Menopause and Its Implications for Stroke in Women

Stroke is the third leading cause of death in women and a major driver of disability. Menopause is a universal transition for midlife women, which is accompanied by menstrual cycle changes, hormonal fluctuations, and, for many women, the occurrence of menopausal symptoms. An accumulating body of research underscores the importance of menopause and its features to stroke risk in women, including the type and timing of menopause, endogenous hormone profiles, and menopausal symptoms, including vasomotor symptoms and sleep problems. In addition, menopausal hormone therapy, a leading approach to managing menopausal symptoms, has implications for stroke risk, which varies depending on the menopausal hormone therapy formulation, route of delivery, and the age and health of the recipient, with transdermal menopausal hormone therapy formulations administered to younger midlife women showing a more favorable profile. This review summarizes the data linking menopause and stroke, and offers suggestions to inform clinical decision-making. Knowledge gaps and directions for future research are highlighted.