WOMEN smokers are at greater risk of suffering a potentially fatal stroke often triggered by physical exertion including sex, new research suggests.
The more a woman smokes the greater their risk of a subarachnoid haemorrhage a form of bleeding on the brain which accounts for one in every 20 strokes in the UK.
There are usually no warning signs but the stroke sometimes happens during physical effort or straining — such as coughing, going to the lavatory, lifting something heavy or having sex.
They are caused by a brain aneurysm bursting — a bulge caused by a weakness in the wall of a blood vessel.
Every year around 6,000 people are admitted to hospitals in England and are more common in women than men.
Smoking generally has been linked to increased risk but the new study by University of Helsinki found women smokers had an even higher risk than women who do not smoke.
And even light smokers have an elevated risk.
It found light smokers who smoked up to 10 a day were 2.95 times more likely to have subarachnoid haemorrhage compared to women non-smokers.
By contrast men who smoked a similar amount were 1.93 times more likely.
Women who smoked up to a pack a day were 3.89 times more likely to have bleeding while men were 2.13 times more likely.
Those women who smoked up to a pack and a half were more than 8.35 times likely while men were 2.76 times more likely to have one.
However scientists said there was good news in that subarachnoid haemorrhage risk significantly decreased among former smokers.
Women and men that quit smoking more than six months earlier had comparable risk to non-smokers.
Dr Joni Valdemar Lindbohm said: "Female sex has been described as an independent risk factor for subarachnoid haemorrhage, but we found strong evidence that the elevated risk in women is explained by vulnerability to smoking,.
"Our results suggest that age, sex and lifestyle risk factors play a critical role in predicting which patients are at risk for subarachnoid haemorrhage and emphasise the importance of effective smoking cessation strategies.
"There is no safe level of smoking. Naturally the best option is never to start.
"Quitting smoking, however, can reduce the risk for subarachnoid haemorrhage in both sexes."
The study published in the journal Stroke involved 65,521 Finnish adults in national surveys.
Since 1972, this study has obtained health information from randomly selected participants through questionnaires and physical examinations.
Slightly more than half of participants were women, and their average age was 45 years.
Average follow-up was 21 years from study enrolment until first stroke, death or study completion at the end of December 2011.
Researchers noted the participants' smoking behaviour could have changed after study enrolment and that alcohol consumption, medication for high blood pressure, or high cholesterol are factors that could have affected results.