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From menarche to menopause: estrogenic influences on stroke-related depression in women

Lauren Kelly Tierney1, Indy Cabeda Diaz1, Shahil H Patel1

  • 1Peritz Scheinberg Cerebral Vascular Disease Research Laboratories, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA.

Frontiers in Neuroendocrinology
|January 21, 2026
PubMed

Post-stroke depression (PSD) is a common and debilitating complication that disproportionately affects women, yet the underlying risk factors remain incompletely understood. Hormonal fluctuations across a woman's lifespan, including those naturally occurring during puberty, pregnancy, and menopause, as well as exposures to exogenous hormones, such as oral contraceptives, assisted reproductive technologies, and hormonal replacement therapies, profoundly influence neurobiological pathways, potentially modulating both stroke risk and subsequent depressive disorders. Female-specific or female-predominant patient factors, including polycystic ovary syndrome, migraine, autoimmune disease, and breast cancer may exacerbate susceptibility to depression after stroke. Behavioral factors, such as smoking, substance use, and stress, further interact with biological predispositions to impact PSD outcomes. Our review presents current evidence on the intersection of hormonal fluctuations, patient factors, and behavioral influences in shaping the stroke risk and manifestation of PSD in women. Addressing the intersecting influences on PSD offers a promising pathway to improve post-stroke mental health outcomes and enhance quality of life for women.

Keywords:
17β-estradiolEstrogen receptor beta (ER-β)EstrogensHypothalamic–pituitary–adrenal (HPA) axisIschemic strokeMenstruationSex-differencesStroke recovery

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