Perimenopause and Menopause Chart

Posted by Nurse Linda in Life After Paralysis on January 01, 2022 # Health


Neurologic and Hormonal Issues

Treatment Suggestions

Irregular periods

Missing periods due to hormonal changes may be mistaken for the body’s reaction to neurological injury, where the menstrual cycle may cease for several months or longer or become erratic for a while.

Use birth control if you do not want pregnancy, even if you are not menstruating. You may still be ovulating.

Monitor your menstrual cycle as it will return in neurological issues but may not because of hormonal decreases in the age range of perimenopause or menopause.

Periods with heavier or lighter flow

Changes in flow can occur due to the body’s response to trauma or disease as well as perimenopause.

Some medications are available to reduce the number of periods which can be desirable if you have difficulty with containment or cleaning. Some women find menstrual collection cups to be a better containment of flow.

A feeling of intense heat inside the body, better known as hot flashes

Internal body temperature control regulation can fluctuate from spinal cord injury or brain injury and is affected by the temperature in the environment.

Dips in estrogen levels can lead to body oversensitivity to internal temperature changes.

Elevations in internal body temperature from menopause and perimenopause can trigger body temperature fluctuations from paralysis.

Make attempts to keep your body temperature within your normal range. With paralysis, your body temperature may be slightly lower than 98.6°. Therefore, an average temperature may be a fever for you. Avoid heat situations such as extreme heat outdoors, cool a hot car prior to entry, avoid sitting next to a heater, use air conditioning or a portable fan, use appropriate blankets for the indoor temperature, and use cooling cloths if in a warm situation. Avoid spicy foods, alcohol, and caffeine which can elevate internal body temperature. Dress appropriately for the weather and in layers so some clothing can be removed. If you generate internal heat from exercise, you may try to slow your intensity for a while. Even if your body does not feel hot or cold, it will respond to environmental temperatures. Humidity builds within the body, making air conditioning a necessity.

Excessive sweating that occurs anytime but especially at night

Some individuals with spinal cord injury and/or brain injury have no sweating in the affected parts of the body or excessive sweating from autonomic dysfunction. The brain does not interpret messages from the body, so it responds full force with reactions such as sweating. Changes in hormone levels can lead to excessive sweating.

Excessive sweating from nervous system injury can be mistaken for perimenopause, or perimenopause can be overlooked as the cause is thought to be nervous system injury. There are medications to control excessive sweating due to nervous system injury and different medications for hormonal causes of sweating.

Avoid spicy foods, alcohol, and caffeine which can make you sweat.

Breast tenderness

Hormonal changes can affect breast sensitivity.

Although nervous system injury does not typically produce breast tenderness, overuse of muscles can make the chest area sensitive if you have sensation. If the sensation is decreased, breast tenderness may be expressed by the body as referred pain to in the left shoulder or jaw, just as pain from any part of the body with absent or decreased sensation.

Weight gain

Inactivity and overconsumption of calories lead to weight gain with paralysis. Changes in hormone levels can lead to weight gain as well.

With normal aging, the number of calories required per day very slowly decreases. Lack of activity by the body can increase weight. Lax muscles may appear as belly fat and hip spread. Perimenopause and menopause can add to this mixture of weight gain sources. Monitor your weight to detect if the gain is in the age range for perimenopause or menopause, from inactivity, overeating or other sources. Maintain a healthy diet.

More intense symptoms of PMS or your first symptoms of PMS

Autonomic nervous system dysfunction can lead to misinterpretations of signals by the brain after paralysis. Hormonal changes can contribute to PMS.

Premenstrual syndrome or those signals that your period is about to begin can be missed if the sensation is low or absent or exaggerated by episodes of autonomic dysreflexia (AD). If you have not had episodes of AD but suddenly you do and cannot find the source, talk with your healthcare professional about the possibility of the source being perimenopause or menopause. Medication to control PMS, the source of the AD episode, will reduce AD if that is the cause.

Hair thinning

Hair loss or hair thinning can be a complication of higher-level spinal cord injury and brain injury.

Hair loss in women is a consequence of hormonal changes with age.

Products are available such as shampoos to add volume to your hair, vitamins for hair and nail growth, and medical treatments to improve your hair quantity and quality. Talk with your healthcare provider for the best treatment specifically for you.

Lower or loss of sexual desire

Sexual desire can be lowered due to disease or trauma issues and concerns. If the ability to obtain an orgasm is affected due to messages not being sent or received by the brain and body, desire can be reduced or frustrating.

Decreased sexual desire from slowing hormone production may impact sexual desire, but this resolves over time.

Change your thinking about sexual function. Most of the sexual gratification is mental. Think about the rhythms and breathing of your partner. Enjoy closeness. Explore sexual aids such as vibrators to increase stimulation, feathers, and stimulation of erogenous areas of your body. Use different sexual positions and pillows or props for your body. You may find sexual gratification by using different parts of your body with sensations such as your underarm, ears, or mouth.

