What are the early warning signs of stroke I should know about?

The fastest way to recognise a stroke is FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000. But stroke presentations in women can be atypical — sudden severe headache unlike any before, sudden vision loss in one or both eyes, sudden confusion, dizziness, or loss of balance can all be stroke symptoms. Calling 000 immediately is critical; time to treatment determines outcome. Never wait to see if symptoms resolve — if they disappear within 24 hours, that is called a transient ischaemic attack (TIA) and requires urgent same-day medical review, as it is a strong predictor of stroke.

Does being a woman in my 40s put me at stroke risk?

Stroke risk in women under 55 is lower than in older age groups, but it is not negligible — and some factors common in midlife do increase risk. These include uncontrolled high blood pressure, smoking, migraine with aura (which roughly doubles ischaemic stroke risk in young women), and combined oral contraceptive use in women who also smoke or have migraines. Perimenopause itself is associated with blood pressure changes. Having these factors reviewed by your GP is sensible, particularly if you have a family history of stroke or heart disease.

Stroke is the third biggest killer of women — and now striking younger

What just happened

An AusDoc therapy update published on 20 June 2026 — authored by Professor Richard Lindley and Dr Anna Holwell, accredited for CPD with both the RACGP and ACRRM — lays out what has changed in stroke care for Australian GPs.

The article’s introductory paragraph anchors the clinical context immediately: 40,000 Australians have a stroke every year. There are currently 500,000 stroke survivors living in Australia. Stroke is the third leading cause of death for women and the fourth for men.

These are not new statistics. What is new is why stroke now deserves fresh clinical attention — evolving definitions, a documented rise in incidence among younger adults, expanded treatment options, and an emerging body of evidence that women, in particular, are being underserved by a diagnostic framework still calibrated to the older male patient.

The both-and

What has changed in stroke understanding

The update covers four key areas of evolution in stroke care. From the accessible summary:

Evolving definitions. The clinical definition of stroke has shifted as imaging has improved. What was once called a “silent stroke” or a TIA is now better understood on a continuum with acute ischaemic stroke — and modern MRI can reveal infarction where clinical history alone would have dismissed it.

Younger Australians are having more strokes. The AIHW’s Stroke in Australia report documents a rising burden in people under 55, a trend that sits against the backdrop of increased metabolic risk factors — obesity, hypertension, and type 2 diabetes — appearing earlier in life. For women, specific risk factors unique to female physiology add to the picture.

Endovascular thrombectomy has extended the treatment window. For suitable ischaemic strokes caused by large vessel occlusion, endovascular thrombectomy — mechanical clot removal via catheter — has expanded the treatment window significantly beyond the original tPA thrombolysis window. Selected patients can now be treated up to 24 hours after onset with good evidence of benefit. This matters enormously for GP referral decisions: calling the hospital early and explicitly activating the stroke team is still the right action even if the patient is “too far out” for old thrombolysis criteria.

The GP’s role in stroke care. Post-acute stroke management — blood pressure control, anticoagulation for atrial fibrillation, secondary prevention — sits substantially in general practice. The update reinforces that GPs are the front line for both recognition and the long game.

The uncomfortable gap: atypical presentations in women

The mental model many clinicians carry for stroke is an older man with sudden right-sided weakness and slurred speech. That picture is real — but incomplete.

Women present with atypical stroke symptoms more often than men. These can include sudden headache, confusion, behavioural change, nausea, and loss of consciousness — symptoms that are also common in other presentations and that, without a high index of suspicion, can lead to delayed diagnosis.

Stroke is the third leading cause of death for women. It is also a leading cause of disability. A woman in her late 40s who has migraine with aura, is taking the combined oral contraceptive pill, and smokes carries a genuinely elevated ischaemic stroke risk compared to population baseline — and that combination should be reviewed by her GP, not because the risk is catastrophic, but because it is modifiable.

Migraine with aura roughly doubles the relative risk of ischaemic stroke in women. Add smoking to migraine with aura, and that risk increases substantially further. This is exactly the kind of compound, modifiable risk that routine general practice is positioned to catch and act on.

My 2 cents

If you are a woman in your 40s reading this, the stroke statistics probably feel like they belong to someone else — someone older, someone less well.

That’s understandable. Absolute stroke risk at 45 is still low. But the relevant question is whether you are accumulating the modifiable risk factors that will shape your risk in the next decade.

Three things worth reflecting on this week:

Do you know your blood pressure? It is the single most important modifiable stroke risk factor. You do not need symptoms to have high blood pressure, and you cannot feel it rising.
If you have migraine with aura and take the combined pill, that combination warrants a conversation with your GP. There are effective alternatives for contraception, and for some women the risk calculus changes when aura is in the picture.
Know FAST. Face drooping, Arm weakness, Speech difficulty, Time to call 000. The Stroke Foundation’s resources are clear and freely available. The single most impactful thing for stroke outcomes is time to treatment — and that clock starts with recognition.

Verdict

Verdict: yes — worth knowing about.

The AusDoc therapy update is a useful clinical frame for GPs, and the reminder that stroke is the third leading cause of death for Australian women — with a rising burden in younger age groups and atypical presentations that can be missed — is one worth sitting with. Prevention belongs in the current decade, not the next one.

Sources cited

Lindley R, Holwell A. Evolutions in stroke care. AusDoc Therapy Update, 20 June 2026. https://www.ausdoc.com.au/therapy-update/evolutions-in-stroke-care/
Stroke Foundation Australia. Stroke statistics — Australia. https://strokefoundation.org.au/about-stroke/stroke-statistics-australia
RACGP. Stroke and TIA clinical resources. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/stroke
Australian Institute of Health and Welfare. Stroke in Australia 2023. https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/stroke-in-australia