Rollin’ Into Menopause
Recently, we’ve been asked about our nursing knowledge/experiences with reference to menopause and the effects it has on women with a spinal cord injury (SCI). We’ve had discussions in regards to our own personal experiences around this topic so we thought it was a good time to dig deeper, see what’s out there, and share our findings. In our own experiences, one of us was already in the throes of perimenopause/menopause before her SCI while the other one was not when she was injured. But interestingly enough, her cycles quickly changed after her injury. Was this sudden change in her cycle because she was at an age when perimenopause typically starts or was it due to post-injury trauma to her body? While doing our research, the majority of articles stated, “that larger studies are needed to examine menopause outcomes concerning the level and completeness of injury (SCI).” No big surprise there, but we still found some information around this topic that is important to know when navigating through perimenopause and menopause.
First, it’s important to distinguish between perimenopause and menopause. Menopause is when the monthly menstruation cycle fully stops. That said, the years of hormonal transition leading to the last period is known as perimenopause and usually begins in a woman’s 40s. As you enter perimenopause, your body will go through changes in hormone levels, including estrogen and progesterone. These hormonal changes may create issues such as an irregular menstrual cycle and night sweats. Some symptoms can last for months or even years after a woman's period stops. Periods can stop for a while and then start again, so a woman is considered to have been through menopause only after a full year without periods. (There also can't be some other reason for the periods stopping like being sick or pregnant.) After menopause, a woman no longer can get pregnant. The average age of menopause is 51, but for some women, it happens in their 40s or later in their 50s. Sometimes called "the change of life," menopause is a normal part of life. After menopause, a woman is postmenopausal, which lasts the rest of her life.
While there are many symptoms associated with perimenopause/menopause, how can we determine, which symptoms are simply due to perimenopause/menopause and which are SCI related and what is the significance an SCI factors in these symptoms?
periods that are heavier or lighter than normal
worse premenstrual syndrome (PMS) before periods
loss of sex drive
urinary tract infections (UTIs)
fertility issues in women who are trying to conceive
Menopause symptoms (Some of these can occur while you’re still at the perimenopause stage)
anxiety or irritability
As you can see, many of the symptoms listed for perimenopause/menopause can also mask or mimic symptoms related to an SCI. And not everyone’s experience is exactly the same so symptoms can vary from one person to the next for either condition. Also, the level of a women’s SCI may play a part in which symptoms are detectable.
Being a woman with an SCI, we have other areas to be mindful of when adjusting to perimenopause/menopause:
Bowel: Hormonal fluctuations around your cycle can stimulate your bowels. This may require some adjustments to your bowel program.
Bladder: Some women experience an increase in infections during this transitional time such as urinary tract infections (UTIs) or yeast infections. Another common issue is incontinence. (Not being able to hold your urine long enough to get to the bathroom. For those of us with an SCI, these are already issues we might see increase during this time.
Autonomic dysreflexia (AD): Autonomic dysreflexia is an especially serious issue for those of us with an SCI (usually above injury level T6). AD can create sudden spikes of high blood pressure, shortness of breath, excessive sweating and can be life-threatening. When dealing with symptoms of hot flashes or excessive sweating, watch out for signs of overheating and AD. Similarly, reduced levels of estrogen as found in menopause can produce headaches but can also be a symptom of AD. Monitoring your blood pressure may be one way to determine if your headache is from AD or a hormonal headache. If your BP remains normal, your headache may be hormonal.
Osteoporosis: Lower estrogen around the time of menopause leads to bone loss in women. Bone loss can cause bones to weaken, which can cause bones to break more easily. When bones become considerably weak, the condition is called osteoporosis. Immobility and lack of weight-bearing with an SCI can increase this risk. Ask your doctor if you need a bone density test. Your doctor can also suggest ways to prevent or treat osteoporosis. Check out our article on Osteoporosis here.
Cardiovascular Disease (CVD): After menopause, women are more likely to have cardiovascular problems, like heart attacks and strokes. Changes in estrogen levels may be part of the cause, but so is getting older. That's because as you get older, you may gain weight and develop other health problems that increase your risk of cardiovascular disease. Ask your doctor about important tests like those for cholesterol and high blood pressure. Discuss ways to prevent CVD.
Skin care: Menopause can cause the skin to become much drier and less elastic. It’s more important than ever to keep moisturized and because of the loss of skin elasticity, be sure to perform meticulous skin checks.
Mental Health: Remember it’s completely normal to experience unusual mood swings, such as feeling blue, feeling irritable or angry, or crying more often. Extra self-care during this time of transition will benefit tremendously.
It would be ideal to find a gynecologist who has experience in treating women with SCIs. However, that can be a tall order to fill. Regardless, talk with your trusted provider to find a gynecologist that can help you navigate the changes you will go through. Educate yourself on the symptoms of perimenopause/menopause and ways to deal with them so you can discuss with your gynecologist what’s right for you, especially with an SCI. Talk with other women in your SCI circle about their experiences with menopause and how they are coping with it.
Just when you think life may be getting easier with no more monthly periods comes a plethora of others issues. Regardless, continue to take care of yourself which is so important when living with an SCI. And know you can get through this challenging transition time of perimenopause/menopause in the same “rock star beautiful way” you have adjusted to living life with an SCI!
It’s all good, so keep on rollin’.
Patty, BSN, RN and Roberta, RN
The Rollin’ RNs ™