroke risk factors include:
- High blood pressure.
- Migraine with aura.
- Obesity.
- Personal or family history of clotting disorders.
- Smoking.
You should discuss your risk factors with your medical provider before using estrogen birth control
Different forms of contraception have different risks of blood clots. According to the ASH, estrogen patches and rings may carry a higher risk because they deliver a higher amount of estrogen to the body than do pills
There are also birth control methods that don’t carry a stroke risk. You can discuss your options with your doctor
You shouldn’t just stop using hormonal contraception methods without another option
“The risk of clotting and stroke related to pregnancy is higher than the risk related to contraception,” Dr. Miller says. “What you should never do is stop all your contraception and not have a plan.”
Hormone therapy and stroke risk
The relationship between hormone therapy for menopause and stroke risk is a complicated one
Menopause itself can increase stroke risk as women’s natural estrogen levels decline. Premature and early menopause can carry an even higher risk
Hormone therapy was initially thought of as a way to counteract postmenopausal stroke risk. But a 2002 study from the Women’s Health Initiative reported that hormone therapy increased the risk of stroke and other complications
More recent findings have provided some context. Many of the women who participated in the study were in their 60s and more than 10 years past the onset of menopause. The type of hormone therapy used was also different, Dr. Miller says
“It’s debatable whether the results of that trial really apply to everyone,” she says
The American Heart Association (AHA) and American Stroke Association (ASA) released guidelines on stroke prevention in 2024. According to these guidelines, women are at a greater risk of stroke from using oral estrogen hormone therapy if they:
- Are 60 or older.
- Are more than 10 years beyond menopause onset.
- Are at greater risk of cardiovascular disease and stroke.
There are many types of hormone therapy. Some carry higher stroke risks than others. For example, oral estrogen therapy carries a higher stroke risk for some women. But estrogen delivered vaginally doesn’t cause a higher risk of blood clots
There are also menopause treatments that don’t involve hormones, Dr. Miller notes. She recommends having a nuanced conversation with your provider about treatment options based on your symptoms and stroke risk factors
“Hormones could help a lot of people, but there are a lot of different kinds of hormones,” Dr. Miller says. “So, they’re not all the same. They’re not all delivered the same way. They’re not always dosed the same way. And then people have different baseline risk factors for stroke.”
How Can Women Decrease Their Risk of Stroke?
Healthy lifestyle habits can help women reduce their risk of stroke. Dr. Miller recommends the AHA’s Life’s Essential 8™
Those recommendations include:
Eat a healthy diet
Eating a nutritious diet is essential for your health and can help prevent stroke. You should focus on the following food groups:
- Fruits and vegetables.
- Healthy oils, like olive oil.
- Healthy proteins.
- Low-fat dairy.
- Whole grains and legumes.
- Fish.
Limit foods high in sodium, added sugars, and saturated and trans fats. Avoid sugary drinks and processed foods
“It’s not that these other foods are forbidden,” Dr. Miller says. “It’s about your overall pattern of eating. It doesn’t mean you can’t have birthday cake on your birthday. But what you don’t want is to have the majority of your diet every single day be things that are not helping your nutrition.”
The Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet are two heart-healthy options. Preparing your food yourself can also be beneficial because you have control over the ingredients
Exercise more
Moving your body can help reduce your stroke risk. The AHA recommends:
- 150 minutes of moderate-intensity cardio exercise per week.
- Or 75 minutes of vigorous-intensity cardio exercise per week.
- Or a combination of the two.
You should also aim for two strength exercises per week. But even if you can’t meet the specific guidelines, moving more in general can be beneficial
“It doesn’t necessarily need to be that you’re doing a 45-minute workout every day,” Dr. Miller says. “Maybe you can just try to get a few more of your steps in. Maybe you can stand up more. Even small steps are better than nothing.”
Quit smoking
Smoking isn’t just bad for your lungs. It also poses significant cardiovascular risks. According to the ASA, current smokers have a 2 to 4 times higher risk of stroke
Quitting smoking can help you lower your risk of stroke and many other health conditions. If you need help quitting, talk to your doctor about re
Get better sleep
Many people don’t get enough sleep at night, and that’s bad for their health. Sleep deprivation and sleep disorders raise your risk of stroke and many other conditions
“A lot of people have sleep disorders that are not diagnosed,” Dr. Miller says. “Things like obstructive sleep apnea , restless legs syndrome, insomnia. And a lot of these things get worse around menopause or can first present around menopause.”
Adults should aim for seven to nine hours of sleep per night. If you’re struggling with sleep, focus on improving your sleep hygiene. Tips include:
- Avoid caffeine or alcohol too close to bedtime.
- Don’t eat before bed.
- Don’t exercise too close to bedtime.
- Don’t use your phone or other electronics before bed.
- Sleep in a cool, dark room.
Manage your weight
Obesity is a risk factor for stroke. Managing your weight can help you prevent obesity. Eating healthy and exercising can help you manage your weight
Although it’s not a perfect metric, body mass index (BMI) is one way you can track your weight:
- A BMI of between 18.5 and 24.9 is considered a healthy weight.
- A BMI of 25 to less than 30 is considered overweight.
- A BMI of 30 and above is considered obese.
Manage your cholesterol
High cholesterol is a risk factor for stroke. You should especially be mindful of your low-density lipoprotein (LDL) cholesterol, also known as “bad cholesterol.” High LDL cholesterol levels can lead to blocked arteries, a risk factor for stroke
Manage your blood sugar
High blood sugar is a risk factor for type 2 diabetes, which is a risk factor for stroke. With type 2 diabetes, your body can’t use insulin correctly, which causes sugar to build up in your blood. Excess blood sugar can damage your blood vessels
Diabetes doubles your risk of stroke, according to the ASA
A healthy diet and regular exercise can help you manage your blood sugar and prevent diabetes
Manage your blood pressure
High blood pressure (hypertension) is a major risk factor for stroke
Blood pressure is typically read as a ratio of two numbers: systolic (the top number) over diastolic (the bottom number). Systolic is the pressure in the arteries when the heart beats. Diastolic is the pressure in the arteries when the heart rests between beats
Normal blood pressure is anything less than 120 systolic and 80 diastolic. You can manage your blood pressure by:
- Eating a healthy diet.
- Exercising regularly.
- Getting enough sleep.
- Limiting alcohol.
- Managing your weight.
- Quitting smoking.
How Should I Talk to My Doctor About Hormones and Stroke Risk?
Dr. Miller says it’s important to talk to your doctor about your personal stroke risk factors if you’re considering pregnancy, hormone contraceptives, or hormone therapy. It’s especially important if you’ve had a stroke or heart attack before
“When you’re considering hormonal therapy or a pregnancy, you always want to talk to your doctor about, ‘What are any special considerations for me?'” Dr. Miller says
You should also talk to your doctor about blood pressure, which is a major risk factor for stroke. If you have high blood pressure, you should consider tracking it at home
“The effect of having high blood pressure over years is going to have a way higher impact on your stroke risk than any hormone treatment,” Dr. Miller says
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