Research confirms link between early menopause, higher ischemic stroke risk

New research showing a connection between early menopause and increased risk of stroke caused by blocked blood vessels highlights the importance of achieving cardiovascular health for women with early menopause.

The study, published by the American Heart Association, looked at data from 16,244 postmenopausal women, ages 26-70, in the Netherlands.

After following the women for about 15 years and adjusting for various factors, researchers found women whose menopause occurred before age 40 had 1.5 times higher risk of ischemic stroke than women who experienced it between ages 50-54. Researchers also discovered a 2% lower stroke risk for each year menopause was delayed.

The risk between earlier menopause and stroke was limited to ischemic stroke, which is caused by a blood clot, and not hemorrhagic stroke, which occurs when a weakened vessel ruptures.

The study also found the link between age at menopause and stroke was stronger for women who experienced natural menopause than for those who experienced menopause after surgery to remove the ovaries.

Stroke is the second-leading cause of death worldwide, and women have a 4% higher lifetime stroke risk than men. Some studies show women who experience menopause at an earlier age have a higher risk of heart disease in general. But previous research has produced mixed results on the relationship between stroke and the age menopause started.

"It is of utmost important for all women to try and achieve optimal cardiovascular health before and after menopause, but it is even more important for women with early menopause," said Dr. Yvonne van der Schouw, the study's co-author and a professor of chronic disease epidemiology at Utrecht University in the Netherlands.

Scientists have been studying how hormone replacement therapies in early menopause might improve cardiovascular health. According to an AHA scientific statement published last year, certain hormone replacement therapies have cardiovascular benefits, decrease the risk of Type 2 diabetes and protect against bone loss.

A growing body of research also is looking at how estrogen impacts a woman's brain health.

Dr. Samar El Khoudary, who was not involved in the new research, said, "This study as well as other similar studies help make us better aware of the risks related to menopause when it comes to cardiovascular health."

She called for more studies to examine how hormone replacement therapy impacts age at menopause and stroke. "It's the big elephant in the room (since) midlife women use hormone therapy to treat menopause-related symptoms," said El Khoudary, an associate professor of epidemiology at the University of Pittsburgh's Clinical and Translational Science Institute.
But whether they use hormone replacement therapy, women experiencing menopause need to educate themselves about the risk of stroke and what they can do to prevent it, El Khoudary said.

"During midlife when women transition through menopause, women need to maintain physical activity, have a healthy diet and a healthy weight, stop smoking, and get enough sleep," she said. "At this stage, reducing their risk becomes very important."