There are medications that can be used to stimulate your libido.

Dryness in the vagina, bowel, skin, eyes, mouth

After paralysis, the vagina may not respond to sexual stimulation for lubrication. Moisture in the bowel may be decreased due to a slow response by the body to supply moisture to the internal bowel or from stool slowly moving through the bowel with more moisture withdrawn by the body as it slowly progresses. Skin can be dry internally from poor hydration and externally from lack of body moisture. Eye moisture is typically not affected with SCI but can be with brain injury or stroke, especially on the affected side, due to the inability to close the eye from paralysis or lack of moisture.

Hormonal decreases lead to decreases in moisture production throughout the body, especially vaginal dryness, skin dryness, and bowel dryness. The eyes and mouth can also become dry from the hormonal decrease in moisture.

Hydration of your body is critical at all times. If you are on a bladder management protocol, as with intermittent catheterization, you may not be able to increase fluid by mouth. If moisture is an issue with intercourse, use lubricant with less oil and water than is used for catheterization or bowel programs. Astro glide is one popular choice, among others. Lubricants that supply a ‘heat’ factor may provide additional stimulation. Feminine hygiene moisturizers can be used in the area of the vulva. Dryness can affect the bowel as well. Adjusting your bowel program to more frequent times may help. Adding fiber to your diet may assist in bowel programs. The skin should be washed with nondrying soap and rinsed thoroughly, and moisturized with emollient-based lotion. Lubricating eye drops will keep the eyes moist. Moisturizing mouthwash, mouth rinse, gel, or spray such as Biotin should be used. Avoid alcohol-based mouthwash as this will further dry your mouth.


A pounding headache is a key symptom of autonomic dysreflexia (AD). Individuals with a head injury, stroke, spinal cord injury or head injury need to be cautious of headaches as this can be an extension of your original injury or disease. Confusing a headache from AD with one from hormonal changes can be difficult.

Check your blood pressure to ensure you are not in an AD episode or other blood pressure issue. A headache may be treated by rest or medication but if they are continuing or powerful, call your healthcare professional for treatment. Some women develop migraine headaches during perimenopause.

Muscle aches

Neurological injury can result in muscle aches from overuse or irritated nerves (neuropathic pain).

In perimenopause and menopause, muscle aches from body changes may be felt.

If you have an increase in muscle aches, a sudden onset, or changes in your pain, examine your usual activities to see if you are doing something new or different. As perimenopause develops with age, you may need different transfer or self-care equipment, seating, or bed surface. Severe or ongoing pain should be checked for issues such as shoulder or hip injury or even fracture that is misinterpreted. Not performing stretching exercises can also lead to muscle aches. Hidden issues such as deep vein thrombosis (DVT) or a starting pressure injury can also lead to muscle aches.

Tone (spasticity)

Tone can be an issue when attempting a sexual relationship. Tone can also increase during sex.

Tone can be controlled through stretching prior to sex, medication, and Botox injections. Positions to reduce tone are also helpful.

Bouts of increased heart rate

Increased heart rate can be a symptom of AD.

Heart rate can also challenge the body if exertion is used, such as with sex.

Monitor your heart rate to capture when your heart is rapidly beating. If this is occurring due to perimenopause, you may need medication to help control it either all day or during sex.

Increased number of urinary tract infections (UTIs)

UTIs are a common complication of neurological injury due to the effects of the autonomic nervous system and its response to bacteria and viruses.

Dryness in the area of the vulva occurs with hormonal changes.

Perimenopause can cause drying to the vagina but also the surrounding moist tissue, including the urethra.

Maintain hygiene using non-drying soap and rinse thoroughly, always wiping from front to back. Use a good catheterization technique and plenty of lubricating gel on the catheter. Wash your hands before and after catheterization without touching things in between, such as washing your hands and then rolling to the toilet. If you use adult continence products, be sure to change them frequently and air the area using the frog position. Prompt treatment for UTIs is the best protection. Do not wait and see.

Difficulty in conceiving

After a neurological injury, your typical cycle may be disrupted by a lack of menstruation or lack of ovulation. This typically returns in time.

Since hormonal changes occur during perimenopause, a disruption in the typical fertility cycle can occur, which is complicated by neurological injury. Always plan if you desire pregnancy or not. Your gynecologist may assist with insemination if pregnancy is desired but does not occur.

Difficulty concentrating

Individuals with brain injury and/or spinal cord injury may have difficulty concentrating due to injury to the brain. Severe trauma or disease can also disrupt concentration until normalcy returns. Some women relate issues with concentration during perimenopause and menopause.

Injury to the brain combined with concentration issues of neurological injury can be even more challenging. The neuropsychologist who provides testing to identify areas of brain function challenges can assist with strategies for both concerns. Keeping a diary, calendar, or memo book can help keep track of activities you need to do. A phone or home device can provide reminders as well. Checking lists and keeping a regular schedule is important.

