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Sexuality and Reproductive Health--Menopause

Sexuality and Reproductive Health Table of Contents

Very little is known about the effects of menopause or the treatment of its symptoms with hormone replacement therapy, or HRT, on disabling chronic conditions.

  • Women with spinal cord injury, motor neuron disease, multiple sclerosis, brain injury, temporal lobe seizures, rheumatoid arthritis, scleroderma, lupus, and diabetes tend to have menopause at an earlier age than the average age of 51.
  • Changes in hormones that occur in the transition to menopause frequently worsen health problems already occurring with the disability or chronic condition.
    • Women with MS and spinal cord injury have more hot flashes, but these must be distinguished from disability-related flushing and body temperature changes that are not related to hormone changes.
    • Skin problems already frequent in women with disabilities may worsen due to the loss of skin elasticity and tissue strength that occurs with menopause. This may increase the frequency and severity of pressure sores and delay wound healing.
    • Changes in vaginal and urethral tissue that accompany menopause may increase the frequency of bladder spasms and infection.
    • Autonomic dysreflexia may increase with high-level spinal cord injury.
    • Spasticity may increase in women with neurologic conditions.
    • Women with disabilities are at increased risk of osteoporosis (bone thinning and wasting), during menopause because of long-term decreased mobility and weight-bearing, certain medications, or the presence of a disorder that directly deteriorates the skeleton, such as arthritis.
  • The extent to which hormone replacement could benefit women with disabilities without unacceptable risks is uncertain because these women were not included in the Women's Health Initiative or other large studies of menopause and hormone replacement therapy.
    • Therefore, the finding that HRT did not significantly improve quality of life may or may not be as true for women with disabilities.
    • Likewise, findings of increased risk of certain types of cancer while on HRT has not been examined in the context of other life-threatening risks or functional decline without HRT for women with physical disabilities.
    • More research is needed on the relative safety and effectiveness of using alternative doses, hormone mixtures, and vehicles for administering HRT, such as the skin patch instead of oral form, for women with various chronic conditions and disabilities.
  • Findings about the extent to which women with physical disabilities use HRT compared to women without disabilities have been inconsistent, depending on the mix of disabilities among the study participants. Because new negative information about HRT has been publicized since those studies were conducted, the effect of this information on HRT usage among women with disabilities is uncertain.
  • Women with disabilities surveyed in a large national study were significantly more likely than women without disabilities to be concerned about the safety of HRT for them, even before publication of recent studies revealing adverse effects of HRT in women without disabilities.
  • More studies are needed on the effectiveness and safety of alternatives to HRT for relieving symptoms of menopause and accompanying midlife health problems in women with disabilities. These may include natural forms of estrogen found in certain herbs and plant-based foods.

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