Kimberly Cansler was standing in her kitchen, shortly before dinner one evening, when her left leg went numb.
"It felt fat, numb, heavy, tingly," she says, recalling that day in 2022. "Out of the blue, no signs or symptoms beforehand."
She managed to reach the sofa, dragging her left foot. But within 20 minutes or so, the numbness moved up her left side. "I felt it go numb from my fingers to my elbow, and then I felt it go up to my shoulder," she says.
As a registered nurse, Cansler knows stroke symptoms backward and forward. But given her younger age, just 44 years old, she struggled to admit what was happening.
"Absolutely, I was in denial. There's no way I was supposed to be having a stroke. No way. I was too young."
Women are far more likely to have a stroke after menopause. But younger women are not immune – and carry a higher risk than men of the same age, recent research shows. As a result, stroke experts are now urging women to know the signs – and their risk – decades earlier than expected.
Other possible stroke symptoms include:
- Weakness on one side of the body
- Trouble with vision, such as loss of vision or double vision
- Problems with speaking or understanding
- Confusion
- Dizziness or losing your balance or coordination
Greater Risk
The gap between men and women in stroke risk at a young age has shown up in several studies.
In one analysis, women ages 35 and younger were 44% more likely to have a stroke than men of the same age range. But by ages 35 to 45, that risk gap had vanished.
That study, published in the journal Stroke, focused on the most common type, called ischemic. Nearly 9 out of 10 strokes are ischemic. They're caused by a clot or a piece of plaque that blocks blood flow to the brain.
Another study, published in Neurology, looked at all types of strokes. Younger women again appeared to be more vulnerable than men – through age 44.
Experts aren't sure why.
For years, doctors thought that a woman's natural estrogen helped protect her against strokes until she reached menopause, says Elizabeth Fracica, MD, MPH, a stroke neurologist at Johns Hopkins University School of Medicine in Baltimore.
"These newer studies are really interesting and very thought-provoking because it goes against the conventional wisdom," she says. "We need to investigate this further and see what's going on in younger women."
A 9-Month Stress Test
A younger woman's stroke risk might change if she gets pregnant.
"Pregnancy can be thought of as a stress test," says Cheryl D. Bushnell, MD, MHS, FAHA, a professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
During pregnancy, the body pumps up the supply of blood to support the growing baby. Plus, the blood clots more easily, she says. "It keeps a woman from bleeding out when she delivers."
But problems can happen. A serious one is preeclampsia, which can lead to very high blood pressure.
"If that happens during pregnancy, then the risk of having a stroke right then and there at delivery goes up pretty dramatically," Bushnell says.
That higher stroke risk also persists, she adds. "It doesn't go away when the pregnancy is over."
Beyond Pregnancy
Bushnell chaired the latest stroke prevention guidelines from the American Heart Association and the American Stroke Association, published in October 2024. It highlights risk factors specific to women, such as pregnancy complications, early menopause, and endometriosis.
Endometriosis happens when tissue grows outside the uterus. It can bring severe pain, trouble getting pregnant, and inflammation both in the abdomen (belly area) and beyond. That boosts the risk of blood clots and strokes, Bushnell says.
Women who lose estrogen's protection earlier than usual, starting menopause before age 45, also face a higher stroke risk. So do those who have primary ovarian insufficiency, a condition that happens before age 40.
Among all young adults, high blood pressure remains the most common traditional stroke risk factor, says Michelle Leppert, MD, an assistant professor of neurology at the University of Colorado School of Medicine in Aurora. But nontraditional factors, such as migraines, contribute as well.
Leppert led a study, published in 2024, that found that migraine topped the list of nontraditional risk factors. Nearly 35% of strokes in women under the age of 35 were linked to migraine, compared with 20% of strokes in men.
It's not clear how migraines raise stroke risk, regardless of age, Leppert says. Researchers are looking at possible causes, she says. They include a higher chance of blood clots and changes in the lining of the blood vessels that may affect blood flow.
Lower Your Risk
Younger adults are still much less likely to have a stroke, compared to older adults. About 10% to 14% of strokes strike adults before age 50.
But their stroke rate is rising.
Risk factors can stack up. For instance, if a younger woman has migraines, Leppert says it's even more important for her to take other preventive actions, such as:
- Quit cigarettes. "Smoking and migraine is a pretty bad combination," Leppert says.
- Keep blood pressure normal, below 120/80.
- Steer clear of contraception that contains estrogen. One good option, Leppert says, is birth control pills with only the hormone progestin.
Women of all ages should also cover the well-known lifestyle habits that lower risk. The American Heart Association calls them Life's Essential 8: prioritize exercise and sleep, eat healthy, don't use tobacco, and manage your weight, blood sugar, blood pressure, and cholesterol.
Women should also tell their doctor about any health problems they had when they were pregnant, Bushnell says. Preeclampsia is not the only one. Developing gestational diabetes or high blood pressure during pregnancy can mean a stroke is more likely later.
Take Action Right Away
When Cansler's left side went numb, her family moved quickly, calling 911. An ambulance took the mother of nine from her home in North Port, Florida, to HCA Florida Englewood Hospital.
Imaging showed where the clot had damaged her brain. But the doctors don't know exactly what caused the stroke.
Cansler has a few theories, including preeclampsia. She gave birth to three of her children. And she was diagnosed with preeclampsia during each of those pregnancies, she says.
If, like Cansler, you do find yourself in an emergency room, speak up if you're concerned that your symptoms aren't being heard.
"We are worse at diagnosing strokes in women overall, not just in young women," Leppert says. She points to a study showing that strokes in women are more likely to be missed in the emergency department. One challenge is that women are more likely to describe a headache or dizziness that can have many other causes, according to the researchers.
Leppert suggests saying something like, "I have migraines, but I have never had this symptom before. Hey, do you think this could be a stroke?'"
Listen to your body, Fracica stresses. Don't ignore any new or severe symptoms that pop up; for instance, if you become so dizzy that you can't walk.
Or you may have had migraines before, but this time is worse. "You're fine, and all of a sudden you have the worst headache of your life," Fracica says.
Time Is Brain
Cansler counts her blessing that she didn't second-guess her symptoms. She got to the hospital in plenty of time to qualify for a type of drug that can break up clots in the brain. Doctors must give those drugs within four and a half hours after the start of symptoms, Bushnell says.
Cansler's symptoms weren't severe enough for her to need that medication, she says. But they were very scary. Imagine, she says, "not being able to put your sock on your left foot."
After her stroke, Cansler started taking baby aspirin and cholesterol medication. She shed 70 pounds, with smaller meals and more fruits, vegetables, and protein.
And thanks to physical and occupational therapy, she shows almost no ill effects more than two years later. She only has trouble with her left foot, she says, when she's very tired.
Don't delay heading to the hospital, she urges others.
"If you don't go and it is something, then your condition could worsen," she says. "You could have another stroke right behind it. Or you could have worse symptoms, right?"
"If it turns out to be nothing, great."
