Menopause Symptoms and Treatment in Singapore
by: Dr. Tan Hue Min, Family Physician, Regis Medical
Menopause is a physiological process that almost every woman will face, except for those who have had their ovaries removed before puberty. Menopause is a process that happens gradually. Women will experience a fall in their oestrogen and progesterone levels during their 30s and 40s. Menopause typically happens between the ages of 40 to 58, with the average being 51 years, as the North American Menopause Society reported.
Menopause in Singapore
The mean age of menopause can be different in different countries. The average age of menopause in Singapore is 49 years, ranging from 40 to 58 years old.
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What Is Menopause?
Menopause is a natural biological process that occurs at the end of a women's fertile, reproductive years. You are medically diagnosed with menopause after going through twelve months without a menstrual period. Menopause is a natural result of ageing. As you age, your reproductive cycle progressively slows down until it comes to a stop. This is a normal, natural process that happens to every woman in their lifetime, and you do not need to worry about it. While menopause can bring along many physical and emotional symptoms that can affect your physical and mental health, they are effective treatments available that will help you manage and treat these symptoms.
While menopause is usually a natural process that occurs as you age, certain medical treatments such as chemotherapy or surgery can cause your body to stop producing eggs. This is known as medical or surgical menopause. Symptoms of medical menopause also tend to be more severe.
Stages and Symptoms of Menopause
Menopause is a process that occurs in three stages: Perimenopause, Menopause and Post menopause.
Perimenopause
Perimenopause refers to the period in which your body begins the natural transition to menopause. It is also sometimes referred to as the menopausal transition. During this period, you may start to notice signs of progressing toward menopause. You may experience menstrual irregularity because of the fluctuations in oestrogen levels. Menopause-like symptoms are also common, such as hot flashes, sleep problems and vaginal dryness. The perimenopause period ends once you have had 12 consecutive months without a menstrual period.
During perimenopause, you may experience symptoms such as:
- Irregular periods. The fluctuation in oestrogen levels and the increasing unpredictability of your ovulation cause your period cycles to become irregular. This can cause longer or shorter periods, lighter or heavier flow, and even cause you to skip periods.
- Hot flashes. Hot flashes are common symptoms during perimenopause and can lead to sleep problems.
- Mood changes. During perimenopause, you may experience mood swings, increased irritability and an increased risk of depression.
- Vaginal and bladder problems. Due to the fall in oestrogen levels, your vaginal tissues may lose lubrication and elasticity, which can cause pain during intercourse. The fall in oestrogen levels can also lead to an increased vulnerability towards urinary or vaginal infections.
- Decreased fertility. Due to the irregularity of your ovulation, you will become less likely to conceive.
- Changes in sexual function. You may experience changes in sexual desire and arousal as a result of perimenopause.
- Loss of bone. Falling oestrogen level causes your body to lose bone faster than it can be replaced. Changes in cholesterol levels. The decline in your oestrogen levels can cause your cholesterol levels to change, which is not ideal for your health. Low-density lipoprotein (LDL) cholesterol levels increase while high-density lipoprotein (HDL) cholesterol levels fall, increasing your risk of heart disease.
Menopause
After 12 consecutive months without a period, menopause is confirmed. Your ovaries stop releasing eggs and you can no longer get pregnant. If you have had a surgery to remove your ovaries, you can have surgical menopause.
Post Menopause
Post menopause starts after you have experienced 12 consecutive months without a period after menopause has occurred and lasts for the rest of your life. Postmenopausal symptoms include:
- Hot flashes and night sweats.
- Vaginal dryness and discomfort.
- Depression.
- Changes in sex drive.
- Dry skin.
- Insomnia.
- Weight changes.
- Hair loss.
- Urinary incontinence.
Menopause Complications
After menopause, you may experience an increased risk of developing certain medical conditions due to the fall in your body’s production of oestrogen. These include:
- Cardiovascular disease. Lowered oestrogen levels can contribute to the development of cardiovascular disease. You may experience an increase in blood cholesterol after menopause, which is a risk factor for developing cardiovascular disease.
- Osteoporosis. Due to the fall in oestrogen levels, your body begins to lose bone faster than it can be replaced. This causes a decline in bone density, which can lead to the development of osteoporosis, where your bones become brittle and weak.
- Urinary incontinence. After menopause, your vaginal and urethra tissues lose elasticity, which can cause you to experience frequent, sudden, strong urges to urinate. This may be followed by an involuntary loss of urine, or the loss of urine with coughing, laughing or lifting.
- Sexual function. After menopause, you may experience vaginal dryness and a decrease in the production of fluids. This can cause discomfort, pain and even bleeding during sexual intercourse. Decreased sensation can also reduce your libido.
- Weight gain. After menopause, you will experience a fall in metabolism, which can cause weight gain to occur.
Diagnosing Menopause
Signs and symptoms of menopause are usually sufficient to tell if you are experiencing menopause. Further blood tests may be used to check your levels of:
- Follicle-stimulating hormone (FSH) and oestrogen (oestradiol), because your FSH levels increase, and oestradiol levels decrease as menopause occurs.
- Thyroid-stimulating hormone (TSH), because an underactive thyroid (hypothyroidism) can cause symptoms like those of menopause.
Treatment Methods for Menopause
While menopause itself cannot be cured, its symptoms can be treated if they are severe or interferes with your daily life.
Hormone Replacement Therapy (HRT) for Menopause
HRT is suitable for treating patients going through menopause and perimenopause. HRT uses oestrogen to replace your body’s declining levels of oestrogen because of menopause. HRT may differ in types and doses and the type and dose most suitable for your condition should be used. Oestrogen can come as skin patches, gels, sprays, implants or tablets.
HRT helps to relieve common menopause and perimenopause symptoms, such as hot flashes, brain fog, mood swings and vaginal dryness. HRT can also help to lower your risk of developing complications of your body’s falling oestrogen levels such as osteoporosis and heart disease.
While evidence has shown the risks of HRT such as increasing your risk of breast cancer, blood clots and stroke, the benefits outweigh the risks which are extremely low. Do consult a doctor if you are interested in HRT.
Lifestyle Changes
Lifestyle changes might be necessary to help you manage your menopause symptoms.
Diet
The fall in oestrogen levels will cause your bone density to decline, potentially leading to the development of osteoporosis. This may also increase your risk of fractures. To manage this, your diet should include daily products that are high in calcium, phosphorus, potassium, magnesium and vitamins D and K, which are vital for your bone health. These include:
- Milk
- Yogurt
- Cheese
In addition to a loss of bone density, menopause has also been linked to a loss of muscle mass. It is ideal for you to consume a protein rich diet to maintain your muscle mass. This will help your muscles support your body and reduce your risks of fractures. These foods include:
- Eggs
- Meat
- Fish
- Legumes
- Dairy products
Menopause may also increase your risk of heart disease, as well as increase your blood cholesterol. Foods high in fat content should be avoided or substituted with foods high in healthy fats like omega-3 fatty acids. Good sources of omega-3 fatty acids include:
- Fatty fish, such as salmon
- Seeds, such as chia seeds
Sleep
Menopause symptoms such as hot flashes, night sweat and mood swings can affect your sleep quality negatively. To improve your sleep quality, you may to take the following steps:
- Follow a regular sleep schedule.
- Try not to nap in the afternoon/evening.
- Adopt a bedtime routine.
- Avoid watching television, using your computer or mobile devices an hour before your bedtime.
- Avoid exercising near your bedtime.
- Avoid eating large meals close to bedtime.
- Avoid caffeine during the evening and night.
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