It’s one of the biggest killers in Australia, but many women don’t know the risk

Olivia Spalding was washing the dishes when a dull headache set in.

It was a hot New Year’s Day, and the 54-year-old, who was helping her family prepare for an event to remember her late father-in-law, assumed it was due to dehydration or stress.

But then an overwhelming sensation of pins and needles spread through her body.

“It was out of nowhere,” she recalled.

Though she didn’t know it at the time, the mother of three was having a stroke.

Despite stroke being one of the leading causes of deaths in Australia and killing more people than breast cancer, women are often diagnosed later than men and have worse outcomes.

Now, an Australian-first clinic at Monash Medical Centre is trying to reduce this gender disparity by providing tailored care to the one in five women who will have a stroke during their lifetime, as well as those at risk.

Since opening its doors 12 months ago, the Stroke in Women Clinic in Clayton has cared for 200 women, including Spalding. About 30 per cent of this cohort is aged under 44.

Associate Professor Shaloo Singhal decided to set up the clinic after observing an increasing number of women landing in Monash Medical Centre’s emergency department after having a stroke during pregnancy and postpartum.

“I realised that it’s not because of bad luck,” said Singhal, who is Monash Health’s deputy head of stroke. “There was a gap in the system that didn’t address certain stroke risk factors that are specific to women.”

These risk factors include endometriosis, early menopause, polycystic ovarian syndrome, as well as pregnancy complications such as pre-eclampsia, which comes on suddenly and is characterised by high blood pressure and protein in the urine.

Hormone replacement therapy (HRT), and the combined oral contraceptive pill are also linked to a small increase in the risk of stroke, according to Singhal, but the single biggest risk factor for men and women is high blood pressure.

The clinic acts as a bridge between different hospital departments, connecting women with rapid access to rehabilitation, psychiatry and obstetrics.

It also provides support to women who have experienced pre-eclampsia during pregnancy, monitoring their risk factors for up to two years after birth to reduce their lifelong risk of stroke.

Singhal said that while traditional stroke care was excellent, it was often modelled on male biology.

A stroke occurs when the blood supply to the brain is interrupted, often caused by a blood clot or fatty deposit blocking the artery leading to the brain.

While both men and women often experience the same symptoms – a drooping face on one side, slurred speech and difficulties lifting both arms – women are more likely to report other symptoms such as generalised weakness in their bodies, confusion or disorientation, nausea or vomiting, and severe headache.

Due to the vagueness of these symptoms, women are often diagnosed later than men, which can lead to poorer long-term outcomes.

Fortunately, Spalding was rushed to hospital by ambulance shortly after her stroke. She spent three weeks at the Victorian Heart Hospital and Monash Medical Centre before a month-long stint at a rehabilitation centre.

In the immediate aftermath, it was impossible for Spalding to read, and she couldn’t walk in a straight line. Sounds and lights were also overwhelming.

But daily physiotherapy sessions at the Epworth, and neurological monitoring at the Stroke in Women clinic have helped restore her strength and co-ordination. She will also be on medication for the rest of her life to prevent another stroke.

Though she still experiences rushes of hot and cold on her right side, and numbness, she is hopeful these symptoms will fade over time.

“I have full-strength and full function of my limbs, which is extraordinary.”

Spalding returned to her job as a manager in April.

The cause of her stroke remains a mystery. Just before, the fit and active woman from Melbourne’s eastern suburbs, received a glowing bill of health from her GP ahead of starting HRT.

Spalding stresses this treatment, which is used to ease the symptoms of menopause, only marginally increases a person’s risk of stroke.

“We may never know,” she said. “This could happen to anyone.”

Stroke Foundation Australia chief executive Lisa Murphy said that while men’s risk of stroke increased as they aged, women experienced two distinct periods of high risk.

An early peak is associated with hormonal changes, pregnancy, postpartum and using the oral contraceptive pill (especially when combined with smoking). Women under 35 are 44 per cent more likely to have an ischemic stroke (one caused by a blood clot) than men.

Then there’s a later peak, linked to women living longer than men.

“We need gender-responsive prevention messages and education care pathways which account for this life course risk,” Murphy said.

Research has found women often face poorer stroke outcomes because they are less likely to be prescribed prevention medications such as statins and blood pressure medication.

Studies have also found that women are less likely to remain on this medication long-term, although it is not known why this is the case.

Murphy welcomed the Stroke in Women Clinic and called for similar models to be rolled out across the country.

“At the moment … there is this gender bias where the whole health system, including right from research through to treatment, is very focused in on the man.”

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