Although women have a lower risk of stroke during middle age, the menopausal transition is a
time when many women develop cardiovascular risk factors. In addition, during the 10 years after
menopause, the risk of stroke roughly doubles in women. Endogenous estrogen levels 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 may
influence the risk of stroke, but the data are not clear. Because of the stroke risk associated with
hormone therapy, this is only indicated for treatment of vasomotor symptoms, but some
formulations may be safe than others. More research is needed to understand which women are at
greatest stroke risk during midlife and to determine the safest formulation, dose, and duration of
hormone therapy that will treat vasomotor symptoms without increasing the risk for stroke.