Two Conditions Doctors Say Quietly Raise Women's Stroke Risk—And How to Protect Yourself

Two conditions that affect millions of women—endometriosis and early menopause—are now recognized as serious stroke risk factors, according to updated guidelines from the American Heart Association and American Stroke Association. The good news: if doctors identify these risks early, many can be managed before a stroke happens. Understanding these connections could help you take action to protect your cardiovascular health.

What Is Endometriosis and Why Does It Raise Stroke Risk?

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus—typically on the abdomen, bowel, bladder, or ovaries. Researchers estimate that at least one in ten women have endometriosis, though diagnosis can take up to 10 years because symptoms mimic other conditions and require laparoscopic surgery to confirm.

The connection to stroke risk comes down to inflammation. "We think the inflammation associated with endometriosis increases problems like high cholesterol and high blood pressure, which are risk factors for stroke," explains Dr. Alexis Simpkins, vascular neurologist and director of stroke research at Cedars-Sinai. Beyond stroke risk, endometriosis can also cause pregnancy complications like preeclampsia (sudden high blood pressure during pregnancy or after delivery), which itself increases stroke risk.

In more severe cases, surgery to remove the uterus and ovaries—sometimes necessary for women with endometriosis—triggers early menopause, adding another layer of cardiovascular risk.

How Does Early Menopause Affect Your Stroke Risk?

Early or premature menopause occurs when menstruation stops before age 45 (or before age 40 for premature menopause). When this happens, the ovaries produce significantly less estrogen, and that's where the stroke risk climbs.

"Estrogen is protective in women for our cardiovascular health," says Dr. Kacey Hamilton, a gynecologic surgeon at Cedars-Sinai. "Women who go through menopause early don't have that estrogen protecting them from the development of cardiovascular disease and stroke." Beyond stroke, early menopause increases risks for osteoporosis, depression, and neurological diseases like Alzheimer's disease and Parkinson's disease.

Many women experiencing early menopause also deal with uncomfortable symptoms—hot flashes, night sweats, vaginal dryness, sleep problems, and brain fog. While hormone replacement therapy can ease these symptoms, it carries its own cardiovascular risks, making the decision complex. "Whether hormone therapy is right for you is an individualized risk-benefit analysis to be made in consultation with your doctor," says Dr. Shlee Song, neurologist and co-director of Cedars-Sinai's Comprehensive Stroke Program.

Steps to Lower Your Stroke Risk If You Have These Conditions

• Monitor cholesterol levels: High cholesterol is a major stroke risk factor, especially for those with endometriosis or early menopause. Work with your doctor to track your cholesterol regularly and manage it through diet, exercise, or medication if needed.
• Control blood pressure: Endometriosis-related inflammation can raise blood pressure, increasing stroke risk. Regular monitoring and lifestyle adjustments—like reducing sodium and managing stress—are essential.
• Manage blood sugar: Maintaining healthy blood sugar levels protects your cardiovascular and neurological health, particularly important for women with these conditions.
• Follow the American Heart Association's Life's Essential 8: These include good nutrition, regular exercise, not smoking, healthy sleep, maintaining a healthy weight, controlling cholesterol, managing blood sugar, and managing blood pressure.
• Get regular check-ups: Women with endometriosis or early menopause should monitor these risk factors regularly with their primary care physician to catch problems early.

Recognizing Stroke Symptoms: The BE FAST Test

Strokes often come without warning, but knowing the signs can save your life. The American Heart Association recommends the BE FAST acronym to identify stroke symptoms with sudden onset:

• Balance loss: Sudden difficulty with coordination or balance
• Eyesight changes: Blurred or lost vision in one or both eyes
• Face drooping: One side of the face droops or feels numb
• Arm weakness: Sudden weakness or numbness in an arm, especially on one side
• Speech difficulty: Slurred speech or trouble speaking or understanding
• Time: Call 911 immediately if you notice any of these signs

Sudden, severe headaches can also signal a stroke, though strokes are often painless—the only symptom may be a sudden loss of function.

Why Early Detection Matters

The updated stroke prevention guidelines now specifically identify endometriosis, early menopause, and pregnancy complications as stroke risk factors unique to women. This recognition is crucial because it shifts the conversation from accepting these conditions as simply uncomfortable to understanding them as serious cardiovascular health concerns.

"The good news is that if we identify these risks early, we can correct many of them before a stroke strikes," says Dr. Song. The key is working with your healthcare team—whether that's your primary care doctor, gynecologist, or neurologist—to monitor the risk factors you can control and make informed decisions about treatments that balance benefits and risks.

If you have endometriosis or experienced early menopause, don't wait for symptoms. Talk to your doctor about your stroke risk and develop a personalized prevention plan focused on managing cholesterol, blood pressure, blood sugar, and overall cardiovascular health.