ALS does not directly impact the endocrine system however, there is evidence of changes in hormone levels in individuals with ALS, the cause of which is not well known. There is little research on the impact of ALS on menstrual flow however, there are anecdotal reports of flow becoming lighter or heavier in some individuals.
Application of products such as tampons, menstrual cups or menstrual pads can continue to be managed by the individual until reductions in mobility prevents them from doing so. Once the individual is no longer able to manage the application of these products, it must be done by a caregiver or healthcare provider. Menstrual pads are used exclusively in order to facilitate application during later stages of the disease.
Menstrual pads should be changed at least every 4-8 hours, more often if bleeding heavily. Caregivers can apply the pads to regular undergarments or briefs, depending on continence needs.
Pads should be checked on a regular basis by a caregiver, every 2-3 hours should be sufficient unless the individual is bleeding heavily, in which case it should be checked at least every hour.
Due to the average age of onset, individuals may be dealing with ALS while also going through menopause.
Menopause can lead to a period of irregular menstrual cycles. Menstruation may be more or less frequent, heavier or lighter than usual or may last for a longer or shorter duration. If perineal care is being provided by a caregiver, undergarments or briefs should be monitored for any bleeding.
Menopause can lead to symptoms such as hot flashes and night sweats. If the individual no longer has the mobility to change their clothing, they will need to notify their caregiver should their clothing become soiled with sweat. Soiled clothing should be changed as soon as possible, as prolonged time spent in wet clothing can lead to skin breakdown.
Menopause can lead to brain fog; this symptom may coincide with brain fog caused by respiratory dysfunction due to ALS itself. Brain fog from menopause will typically last throughout the entire day, whereas brain fog from respiratory dysfunction is primarily noted upon waking in the morning and may be accompanied by headaches, increased fatigue or shortness of breath. Feelings of brain fog should always be reported to the healthcare provider.