Stroke recovery isn’t equal: Why women are missing out on lifesaving medications

After a stroke, when it comes to recovery, women are falling through the cracks, especially the youngest and the oldest among them.

This is because, as new research from Monash University can reveal, women are significantly less likely than men to be prescribed, initiate or continue taking key stroke prevention medications.

In the largest Australian study of its kind, published in the journal Stroke, the researchers essentially show that not everyone is getting the same chance at recovery.

Their study followed more than 18,000 patients who survived their first stroke or transient ischemic attack (TIA). They found that women across all age groups were less likely to start or stay on medication. But the effect was particularly pronounced in the youngest and oldest women.

Thousands of Australians experience a stroke or TIA every year, and for many, surviving the event is just the beginning. The real challenge lies in preventing a second, potentially fatal stroke, and that often means staying for years on medications such as blood thinners, cholesterol-lowering drugs or antihypertensives.

Real-world behaviour

What made this study different was its ability to track medication use after hospital discharge, offering a rare glimpse into real-world behaviour rather than just hospital records.

The team used linked data from the Australian Stroke Clinical Registry and prescription databases.

“Particularly concerning are the sex differences seen in younger and older women,” says lead author Dr Lachlan Dalli – those under 45 and those over 90. “These groups are at real risk of missing out on medications that are proven to save lives.”

The data shows women under 45 are less likely to initiate the medications and more likely to stop taking them. In some cases, this could be due to concerns about pregnancy or interactions with other medications such as antidepressants.

But even after adjusting for these factors, the disparity persisted.

At the other end of the age spectrum, women over 90 were also more likely to discontinue their medications. Many in this group live alone, are frail, and have limited social support, all of which can make managing a complex medication routine more difficult.

Stroke doesn’t discriminate – our systems still do

Despite decades of progress in stroke care, gender-based disparities remain deeply embedded in the health system. Past research has shown women are less likely to receive emergency treatments such as clot-busting drugs or be admitted to stroke units.

This new study shows the gap extends far beyond the hospital walls, into pharmacies, households and daily life.

“These medications are critical for preventing another stroke,” Dr Dalli says. “They’re not optional. So when we see differences this large, it’s not just a clinical issue, it’s a health equity issue.”

The reasons are complex. Social factors, medical caution during pregnancy, lack of advocacy, mental health, affordability and even unconscious bias may all play a role.

For older women, the absence of a partner or support network can make managing prescriptions overwhelming. For younger women, competing priorities such as caregiving, employment or planning a family can complicate follow-through.

What needs to change

“Our research sends a strong signal to clinicians, health planners and policymakers: We must do better,” says Dr Dalli, who adds that the findings suggest that strategies such as community education, digital health tools or decision-support systems could help identify patients at risk of discontinuing treatment.

They also underscore the importance of understanding women’s experiences to address the underlying reasons for these disparities.

Approaches such as community education, digital health tools and clinical decision-support systems may help improve continuity of care and identify those at higher risk of discontinuing treatment.

“With stroke, every missed opportunity matters,” says senior author, Professor Monique Kilkenny. “We need to design care that truly supports all patients, not just the average one.”

With growing national focus on women’s health and equity in healthcare delivery, this research provides a timely and evidence-based opportunity to address gaps in stroke prevention, she says.

Ensuring that women of all ages have equitable access to guideline-recommended medications has the potential to prevent thousands of strokes, reduce long-term disability, and save lives.

“As Australia continues to invest in women’s health and equity-focused reforms, this research offers a starting point for more inclusive post-stroke care,” says Professor Kilkenny. “Stroke doesn’t discriminate, and our systems need to be designed to reduce systematic bias and inequities in care.”