From One Phase to Another

Reprinted from PN February 2002

Perimenopause: What is it? Does SCI impact women who have it?

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For most women, menopause is a beginning and an end. A new stage starts, while the reproductive years end. Menopause does not happen overnight. It occurs when menstrual periods cease permanently. But before menopause, there is a phase called "perimenopause"the gradual transition from normal menstrual periods to complete cessation. Although every woman is different, the perimenopausal phase typically begins in a woman's mid to late forties. According to the World Health Organization, it lasts two to eight years.

Initially, the ovaries slow down production of estrogen and progesterone, the hormones most associated with the menstrual cycle. Reduced production causes other hormonessuch as follicle-stimulating hormone (FSH), inhibin, estradiol, and luteinizing hormone (LH)to change. As production of estrogen and progesterone does not fall at the same rate (and may even have episodes of increase), the perimenopausal experience may be quite a wild ride when hormones rise and fall.

What about SCI? Little information exists concerning spinal-cord injury's impact on perimenopause and its associated symptoms. Since many women with SCI regularly take one or more medications, it is possible these may alter the way they experience perimenopause. Such changes could come from drug interactions or changes in the way the liver and kidneys work.

Some evidence shows that SCI affects hormonal balance. For example, for the first six months to a year after SCI, most women have absent or irregular menstruation. For a small number of women, periods may stop completely after injury. A woman injured during perimenopause may be particularly impacted by SCI and have altered or exaggerated perimenopause symptoms.

One way to guess how women with SCI might experience perimenopause is to look at how women without SCI experience it. There's no reason to believe it is completely different between the two groups. As estrogen levels decrease, many perimenopausal women face increased risk for chronic diseases such as osteoporosis, hypertension, diabetes, and hypothyroidism. There may be higher risk for some types of cancer, particularly those of the reproductive tract. Since natural changes in the production of estrogen can affect the skin and digestive and urinary tracts, individuals with SCI may need to be extra vigilant. Regular checkups and open communication with healthcare providers become increasingly important.

To find out more about how women with SCI experience perimenopause, Craig Hospital surveyed 371 individuals ages 35-55 (269 have responded to date) about their symptoms. Although the study was not designed to detect symptom differences between individuals with SCI and those without, the emergence of patterns dramatically different from those reported in general-population surveys suggests promising areas for future research.

Among the best Internet sites about perimenopause is the North American Menopause Society Web site ( For a slightly less medical perspective with many links to other information, try the Association of Reproductive Health Professionals ( Two branches of the National Institutes of Health (NIH) have ongoing perimenopausal research: the National Institute on Aging ( and the National Institute of Mental Health Behavioral Endocrinology Branch (

Other women may also be excellent sources of information. By discussing shared experiences, women learn from one another what is normal and what is not.

Menopause is not a diseaseit is a natural part of every woman's life. Perimenopause is just part of the journey, shared by all women, injured or not.

Janie Cilo is a consulting nurse informaticist and David Weitzenkamp a research associate at Craig Hospital. This article was prepared with funding from the U.S. Department of Education's National Institute on Disability and Rehabilitation Research (NIDRR). The opinions here are those of the grantee and do not necessarily reflect those of the U.S. Department of Education. For more information about this and other research projects at Craig Hospital, contact: Research Department, Craig Hospital, 3425 South Clarkson Street, Englewood, CO 80110. (303) 789-8308 /


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