It doesn’t have to be that way for women. It is about understanding the condition and finding ways that work for you in dealing with it.

BY: Dr Susan Logan

Is menopause a bad word? Ask most women what they think and the thoughts are often negative including “old”, “wrinkled” and “past it”. However, it doesn’t have to be …

So what is the dreaded menopause? It is just part and parcel of what women’s bodies undergo. We are born with all our eggs (about one to two million). Most die off so that when we start our periods, only 400,000 remain. When a woman runs out of eggs … that, is what is called menopause. In general, this is a good thing as the average age coincides with the potential emergence of other health issues – heart and blood vessel (cardiovascular) disease, cancer, etc, when a pregnancy might be dangerous. For most women, unless you have your ovaries removed or destroyed, the diagnosis of menopause is made after you have stopped your period after 12 consecutive months.

 

When do you get menopause?

This can vary. Less than 0.1 percent of women undergo what is called perimenopause (or menopause transition) below the age of 30 years and about one percent under 40 years. Permanent cessation of periods under 40 years is called premature menopause. In Singapore, the average age is 49 years with about 90 percent of women reaching menopause by the age of 53. Rarely, a woman may continue to have a regular period into her 60s. If you start bleeding after menopause, it is important to seek medical advice to make sure there are no serious medical causes.

 

Can it change your life?

The age that menopause occurs tends to a challenging time anyway. You might be juggling many roles such as a wife/partner, mother, sister, daughter, carer, employee and friend. You might have been married now for 20 years and there may be difficulties with your sex life or general relationship. Your marriage may have ended and you are embarking on a new relationship. You may be dealing with children’s exams or watching them leave home. You may be embroiled with relatives’ and friend’s problems. You may be caring for children and/or elderly relatives. You may be at the top of your career or starting working life again after bringing up the family.

About 50 percent of women will experience symptoms such as body aches, irritability, sleep disturbances (the three most commonly reported symptoms by women in Singapore), hot flushes, irregular periods, mood changes, difficulty concentrating, feeling tired, giddiness, pain during sex, loss of interest in sex, bladder symptoms, sleep problems, night sweats and so on. Furthermore, as women in Singapore now have a life expectancy of 85 years, age-related health issues such as cancer, heart disease and stroke are common.

If you then add up family and work responsibilities, social dynamics, menopausal symptoms and emerging health matters, it is not surprising that many menopausal women feel they are “losing it”!

 

How can you deal with it better?

Read up as much as you can about it so you understand what to expect and what you can do about it. Don’t accept that the troublesome symptoms you are experiencing are just part of getting older and you need to put up with them. There is plenty of information out there. The Health Promotion Board is a good start (www.hpb.gov.sg/HOPPortal/) and has produced an information leaflet “Menopause – what every woman should know”. Your local library is also a good source. There are many things that you can do to ease your symptoms:

• If you suffer from hot flushes (this is a feeling of warmth that spreads over the body that begins, and is most strongly felt, in the head and neck regions) – exercise; turn up the air conditioner; reduce your intake of caffeine, alcohol, hot drinks and spicy food; wear layers (remove or replace depending on environment and symptoms); use fans or pace your breathing during a hot flush; increase soy in diet; or seek medical advice if affecting quality of life.
• If your periods are frequent or heavy – seek medical advice.
• If you suffer from incontinence – start pelvic floor exercises; wear a pad; or seek medical advice if it’s affecting your quality of life.
• If sex is sore – use vaginal moisturisers/lubricants bought from a pharmacist; vaginal estrogen is very helpful and available on prescription.
• If mood/memory/concentration changes affect your quality of life – seek medical advice as a lot can be done from short-term hormone replacement and certain antidepressants that can help mood, sweats and sleep to mental well-being programmes (for instance: www.hpb.gov.sg/HOPPortal/programmes-article/350 which focuses on mental well-being and cognitive skills training) and, of course, exercise!
• After menopause, your risk of certain conditions increases such as heart and blood vessel disease, osteoporosis, urinary incontinence, sexual function and weight gain – so keep physically and mentally healthy by participating in regular exercise (add in weight-bearing exercises as well), maintain a healthy weight, eat a low-fat/salt/sugar diet that has adequate calcium, get enough sleep, get 15 minutes of sunshine for vitamin D, stay smoke-free, participate in cancer screening programmes for breast, cervical and bowel cancer, and osteoporosis.

Bone mineral density (BMD) test is recommended for those aged 65 onwards, otherwise between 45 to 64, use the Osteoporosis Self-Assessment Tool (OSTA) to assess risk (updated guidelines are expected soon), and have regular checkups for diabetes, high blood pressure and high cholesterol. Don’t forget to take time to relax and enjoy hobbies, family and friends.

If you seek medical advice, your doctor may recommend hormone replacement therapy (HRT). Newer preparations are available that are safe and very effective in treating menopausal symptoms.

Menopause doesn’t need to be a bad word. You are still you but without the risk of pregnancy and the inconvenience of periods (and saving money on buying sanitary pads). Embrace your post-reproductive years and if need be, seek advice if symptoms are adversely affecting your life.

 

SIDEBOX – Complementary and alternative therapies: Dr Susan Logan gives her input “Herbal”, “natural” and “plant derived”: These do not necessarily mean safe. Plant estrogens: These are not as good as traditional HRT for vasomotor relief. There is currently no hard data on benefits to coronary heart disease and fractures but they do appear to demonstrate some benefits on the skeleton and cardiovascular system. Bioidentical hormones: Unregulated compounded bio-identical hormones are not recommended due to the lack of data for efficacy and safety. Evening primrose oil: Limited evidence shows no difference compared with placebo. Black cohosh/red clover, etc: There is currently no strong research evidence. Efficacy quality control issues and long-term safety have not been established. Those with oestrogenic properties (ginseng, black cohosh and red clover) should not be used by women with contraindications to estrogen, e.g. breast cancer. As there have been serious drug interactions and side effects reported, discuss planned use with your doctor. Yoga: There is limited evidence in the context of menopausal symptoms, but certainly benefits from physical activity and paced respiration. Acupuncture: There is again limited evidence but it may help some women with none of the potential risks associated with herbal remedies.

 

Dr Susan Logan is a consultant at the National University Women’s Centre.

 

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