Abstract
Although women have a lower risk of stroke during middle age than men, the menopausal transition is a time when many women develop cardiovascular risk factors. Additionally, during the 10 years after menopause, the risk of stroke roughly doubles in women. Endogenous oestrogen concentrations decline by 60% during the menopausal transition, leading to a relative androgen excess, which could contribute to the increased cardiovascular risk factors in women. Earlier onset of menopause might affect the risk of stroke, but the data are not clear. Because of the stroke risk associated with it, hormone therapy is recommended only for treatment of vasomotor symptoms, and some formulations might be safer than others. More research is needed to understand which women are at greatest stroke risk during midlife and to identify the safest formulation, dose, and duration of hormone therapy that can be used to treat vasomotor symptoms without increasing the risk of stroke.