Serum Estrogen Level in Postmenopausal Women with Ischemic Stroke: An Analytic Cross-Sectional Study

Document Type : Original Article


1 Neurologist, Neurology ward, Department of Internal Medicine, Kowsar Hospital, Medical school, Semnan University of Medical Sciences, Semnan, Iran

2 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran

3 Endocrinologist, Department of Internal Medicine, Kowsar Hospital, Medical school, Semnan University of Medical Sciences, Semnan, Iran

4 Kowsar Hospital, Medical school, Semnan University of Medical Sciences, Semnan, Iran

5 Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

6 Department of pediatrics, Semnan University of Medical Sciences, Semnan, Iran


Stroke is the third cause of death worldwide. The present study aimed at determining serum estrogen levels in postmenopausal women with ischemic stroke and compare with a control group admitted to Department of Neurology in Kowsar Hospital of Semnan, Iran in 2017.In this analytic cross-sectional study, serum estrogen levels in 33 women with ischemic stroke (who were eligible to be included in the study) were compared with a control group through the convenience sampling method. The demographic data were collected, and serum estrogen levels were measured through the quantitative luminescence Immunoassay technique in both groups and, the degree of disability was determined using the Modified Rankin Scale (MRS) in case group. In case and control group, the age of patients was 74.48±13.44 (mean ± SD) and 73.35±12.89 years respectively, and estrogen levels were 16.65±2.83 and 22.94±3.11 pg/dl respectively, with a significant difference (p=0.03). Hypertension was the most common risk factor in case and control group (84.8% and 78.7%). In case group there was a significant relationship between the degree of disability at discharge from the neurology ward and the degree of disability before undergoing stroke treatment (p < 0.001) and, there was no statistically significant relationship between serum estrogen levels and age, number of risk factors, and disability at admission and at discharge. The results showed that serum estrogen levels in postmenopausal women with ischemic stroke were significantly lower than control group and normal estrogen range in healthy postmenopausal women.


