A Stroke at 30

At age 30, Monifa Thomas was a health and medicine reporter for the Chicago Sun-Times. Not long after she sailed through a complete physical, Monifa had a stroke. She was paralyzed on her right side and had great difficulty speaking.  Jay Shefsky has the story of her recovery and return to the health and medicine beat.  

Read an interview with Dr. Shyam Prabhakaran, associate professor for neurology at Northwestern University’s Feinberg School of Medicine and local American Stroke Association volunteer.

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Dr. Shyam PrabhakaranQ: Why are women more at risk for stroke-related deaths than men?

Statistically, men actually have higher risk than women in first decades of their lives. The risk is increased in women during the last decades. Women on average live longer than men so there are more women dying from it than men. Middle-aged women have more increase risks while middle-aged men tend to have reduced chances for stroke later in life.

Q: There have been reports that hormonal contraceptives double the risk for stroke in women. Is this accurate?

It’s not quite doubled but we think of it in relative risks and absolutes. There is some evidence that it increases your risks if you’re on it but if we look at absolute numbers, the number of relevant cases is quite small. The excess risk is about going from estimated 20 in 100,000 people to about 40. So it is in fact doubled but it’s not a huge risk. I want to press that you are not a ticking time bomb if you’re on contraception.

Q: What is the cause for the increase?

The estrogen levels in birth control contribute to the increased risks. Luckily, newer medicine has much lowered estrogen in formulas because it’s been clear that the estrogen increases risks. There are even some with no estrogen and include progesterone and those have very low-increase risk and some have no-increased risks.

Q: Are there other hidden stroke risk factors for women?

Maybe, but that’s part of the puzzle. While we want to identify risk factors, we obviously don’t know that there’s just a clear relation with hormonal contraceptive. Other factors could be if you smoke or have migraines in addition to birth control. Another important factor in rather contraceptive pills may lead increased risks is people with a history of genetic clotting disorders. They might not show signs of stroke until they start taking birth control pills, so it’s adding onto the risks they’ve already had.

Q: Should users rule out the increased risks of birth control seeing as the risk is small?

I think it’s very important not to cast a broad criticism of contraceptive pills that could lead to the thought that people should avoid it. It’s a really important message to learn about the risks in contraception but for most people it is very helpful and not just in preventative care. Careful planning and researching information is always recommended for people considering it.

Interview has been edited and condensed.

--Interview by Taurean Small

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