Stroke is a leading cause of death and disability in women. Although most strokes can be attributed to traditional vascular risk factors, some risk factors are specific to women. Researchers reviewed the literature regarding women-specific stroke risk factors, including endogenous hormone levels, exogenous hormone therapy, pregnancy, parity, age at menarche, and menopause.

The limited data on the relationship between endogenous sex hormones and stroke in women indicate no association between estradiol levels and risk of ischemic stroke. Low testosterone levels are associated with a higher stroke risk in men, but the same relationship hasn't been found in women. Low levels of the adrenal hormone dehydroepiandrosterone, however, are associated with a higher risk of ischemic stroke and a greater severity of stroke in women. Data specific to stroke are limited, but some studies have shown an association between earlier age at menarche and greater cardiovascular disease (CVD) morbidity and mortality. Similarly, natural menopause onset before age 45 is associated with a slightly higher risk of total CVD mortality; however, this association wasn't found for stroke mortality risk independently. Surgical menopause has also been associated with a higher risk of CVD.

Oral contraceptives that contain a combination of estrogen and progestogen-even the newer, lower-dose formulations-are thrombogenic and have been associated with a higher risk of CVD. The risk of stroke associated with nonoral combined hormonal contraceptives, such as the vaginal ring and contraceptive patch, seems to be the same as with oral formulations. Data are limited, but researchers have not found a link between progestogen-only hormonal contraceptives and an increased risk of ischemic stroke. The risk of stroke increases in women using combined oral contraceptives who have other CVD risk factors, such as smoking, being older than age 35, and having a history of migraines with aura. Postmenopausal hormone therapy has been consistently associated with an increased risk of stroke, particularly ischemic stroke, in what is considered a dose-response relationship.

Pregnancy and the peripartum period are associated with an increased risk of stroke. The peripartum period-from two days before to one day after delivery and, to a lesser extent, up to six weeks postpartum-is associated with an increased risk of ischemic stroke and intracerebral hemorrhage. Eclampsia and preeclampsia are the strongest risk factors for these types of pregnancy-related strokes.

Limited data are available on the effect of exogenous estrogen therapy in transgender women. Medical providers are advised to look out for deep vein thrombosis and pulmonary embolism in transgender women receiving estrogen therapy. Testosterone for transgender men doesn't seem to be associated with an increased risk of thromboembolic complications.

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