Menopause
What is menopause?
Menopause is the last stage of a gradual natural process which leads to menstruation stopping
permanently and the end of a woman’s reproductive period. A woman has officially reached menopause
when she has not had menstruation for one complete year, and she has gone through a ‘change of life’.
The average age of menopause in Singapore is around the age of 50. However, menopause has a wide
starting age ranging from age 42 to 58. A woman who reaches menopause before the age of 40 is
regarded as having premature menopause.
What happens before menopause?
The transition period before menopause is called perimenopause, when the body starts producing less
oestrogen. During this period, your menses becomes irregular and this can begin up to 10 years prior to
your last menstrual period.
How does menopause affect you?
Apart from the biological changes, menopause can affect you emotionally and physically, depending on
how quickly the production of oestrogen is reduced, your stress level, lifestyle and family relationships.
Menopause is a fact of life that affects every women around the world and the attitude with wich you
approach menopause can affect the experience of this condition.
What are some symptoms of menopause?
Each women experiences menopause in their own special way. Some women experience extremely
uncomfortable changes while others hardly notice any difference in their bodies or moods. Symptoms
may also come and go over an extended period.
Some common symptoms are:
Irregular menses
This is usually the first sign of menopause. Some may have heavy menses, more frequent menses or
intermenstrual spotting or bleeding.
Hot flushes and night sweats
It is a feeling of warmth that spreads over the body and is often most pronounced in the face, neck and
chest. It can happen at any time of the day, and may vary from mild to intense, often accompanied by
sweating, palpitations and anxiety. It may also be severe enough to wake you up from sleep leading to
insomnia, poor sleep and tiredness. Hot flushes may last from a few seconds to 30 minutes or more and
can affect up to 70% of women.
Difficulty in sleeping
Most of the time, this is related to interrupted sleep as a result of hot flushes.
Body aches, stiffness
As your oestrogen level falls, you may notice a loss of muscle strength. This may also be aggravated by
emotional stress and tension leading to aches in the neck and back.
Weight gain
Excessive weight gain is a common problem during menopause. Due to hormonal changes, fat tends to
settle around the waist and your abdomen becomes rounder. When one reaches menopause, we need
less calories as the body does not burn up calories as fast as before.
Skin and hair changes
With reduced oestrogen levels, the skin’s connective tissue becomes less elastic and the skin gets
thinner, drier and more wrinkling. Hair growth also slows down and becomes thinner
Vaginal / urinary tract changes
The vaginal lining becomes drier, thinner and less elastic, one may find sexual intercourse more
uncomfortable, leading to loss of sexual desire. The skin around the vaginal opening may also become
dry leading to itchiness and vaginal discomfort.
Changes around the vagina can also cause the urethra to become irritated or inflamed, leading to
frequent urinating or urine infection.
There may also be incontinence where urine leaks when you cough, laugh or exercise, due to the
weakening of the pelvic floor muscles as we age and lack of exercise.
Emotional changes
One may experience mood swings, anxiety, forgetfulness, feeling tired, lethargic or depressed. These
symptoms may be made worse by other physical symptoms such as hot flushes or body aches.
Decreased bone density
There is a rapid loss of bone in the first 3 to 5 years after menopause. This may then lead to
osteoporosis and increasing risk of fractures.
Other symptoms
Some women may experience symptoms like headaches, breast tenderness and palpitations.
How can I cope with menopause?
Lifestyle changes
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Have a healthy and well balanced diet to combat unwanted weight gain. Reduce fat intake, eat
healthier fats like olive oil and increase intake of whole grain breads and cereals
Ensure adequate calcium and vitamin intake to prevent osteoporosis. Foods that are high in
calcium include cheese, sardines and green leafy vegetables
Wear cool clothing if you get hot flushes
Avoid/reduce intake of alcohol, coffee and spicy food that can trigger hot flushes
Lead an active lifestyle with regular exercises like yoga, tai chi and pilates that will help you
maintain a healthy weight and also help prevent osteoporosis
Medication
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However, in cases where the symptoms of menopause are bothersome or severe, hormone
replacement therapy can be prescribed by your doctor
Antidepressants may also be prescribed for mood swings and insomnia
Medications can also be prescribed for women who are at a higher risk of osteoporosis
Annual check-ups
All perimenopausal and menopausal women should have annual check-ups to include a breast screening,
pap smear, pelvic examination, and screening for risk of heart disease, cancers and bone mass density
changes.
Menopause is an unavoidable change that every woman will experience but the duration and symptoms
vary in every individual. It is influenced by one’s lifestyle, diet, stress level, family support, general health
and cultural perspective.
Many woman continue to live active and interesting lives and even find new challenges after
menopause as it coincides with a ‘change of life’, either the end of child raising responsibilities or
retirement.
This article is contributed by
Dr Lau Pik Onn
Resident Doctor, Thomson Wellth Clinic
MBBS (S’pore)
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