What you should know about 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.

The transition period before menopause is called perimenopause, when the body starts producing less oestrogen. During this period, your menses become irregular. This can begin up to 10 years prior to your last menstrual period.

Apart from biological changes, menopause can affect you emotionally and physically. How you are impacted will depend 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 influence your experience of this process.

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.

Some common symptoms are:

Irregular menses

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

Hot flushes and night sweats

A hot flush 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 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 can last from a few seconds to 30 minutes or more and affect up to 70 % of women.

Difficulty sleeping

Most of the time, this is related to interrupted sleep due to hot flushes.

Body aches, stiffness

As your oestrogen level falls you may notice a loss of muscle strength. This can 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, changing your body shape from ‘pear’ to ‘apple’ shaped. Following menopause, less food needs to be consumed as the body does not burn energy 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 wrinkled. Hair growth also slows down and becomes thinner.

Vaginal/urinary tract changes

The vaginal lining can become drier, thinner and less elastic following menopause. One may find sexual intercourse 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 cause the urethra to become irritated or inflamed, leading to frequent urination or urinary tract infections.

Incontinence may also develop, where urine leaks when you cough, laugh or exercise due to the weakening of pelvic floor muscles.

Emotional changes

During menopause, you may experience mood swings, anxiety, forgetfulness, tiredness, lethargy or depression. 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 density in the first three to five years after menopause. This can lead to osteoporosis and an increased risk of fractures.

Other symptoms

Some women may experience other symptoms, such as headaches, breast tenderness and palpitations.

Lifestyle changes

• It’s important to consume a healthy and well balanced diet to combat unwanted weight gain. This includes reducing fat intake, eating healthier fats like olive oil, and increasing intake of whole grain breads and cereals.
• Ensure adequate calcium and vitamin D 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, as these can trigger hot flushes.
• Lead an active lifestyle with regular exercises like yoga, tai chi and pilates. These can help you maintain a healthy weight, relax and prevent osteoporosis.

Medications

• 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, including 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 can vary for every woman and are influenced by lifestyle, diet, stress level, family support, general health and cultural perspective.

Many women continue to live active and interesting lives following menopause. You may even find new challenges coinciding with a ‘change of life’, such as the end of child raising responsibilities or retirement.