Menopause and Women with SCI
Craig Hospital in Englewood, Colo., is site of the most extensive comparison studies involving menopause in women with SCI and the general population.
The national spinal-cord-injury (SCI) statistical database has reported that approximately 18% of SCIs occur in women. In spite of this significant number, little is known about the healthcare issues that are unique and particular to women with these injuries. Nowhere is this more apparent than with menopause-related issues, which are generally well studied and understood in the able-bodied population.
As women with SCI continue to enjoy longer life expectancies, it is especially important that these issues be better understood. The current scarcity of information related to women’s health and menopause is particularly dangerous since it may ultimately lead women with SCI to avoid gynecological care and forsake routine and preventative health maintenance.
Menopause is typically preceded by several years of perimenopause, the transition years when the majority of women begin to experience some symptoms
of hormonal change. During this time, the production of most reproductive hormones such as estrogen, progesterone, and testosterone begin to diminish and become more irregular, and fertility diminishes.
The typical symptoms associated with perimenopause include:
- Changes in skin
- Vasomotor instability
- Hot flashes
- Decline in sexual libido
- Memory problems
- Bladder changes
- Dryness of the mucosal surfaces
The most significant and common symptom for most women, however, is a change in the menstrual pattern. Studies have demonstrated that up to 90% of women notice a change in flow, quantity, and/or regularity as they begin perimenopause.
Menopause itself is a gradual process that is a major transition in the life of every woman. It represents a time of emotional, social, and physical upheaval marked by alterations in the menstrual pattern. Adverse complications and dramatic fluctuations often require medical and psychological interventions to ensure stability and a sense of well-being.
Menopause is triggered by the gradual shutting down of a woman’s ovaries, which are part of the body’s endocrine system. This process involves the entire scope of a woman’s reproductive functioning from brain to genitals. It is a major physical and psychological event that has some effect on almost every aspect of a woman’s body and life.
The gradual appearance of symptoms associated with perimenopause and menopause may begin to appear around age 40, although they are much more common as a woman nears 50. Conversely, for some the first signs of perimenopause begin as early as the mid to late 30s. These physical and psychological symptoms often last anywhere from four to ten years and signal the decline of ovarian functioning.
Erratic hormonal levels are common at this time of life, and these tend to fluctuate in unreliable and unpredictable manners. Often, moods tend to fluctuate dramatically as well.
Few studies have examined the menopausal differences between women with SCI and those without disabilities. Amy Dannels and her colleagues at Craig Hospital (Englewood, Colo.) are the exception. They found that the onset of perimenopausal symptoms does not differ significantly between women with SCI and the general population.
The average age when symptoms are likely to appear is 44 years for all women. For women with and without SCI, the symptoms reported most frequently included: change in menstrual cycle (60%), sleep disturbance (43%), night sweats (41%), hot flashes (39%), and decreased sex drive (38%).
Dannels and her colleagues also questioned whether there were differences according to level of injury. They found no significant differences in the severity of symptoms between women with paraplegia and those with tetraplegia. However, their study pointed out that women with incomplete injuries rated night sweats as more severe than those with complete injuries. Also, women with paraplegia had greater complaints of palpitations and reported more changes in the amount of bleeding with menstruation cycles than those with tetraplegia (Dannels, A, Charlifue, S. “The Perimenopause Experience for Women with Spinal Cord Injury.” Spinal Cord Injury Nursing, Spring 2004, pp. 9–13).
What is especially important for women with SCI is that many indicators of menopause mimic or mask physical symptoms commonly associated with the SCI. As a result, treatments for SCI-related conditions might be delayed if a woman mistakenly believes her symptoms are a result of menopause rather than her injury.
For many women, autonomic dysreflexia (AD), infections, impaired temperature regulation, bladder changes, and skin dryness may be a result of the SCI but may be impacted by menopause as well.
One example of this confusion is the presence of headaches. Frequent during menopause, headaches are usually caused by reduced estrogen and a subsequent constriction of blood vessels in the brain. These headaches, however, may also be a symptom of AD if the woman’s injury is above T6. Failure to manage blood pressure adequately could make AD difficult to differentiate and lead to a hypertensive crisis.
Depression is another complicated issue. It is not only the most prevalent emotional response to SCI but also extremely common during menopause. Depression can be triggered by poor sleep patterns, irritability, fluctuating hormone levels, and a general sense of losing control. In either case, the severity of emotional distress can become debilitating and potentially dangerous if left untreated.
After SCI, good physical and psychological health depends on multiple body systems and functions. It is imperative that women monitor their bodies and be alert to changes that may signal underlying problems. Changes in skin, bladder, bowel, temperature regulation, and blood pressure all must be carefully watched. With menopause, dramatic changes are commonplace. Women must adjust to these fluctuations and continue to be alert to any potential secondary complications of SCI.
Clearly, menopause is not yet understood for women with SCI. Although further research is certainly needed, these women must coordinate gynecological appointments with ongoing SCI care. Avoiding routine gynecological care is potentially dangerous and unsafe.
As healthcare providers, we have a responsibility to educate women regarding menopause and the symptoms often associated with this phase of life. As women with SCI lead longer and healthier lives, our responsibility is to ensure that quality of life and personal safety are never compromised.
Menopause and Women with SCI
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