Perimenopause and Paralysis

Posted by Nurse Linda in Life After Paralysis on June 24, 2022 # Health

Perimenopause Most women know that menopause is the ending of the menstrual cycle in women. However, prior to menopause, women have a transitioning time called perimenopause. This is when their body is changing and preparing for menopause. This transition can last from two to ten years or, for some, even longer. Perimenopause usually begins for the majority of women between the ages of 40 to 44; however, a very few women have noted changes starting in their 20s and a few others much later. Some women will notice changes occurring; others will not.

The timing of the onset and duration of perimenopause is the same for women with and without paralysis. It is important to note that paralysis can hide the signs of perimenopause or cause them to be mistaken for other issues.

The cycle of reproduction in women begins with the onset of menstruation as a teenager. Fertility peaks in the early 20s. Perimenopause is a stage when hormones, especially estrogen, begin to change, but no signs are noted. Perimenopause is the start of the cessation of menstruation, but it is a process that takes some time as the body changes hormone production. Menopause is the end of menstruation for 12 consecutive months.

Perimenopause is a process of transition, not an overnight change. Much like in puberty with menstruation onset, changes occur in perimenopause but might not be noted or accredited to perimenopause because menstruation does not change. Cycles are still occurring. Pregnancy can still happen. There might be some subtle changes in flow increase or decrease or length between cycles, but the body is processing as it has for years. Subtle changes are easy to discount, explain away, or not even notice in a hectic life. Therefore, most women do not think much about perimenopause, although it can impact their life significantly.

Perimenopause lasts years. During this time, ovaries slow the production of hormones, particularly estrogen and progesterone. Fewer eggs are released into the uterus. In the perimenopausal stage, body reactions to the changes in hormone production may or may not be noticed.

There are four stages of perimenopause. You may not recognize the stage, but this is happening in your body.

  • Stage 1: Minimal changes. These include menstruation, changes in flow, distractibility and forgetfulness, a decline in sexual desire, an increase in PMS symptoms, and heightened emotions.
  • Stage 2: Emotional disruption, heavier but still regular menstruation, increased PMS, increase in all signs.
  • Stage 3: Menstruation becomes irregular in flow and frequency, cramps, anxiety, mood disruptions peak, sleep disturbances, the lowest point for sexual desire.
  • Stage 4: Cessation of menstruation, the mood begins to stabilize, sexual desire returns, and hot flashes and night sweats may increase.

There is no laboratory test for perimenopause. It is a symptom-based diagnosis.

Signs of perimenopause include both physical changes and effects on your mental function and wellness. Symptoms of perimenopause are similar to menopause, but the duration of the symptoms is more sporadic in perimenopause.

Physical changes include irregular periods, periods with a heavier or lighter flow, a feeling of intense heat inside the body, better known as hot flashes, excessive sweating that occurs anytime but especially at night, breast tenderness, weight gain, more intense symptoms of PMS or your first symptoms of PMS, hair thinning, lower or loss of sexual desire, vaginal dryness, headaches and muscle aches, bouts of increased heart rate, increased number of urinary tract infections, and difficulty in conceiving. Some women have extreme signs, others will have some noticeable signs, and some have very few to no noticeable changes.

Mental effects include difficulty concentrating, memory challenges and mood swings. During perimenopause, these signs tend to develop slowly over time, increase in occurrence and intensity as you head toward full menopause, and may continue after menopause. They may be irregular in timing and severity or, very infrequently, may not even be noticed. Not everyone has every sign, but some women have all the signs.

For individuals with paralysis from spinal cord injury or brain injury, the signs of perimenopause may be overlooked, mistaken for neurological issues, or exaggerated. With neurological injury or disease, signs of perimenopause such as intense body heat, excessive sweating, headaches, and increased heart rate can be confused with autonomic dysfunction.

It may be that you have never had an episode of autonomic dysfunction exhibited by autonomic dysreflexia (AD), but suddenly you do, or your AD episodes increase. After checking for the usual causes of AD, bladder flow issues, bowel impaction and skin irritation or other irritating body issues below the level of injury, and finding nothing is amiss, it is time to think about the possibility of perimenopause as the source.

Perimenopause is an issue that does not come to mind immediately with AD but if all other causes are eliminated as a trigger, perimenopause could be the issue. Since there is not grand notice to the body that perimenopause has started, it might take some thinking to consider it. Knowing your age and any nuances of signs of perimenopause will help you and your healthcare professionals to consider this source.

