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 become 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 woman around the world and the attitude with which you approach menopause can affect the experience of this condition.

What are some menopause symptoms?

Each woman 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.

1. Irregular menses

This is usually the first sign of menopause. Some may have heavy menses, more frequent menses or intermenstrual spotting or bleeding.

2. 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.

3. Difficulty in sleeping

Most of the time, this is related to interrupted sleep as a result of hot flushes.

4. 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.

5. 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.

6. 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.

7. Vaginal/urinary tract changes

The vaginal lining becomes drier, thinner and less elastic, one may find sexual intercourse more uncomfortable, leading to a 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.

8. 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.

9. 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 an increased risk of fractures.

10. Other symptoms

Some women may experience symptoms like headaches, breast tenderness and palpitations.

Coping with menopause symptoms

1. Lifestyle changes

• 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 bread 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

2. Medication

• 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

3. Annual checkups

All perimenopausal and menopausal women should have annual checkups including 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 women 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.