Memory challenges

Memory can be affected by injuries to the brain both through brain injury or stroke and through hormonal changes. Forgetfulness can be increased as perimenopause and menopause occur, especially if memory issues are a concern after a head injury or stroke. Sometimes, memory issues from hormonal changes are overlooked if memory issues are already present.

Use the strategies for concentration listed above to help your memory.

If memory issues become more challenging due to hormonal changes, sometimes addressing the hormonal change can stabilize memory changes.

Mood swings

Individuals with injury to their brain or challenges to life such as frustration or depression because of neurological injury can have mood swings. Changes in hormonal levels due to perimenopause and menopause can lead to bouts of flashes of temper. Added with neurological injury, frustrations are a challenge.

Activity is known to improve mood. Add it to your daily schedule either by doing an activity yourself or having someone provide it to your body. Medication can be taken for either source of mood swings if they are harming your life and relationships. Counseling is also very helpful in learning how to cope with these changes.

Sleep disruption

Individuals with spinal cord injury or brain injury may have sleep disruption from personal care activities during the night, stress, depression, or other issues. Hormonal changes cause sleeplessness for some individuals.

Practice good sleep hygiene. Turn off electronics a few hours before bed, and stick to a sleep schedule.


Loss of bone density can occur from changes in hormones in women but also from lack of muscle use and weight-bearing from neurological issues. When or if bone density changes occur with neurological issues does not happen at a set time. You may have sudden bone density loss or late bone density loss with neurological disease.

Maintain a bone density testing schedule. You can have years of normal bone density until bone loss appears. The combination of neurological disease and hormonal changes can speed up bone loss. Bone density testing can catch bone density loss early, which allows for early treatment.

Keep up with stretching exercises to provide muscle pull on the bones for strengthening, and use a standing frame to put weight through your bones.

Irregular Heartbeat/Palpitations

Brief or long-lasting irregular heart beating, and palpitations can be caused both by neurological issues and hormonal changes. It can be a symptom of long-term cardiovascular changes. Changes in heart rate (fast or slow) are a sign of autonomic dysreflexia.

Check with your healthcare professional to assess the status of your heart. Irregular beats and palpitations can be warning signs of heart health issues. Treatments depend on the source of the problem, so correcting the issue depends on the source, neurological, hormonal, or cardiac. Irregular heart beating and palpitations can lead to neurological issues such as stroke or a second stroke.

Teeth and Gum Changes

Mouth dryness can be due to hormonal changes. It can also be an effect of medications taken for neurological issues. Dry gums allow bacteria to enter your tooth sockets and lead to decay and bad breath.

Maintain a strict dental care check-up to ensure the health of your teeth. Check with your healthcare provider to see if your medications cause mouth dryness. Mouth rinses and sprays such as Biotin are best to help keep your mouth moist. Some people use hard candy to keep their mouth moist, which adds sugar to your teeth, enhancing decay and adding more calories to your diet.

Body Hair

With hormonal changes, body hair becomes thicker and dryer. Hair may develop in places where it did not grow before, like your upper lip. Neurological injury tends to lead more to hair loss.

Removal of excess body hair can be done with over-the-counter depilatory creams, removal, or cosmetic treatments.

Skin changes

Hormonal changes can make the skin drier with a rough texture. Individuals with paralysis need moisture on their skin to maintain elasticity and pressure reduction movements to decrease the risk of pressure injury.

Use emollient lotion to keep your skin moist, which allows elasticity. Check your skin frequently, especially during perimenopause and menopause, as pressure injury can occur from internal skin changes. Maintain or increase your pressure releases and turning. Ensure your pressure dispersion equipment is still effective.


Fatigue is an overall feeling of exhaustion not improved by sleep. Individuals with paralysis can have fatigue from not being able to ‘turn off’ their body during sleep, exhaustion from the physical activity of moving their body, lack of exercise, continuous lack of sleep, and mental health challenges.

Hormonal changes can create fatigue.

Discuss fatigue with your healthcare professional to establish the source of your fatigue. You may need to adjust your sleeping schedule, add exercise (even passive exercise helps), check your diet for nutrients, and check your physical and mental health.

Depression and anxiety

Mental wellness can be challenging with life-altering changes in your body and mind. Depression and anxiety are more common in individuals who have life-altering conditions.

Some women report depression in perimenopause and menopause due to hormonal changes. Some reflect the end of menopause as affecting their self-worth as women.

Discuss your mental health at each visit with your healthcare provider. Treatment and counseling can help you get to the source of your concerns and learn to recognize them and how to deal with them.

Lability (challenges controlling your emotions)

Individuals with paralysis from some diseases have difficulty controlling their emotions. This may include some individuals with brain injury, stroke, multiple sclerosis, or other diseases.

Hormonal fluctuations can also affect your ability to control extreme emotions.

Therapy can help you identify situations that will challenge your emotions. Techniques to control your emotions can be learned to help keep your emotions in check.

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.