1. Brown M.M., 1992. Balloon angioplasty for cerebrovascular disease. Neurological Research. 14(2), 159-162.
2. Robinson R.G., Jorge R.E., 2016. Post-stroke depression: A review. Am J Psychiatry. 173(3);221-231
3. Black J., Hawks J., 2009. Medical Surgical Nursing: Clinical Management for Positive Outcomes, 8e (2 Vol Set) without CD, 1st Edition. 15th September. 1-2368.
4. Lin L.Y., Lee C.H., Yu C.C., Tsai C.T., Lai L.P., Hwang J.J., Chen P.C., Lin J.L., 2011. Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation—a nation wide database analysis. Atherosclerosis. 217(1), 292-295.
5. Outpatient ST. Therapy-based rehabilitation services for stroke patients at home. 2003.
6. Hawkey B., Williams J., 2009. Role of rehabilitation Nurse. Royal College Nurs. 3(178), 4-28.
7. Menken M., Munsat T.L., Toole J.F., 2000. The global burden of disease study: implications for neurology. Archives of Neurology. 57(3), 418-420.
8. Azarpazhooh M.R., Etemadi M.M., Donnan G.A., Mokhber N., Majdi M.R., Ghayour-Mobarhan M., Ghandehary K., Farzadfard M.T., Kiani R., Panahandeh M., 2010. Excessive incidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke. 41(1), e3-e10.
9. Hosseini A.A., Sobhani-Rad D., Ghandehari K., Benamer H.T., 2010. Frequency and clinical patterns of stroke in Iran-Systematic and critical review. BMC Neurology. 10(72), 1-10.
10. Roger V., Go A., Lloyd-Jones D., Benjamin E., Berry J., 2012. Borden W., Heart disease and stroke statistics-2012 update: a report from the American Heart Association. 125(1), e2-20.
11. Dirnagl U., Iadecola C., Moskowitz M.A., 1999. Pathobiology of ischaemic stroke: an integrated view. Trends in Neurosciences. 22(9), 391-397.
12. Kolominsky-Rabas P.L., Wiedmann S., Weingärtner M., Liman T.G., Endres M., Schwab S., Buchfelder M., Heuschmann P. U., 2015. Time trends in incidence of pathological and etiological stroke subtypes during 16 years: the Erlangen Stroke Project. Neuroepidemiology. 44(1), 24-29.
13. Wenger N.K., Speroff L., Packard B., 1993. Cardiovascular health and disease in women. New England Journal of Medicine, 329(4), 247-256.
14. Gibson C.L., Gray L.J., Murphy S.P., Bath P.M., 2006. Estrogens and experimental ischemic stroke: a systematic review. Journal of Cerebral Blood Flow & Metabolism. 26(9), 1103-1113.
15. Hendrix S.L., Wassertheil-Smoller S., Johnson K.C., Howard B.V., Kooperberg C., Rossouw J.E., Trevisan M., Aragaki A., Baird A.E., Bray P.F., 2006. Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation. 113(20), 2425-2434.
16. Wassertheil-Smoller S., Hendrix S., Limacher M., Heiss G., Kooperberg C., Baird A., Kotchen T., Curb J.D., Black H., Rossouw J.E., 2003. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women's Health Initiative: a randomized trial. Jama. 289(20), 2673-2684.
17. Grodstein F., Manson J.E., Stampfer M.J., Rexrode K., 2008. Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy. Archives of internal medicine. 168(8), 861-866.
18. Jayedi A., Soltani S., Abdolshahi A., Shab-Bidar S., 2020. Healthy and unhealthy dietary patterns and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies. British Journal of Nutrition. 124(11), 1133-1144.
19. Brann D.W., Dhandapani K., Wakade C., Mahesh V.B., Khan M.M., 2007. Neurotrophic and neuroprotective actions of estrogen: basic mechanisms and clinical implications. Steroids. 72(5), 381-405.
20. medscape, Reference range of estradiol. URL: available
21. Simpkins J.W., Singh M., Brock C., Etgen A.M., 2012. Neuroprotection and estrogen receptors. Neuroendocrinology. 96(2), 119-130.
22. Yao J., Brinton R.D. 2012. Estrogen regulation of mitochondrial bioenergetics: implications for prevention of Alzheimer’s disease Advances in pharmacology. pp. 327-371: Elsevier.
23. de Leciñana M.A., Egido J.A., 2006. Estrogens as neuroprotectants against ischemic stroke. Cerebrovascular Diseases, 21 (Suppl. 2), 48-53.
24. Lobo R., 2009. The risk of stroke in postmenopausal women receiving hormonal therapy. Climacteric, 12 (sup1), 81-85.
25. Simpkins J., Yang S., Wen Y., Singh M., 2005. Estrogens, progestins, menopause and neurodegeneration: basic and clinical studies. Cellular and molecular life sciences: CMLS. 62(3), 271-280.
26. Hasanzadeh H., Rezaie-Tavirani M., Seyyedi S., Emadi A., 2015. Proteomics Study of extremely low frequency electromagnetic field (50 Hz) on human neuroblastoma cells. Koomesh. 17(1), 233-238.
27. Nasr R., Hasanzadeh H., Khaleghian A., Moshtaghian A., Emadi A., Moshfegh S., 2018. Induction of apoptosis and inhibition of invasion in gastric cancer cells by titanium dioxide nanoparticles. Oman Medical Journal. 33(2), 111-117.
28. Van Swieten J., Koudstaal P., Visser M., Schouten H., Van Gijn J., 1988. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 19(5), 604-607.
29. Daroff R.B., Jankovic J., Mazziotta J.C., Pomeroy S.L., 2015. Bradley's neurology in clinical practice e-book. Elsevier Health Sciences; Oct 25.
30. Saberi A., javadpoor M., farahmand N., kazemnezhad E., 2015. The serum level of estrogen and progesterone and their ratio in patients with ischemic stroke: a comparative study. Caspian Journal of Neurological Sciences. 10,1(1), 35-42.
31. Scarabin‐Carré V., Canonico M., Brailly‐Tabard S., Trabado S., Ducimetière P., Giroud M., Ryan J., Helmer C., Plu‐Bureau G., Guiochon‐Mantel A., 2012. High level of plasma estradiol as a new predictor of ischemic arterial disease in older postmenopausal women: The three‐city cohort study. Journal of the American Heart Association. 1(3), e001388.
32. Raz L., 2014. Estrogen and cerebrovascular regulation in menopause. Molecular and Cellular Endocrinology. 389 (1-2), 22-30.
33. Sheikh N., Tavilani H., Rezaie A., 2010. Decreased endogenous progesterone and ratio of progesterone to estrogen in stroke ischemia. African Journal of Biotechnology. 9(5), 732-734.
34. Alkayed N.J., Harukuni I., Kimes A.S., London E.D., Traystman R.J., Hurn P.D., 1998. Gender-linked brain injury in experimental stroke. Stroke. 29(1), 159-166.
35. Krause D.N., Duckles S.P., Pelligrino D.A., 2006. Influence of sex steroid hormones on cerebrovascular function. Journal of Applied Physiology. 101(4), 1252-1261.
36. Viscoli C.M., Brass L.M., Kernan W.N., Sarrel P.M., Suissa S., Horwitz R.I., 2001. A clinical trial of estrogen-replacement therapy after ischemic stroke. New England Journal of Medicine.345(17), 1243-1249.
37. Dubal D.B, Kashon M.L., Pettigrew L.C., Ren J.M., Finklestein S.P., Rau S.W., Wise P.M., 1998. Estradiol protects against ischemic injury. J Cereb Blood Flow Metab. 18(11), 1253-1258.
38. Lee J.S., Yaffe K., Lui L.Y., Cauley J., Taylor B., Browner W., Cummings S., 2010. Prospective study of endogenous circulating estradiol and risk of stroke in older women. Archives of Neurology. 67(2), 195-201.
39. Farajzadeh M., Darand M., 2009. Analyzing the influence of air temperature on the cardiovascular, respiratory and stroke mortality in Tehran. Iranian Journal of Environmental Health, Science and Engineering. 6(4), 261-270.
40. Plesnila N., Zhu C., Culmsee C., Gröger M., Moskowitz M.A., Blomgren K., 2004. Nuclear translocation of apoptosis-inducing factor after focal cerebral ischemia. Journal of Cerebral Blood Flow & Metabolism. 24(4), 458-466.
41. Yu S.W., Wang H., Dawson T.M., Dawson V.L., 2003. Poly (ADP-ribose) polymerase-1 and apoptosis inducing factor in neurotoxicity. Neurobiology of Disease. 14(3), 303-317.
Volume 11, Issue 1
March 2021
Pages 91-98
  • Receive Date: 07 January 2020
  • Revise Date: 22 January 2020
  • Accept Date: 03 January 2021
  • First Publish Date: 04 January 2021