Menopause before 40 tied to a higher stroke risk, new study finds

Menopause before age 40 could mean an increased risk of stroke caused by blocked blood vessels, according to a new study that found that, for each year menopause is delayed, stroke risk fell by 2%.

Some studies previously found that women who experience menopause at an earlier age have a higher risk of heart disease in general. But research has shown mixed results on the relationship between stroke and the age menopause started.

Now, a new study, published by the American Heart Association journal Stroke, looked at data from 16,244 postmenopausal women between 26 and 70 in the Netherlands. After following the women for about 15 years and adjusting for various factors, the researchers found women whose menopause occurred before 40 had 1.5 times higher risk of ischemic stroke than women who experienced it between 50 and 54.

The 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 vessel blockage, 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.

“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.

The results point to the need for new research into the link between early menopause and stroke risk, van der Schouw said. She said further studies “may eventually lead to new, still unknown pathways and new clues for preventive measures.”

Stroke is the second-leading cause of death worldwide, and women have a 4% higher lifetime stroke risk than men.

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

A 2019 study in the journal Menopause found that giving women estrogen early — within the first five years of menopause — might protect against cognitive decline. It also showed women exposed longer to natural estrogen because of longer reproductive periods had better cognitive function later in life.

Dr. Samar El Khoudary, who wasn’t in the new research, said the study was limited by the use of data that relied on participant questionnaires to report details on menopause. She called for more studies to examine how hormone-replacement therapy affects 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 no matter 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.