Menopause and Paralysis

Posted by Nurse Linda in Life After Paralysis on June 27, 2022 # Health

menopauseMenopause occurs when menstruation has ceased for twelve months. Your body has been transitioning to menopause for years prior to it happening during the perimenopause phase. You may have had signs of approaching menopause during perimenopause or may not until menopause occurs.

Menopause occurs in women in their early 50s. Some have natural menopause when estrogen and progesterone are extremely low or no longer being produced by the ovaries. Some women have artificial menopause at an earlier age due to hysterectomy, chemotherapy, or radiation where their ovaries and/or uterus are removed. Other healthcare issues that can affect menopause onset are autoimmune disease, smoking, being underweight or overweight and having multiple babies. Autoimmune neurological diseases include multiple sclerosis, autoimmune encephalitis, autoimmune epilepsy, and central nervous system vasculitis.

After extreme trauma or with a disease, especially spinal cord injury or brain injury, menstruation can stop at any age, sometimes for months. This can make the individual think they have reached menopause, but this is not true. This is a reaction to trauma or illness. Ovulation or egg production can still be occurring, so birth control prevention should be used if pregnancy is not desired. Menstruation will return within weeks to months.

The exact time menopause occurs usually discovered by looking back over time. The cycle of menstruation may have started and stopped or not follow your natural pattern during perimenopause. Because of this, menopause is not cited until menstruation has ceased for one year. Female family members follow the same age pattern for menopause, so when your mother reaches menopause is about the same as you will, as your daughter and so on.

There are some signs of menopause that are caused by hormonal changes. Not every woman will have all the signs, and they can be at different intensities. The most common sign of menopause is intense internal body heat or hot flash that is accompanied by sweating. If you have a brain injury, stroke, or spinal cord injury from trauma or disease, you may have issues with body temperature control. Making sure you keep your body temperature regulated is important to help distinguish between autonomic dysfunction and a menopause sign because treatments are different. Keeping your body at a regular temperature by avoiding too hot or too cold environments is important for your comfort. Hot flashes can be controlled by medication or by use of cooling means, but if you struggle to keep your body at a regular temperature, adding too much cooling can send you into a chill.

Sweating is not a response that some individuals have after a neurological injury. The body may send a signal for sweat to be released, but this signal is not received by the brain. A vasomotor issue then occurs where the vascular system cannot respond to sweat. This can send additional blood flow where the body can respond as in the head, face, neck, and chest.

Hot flashes and sweating can occur together or separately. Some women have hot flashes without sweating; others may have sweating without hot flashes. There are other issues that can occur with hot flashes and sweating, either separately or together. These are flushing, chills, anxiety, and heart palpitations.

Hot flashes and sweating can lead to headaches and blood pressure elevation, which are symptoms of autonomic dysreflexia. Monitoring blood pressure is critical to ensure an autonomic dysreflexia event is not occurring. If an AD episode is triggered, quick action must be taken to ensure the safety of the individual. Treatment for hot flashes and sweating can be supplied which will reduce the incidence of AD episodes. More information about signs and treatments for AD, which is a medical emergency, can be found here.

Vaginal dryness from decreased estrogen production is another common symptom of menopause. This can create dryness, itching and irritation. If you have a neurological disease, you may already be experiencing vaginal dryness from a disruption in the autonomic nervous system (ANS). Menopause can further compound this. The dryness can extend through the vulva, which is the internal labia that includes the clitoris and urethra, and vagina. This is a naturally moist area of the body. The dryness can interrupt the sexual response of lubrication and increase urinary tract infections (UTIs) due to dryness around and in the urethra. Moisturizing products such as Astro glide and vaginal moisturizers can assist with keeping the area moist. Vaginal lubricants can be used to enhance sexual function. Keeping the urethra clean and moist is important in reducing UTIs. Clean the urethral area with mild soap and water, and be extra careful in completely rinsing the area as soap residue or urethral cleansers for catheter insertion are extremely drying.

Dryness can extend internally to the bowel, which is a mucous membrane as well. Adding fiber and movement to your lower body may assist with bowel function. A bladder management program may restrict adding fluid, but if you can add water to your diet, do so slowly.

Actions can be taken to reduce signs of menopause. You can choose to take the actions based on your signs of menopause or not. Be sure to consult with your healthcare provider, as you will have unique differences based on your own health status. Actions include:

Hormone Replacement Therapy (HRT) is the replacement of estrogen or estrogen and progesterone through medication. It is effective for hot flashes and sweating as well as some of the other signs of menopause. It should be noted that this is not a treatment that is without side effects. HRT can be accomplished via pills, patches, gels, sprays, intranasal sprays, and vaginal inserts.

HRT can relieve or reduce hot flashes and sweating and vaginal dryness, protect from bone loss, help with sleeping, reduce irritability, and decrease the risk of diabetes, colon cancer and tooth loss. There are risks with HRT that include an increased risk of blood clots and strokes, which are concerns if you have a neurological disease, an increased risk of endometrial cancer if the uterus is still in your body, and an increased risk of gallbladder disease and gallstones, and increased risk of breast cancer with long-term use. Interestingly, there is an increased risk of developing dementia if HRT is started after midlife, an issue that can be complicated with brain injury or stroke, but a decreased risk of dementia if HRT is started in midlife. This would be a topic to discuss with your healthcare professional for your individual risk vs. benefit. The American Heart Association does not recommend HRT to prevent heart attack or stroke based on current research. There are side effects of HRT, including bleeding or spotting if the uterus is present, breast tenderness, mood swings, fluid retention, and headaches.

If HRT is not your desired option, there are other medications that can help with signs of menopause. These include antidepressants, antiseizure medication, nerve pain medication such as Neurontin and Lyrica, overactive bladder medication Oxybutynin, and some hypertension medication such as clonidine. These medications also have side effects but may be less risky for you than HRT. Some women are already taking these medications for their intended use. Some will find less signs of menopause because they are already taking them. However, you may not realize these medications are working to reduce menopause signs because you would be already taking them.

Not all actions need to include medications. There are some activities you can do to help yourself.

Manage your environment, especially if you cannot sense temperature. Dress in layers and for the temperature. Remove a layer as the temperature increases. Use a fan. Drink cool fluids.

Be mindful of humidity which requires air conditioning as humidity builds in your body.

Some foods and fluids can trigger a hot flash. Avoid spicy foods, caffeine (drinks and chocolate), and alcohol.

Bowel function can become slower due to the dryness of mucous membranes. Adding fiber may assist in bowel processing.

Smoking can trigger hot flashes as the nicotine binds to your blood cells, depriving them of oxygen.

Increased weight holds heat in your body. It is also more difficult to move if you have mobility issues. Talk with your healthcare provider about a healthy diet for you.

Some women find some over the counter products to help their symptoms. There are many and these are generally unregulated. Before adding any product, check with your healthcare professional for safety and if there is any interaction with your current medications.

Having a good relationship with your healthcare professional that is experienced in neurological conditions and menopause is a great start. This may not be a combination of specialties that one healthcare provider has. Be sure your healthcare provider and gynecologist are working together for your best interests.

Check out the chart containing concerns, neurological and hormonal issues and possible treatments in both perimenopause and menopause. Nurse Linda

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

In our community, Nurse Linda is a blogger where she focuses on contributing functional advice, providing the "how-to" on integrating various healthcare improvements into daily life, and answering your specific questions. Read her blogs here.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.