Just as heart-attack symptoms may differ between men and women, so do stroke risks.
Now, the American Heart Association has issued its first guidelines for preventing strokes in women. They focus on birth control, pregnancy, depression and other risk factors women face uniquely or more frequently than men.
General guidelines for stroke prevention currently focus on controlling blood pressure and diabetes, quitting smoking, more exercise and healthy diets.
The new ones add gender-specific advice, said Dr Cheryl Bushnell, stroke chief at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. She led the panel that wrote the guidelines, published in Stroke, a Heart Association journal.
The guidelines state that women should be checked for high blood pressure before starting on oral contraceptives because the combination raises stroke risks. The risk is small but rises steeply in women ages 45 to 49. More than 10 million American women use birth control pills.
Strokes are uncommon during pregnancy but the risk is still higher, especially during the last three months and soon after delivery. The big worry is pre eclampsia, dangerously high blood pressure that can cause a seizure and other problems.
"It doubles the risk of stroke later in life and it quadruples the risk of high blood pressure" after pregnancy, Bushnell said.
Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin (about 81 milligrams) after the first three months of pregnancy, and calcium supplements anytime, to lower the risk of pre eclampsia, the guidelines say.
Pregnant women with very high blood pressure (160 over 110 and above) should be treated with medications, and treatment may be considered for those with moderately high blood pressure (150 to 159 over 100 to 109). Certain blood pressure medicines are not safe during pregnancy, the guidelines note.
The guidelines point out that women are four times more likely to have migraines than men, and they often coincide with hormone swings. They mention that migraines alone don't raise the risk of stroke, but ones with aura do. Using oral contraceptives and smoking raise this risk even more, so the guidelines urge stopping smoking.
Moreover, the guidelines also suggest women over age 75 should be checked for atrial fibrillation, which can contribute to stroke risk. Doctors do this by taking a pulse or listening to the heartbeat.
Hormone therapy not is not advised to try to prevent strokes.