There are options for treating perimenopause to help curb episodes of AD as well as treatments for AD itself. Getting to the cause of the trigger and treating that cause is the best treatment over time. More information about treating AD and especially in an emergency AD episode, is located here.

The signs of dry vagina, urinary tract infections, and bowel slowing are issues with spinal cord injury, brain injury or stroke and perimenopause. These symptoms compile together. Lubrication of the vagina and increased numbers of urinary tract infections are consequences of the autonomic nervous system’s ability to respond to these body needs. The vagina is a mucous membrane opening to the body that requires moisture, as do the rectum, eyes, and mouth. Extra moisture is needed by the vagina during sexual intercourse, which is provided by the body unless the autonomic nervous system cannot process that message to the brain. Water-based lubrication can be applied to the area. The urethra or opening to the bladder is also a mucous membrane opening. When the vulva (the area where your urethra, clitoris and vagina are located) becomes dry, moisture does not keep this area protected, which allows more bacteria to enter. In addition, drying cleansing solutions and soap for cleaning to catheterize may cause more urinary tract infections to occur. Cleaning the area and rinsing thoroughly are needed.

A dryer stool may be noticed as the bowel is also a mucous membrane that can become dryer after hormonal changes. The body is constantly removing water from your body waste, so the longer it sits in the bowel, the dryer stool becomes. Impactions, hemorrhoids, and fistulas may occur. Increase water intake slowly if your bladder management program allows the increase. Add fiber and lower body movement either under your own power or have someone move your body to increase bowel function.

Concentration and memory challenges are often a consequence of brain injury or stroke. Further issues with brain function can be compounded with perimenopause. Therefore, noticing or caregivers who notice changes in your mental status is important to bring to your healthcare professional’s attention. If you have not had concentration and memory challenges previously but develop these now, they are probably from the hormonal changes of perimenopause. However, with perimenopause, concentration and memory issues will subside.

Mood swings are credited to many issues. One is frustration from huge lifestyle changes with significant neurological issues. Mood swings can be overlooked as frustration but can be from perimenopause when hormonal levels can become elevated and drop several times within one day.

When physical and mental challenges occur during perimenopause, especially without realizing that it is happening, individuals, their families and their caregivers can become frustrated with each other due to changes. Often it is very difficult to control these changes due to the volatile nature of the hormonal disruption.

There are actions you can take to help control the signs and extreme hormonal changes.

  1. Recognize that this is an internal hormonal issue. Talk with your healthcare provider or gynecologist to find the treatment that is best for you as a unique individual.
  2. Consume a heart-healthy, low fat, high fiber, calcium-rich diet.
  3. Ask if supplements such as calcium and vitamin D will help maintain bone density. Be sure to check with your healthcare provider as too many supplements can lead to other health concerns if you have neurological issues.
  4. Slowly eliminate alcohol and caffeine from your diet. Both can disrupt sleep, trigger hot flashes, add calories, and affect urinary continence.
  5. Add activity to your body to stretch your muscles which will help relax your body and engage the bowel to increase movement.
  6. Engage in mind-body activities such as yoga, meditation, and relaxation.
  7. Hormone replacement therapy (HRT) must be based on your own medical history. Different hormones are used depending on your needs. Some are safer than others. There are risks to this treatment that include cancer, gallstones, blood clots and stroke. These risks are higher in those with neurological conditions. Discuss this option fully with your healthcare provider to decide if this treatment is the right uniqueness for you.
  8. Antidepressants can be prescribed for depression, neuropathic pain, and extreme hot flashes, especially if hormone therapy is not recommended for you. If you already use antidepressants, you may have fewer hot flashes.
  9. Gabapentin is used for nerve pain and hot flashes. Some side effects of medications can be positive. If you already take this medication for nerve pain, you may have fewer hot flashes as a pleasant side effect.
  10. Estrogen cream can be applied to the vagina to improve vaginal dryness, improve intercourse, and assist with urinary symptoms. Over the counter lubricants such as Astro glide or vaginal moisturizers may be preferred.

Perimenopause is an often-overlooked part of the human female body process. However, if you are prepared and knowledgeable, you can help reduce transition issues. Connecting your knowledge of neurological issues and signs of perimenopause will increase your ability to obtain the health treatment you need.

View the chart about the comparison of neurological and hormonal issues with suggestions for treatment. It is the same for 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.

And if you want more Nurse Linda, sign up for her monthly webinars here. Don’t worry, we archive her answers so you can refer back and sift through her advice. Consider it Nurse Linda on-demand!

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.