Menopause, the time in a woman's life when her periods eventually stop, can come with its own special set of concerns. For instance, when is it considered premature?

Dr Ang Seng Bin, Head and Consultant Family Physician from the Department of Family Medicine Service at KK Women's and Children's Hospital, gives detailed answers to your questions.

Question by playst

If a person has begun to have menopause, does she still have to be concerned about birth control?

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

During the period around menopause, one could still be pregnant. The menstrual disturbance sometimes makes it hard to predict the ovulation period. As such, it is advisable for one to use contraception as long as one is within 12 months of the last menstrual period. Menopause is determined when one does not have menses for 12 consecutive months.

Question by albertlaw

My sister aged 49 has just experienced the symptoms associated with menopause and she is keen to know whether hormone replacement therapy can slow down or reduce problems associated with menopause. What’s your advice

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

Hormone replacement is not a treatment suitable for all. In the Women’s Health Initiative Study, it was noted that there is an increased risk of breast cancer in women using combined hormone therapy. As such, the latest recommendations are that hormone therapy (not replacement), should only be started in women with severe menopausal symptoms while those with mild to moderate symptoms should try lifestyle management first. These include exercise, healthy diet, reduction of weight, avoiding alcohol and smoking, as well as triggers such as spices, coffee etc.

Question by rachel

What exactly are 'hot flashes" during menopause? How do I know if I'm having one, and what should I do to cope and get rid of it? Is medication a must or can it be avoided?

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

Hot flashes are sudden feeling of intense heat experienced by women during the perimenopause. It usually comes suddenly and is short-lived, usually between 5 to 10 minutes. This could occur several times a day or night depending on individual. If one experiences ”hot flashes” that lasts more than 30 minutes each episode, please seek the advice of a health professional as medical conditions such as hyperthyroidism that can mimick hot flashes needs to be excluded.

Lifestyle modifications like exercise, healthy diet, improving sleep hygiene, relaxation techniques like deep breathing exercises, reduction of weight, avoiding alcohol and smoking, as well as triggers such as spices, coffee etc can be tried first. Most of the times this would help relieve the symptoms. The good news is for most women, the symptoms do decrease with time from the last menstrual period.

Medication is used only if the symptoms are severe and it affects the social function of the patients.

Question by​ mosmos

Does menopause affect one's mood? How do the loved ones help the affected person in coping with the mood swings?

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

While many believe that menopause can lead to mood disturbances, many studies have shown that menopause does not significantly affect one’s mood. The usual cause of mood disturbances are due to sleep disturbances during the perimenopause period that are caused by hot flushes. However, in women who have history of depression when they were younger, they have a higher tendency to have mood disturbances during this period.

A supportive family is certainly important as a woman transits through menopause. Encouraging a woman to increase her social activities can help alleviate some of the mood changes that are associated with the empty nest syndrome (where children leave home to set up their own family). Spouse support in providing a conducive sleep environment can improve the sleep and hence reduce mood disturbances.

Question by student

Hi, My mum is just turning 50 and she seems to be behaving very moody and cranky lately. Is there a test for menopause? Umm, how do I tell her to go for it without getting her upset? What does the check up or test involve? How can I just help her at home to cope better?

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

There is currently no test for menopause. Diagnosis of menopause is retrospective. The last menstrual period of a women’s life is determined retrospectively when she has no menses for 12 consecutive months.

Menopause could be used as a signpost for health checks. Screening for diabetes, cholesterol, hypertension and cancers like breast cancer, cervix cancer and colorectal cancer should be done at this stage to detect disease early and improve quality of life in the later years.

Question by zubaidah

I am female, 59 years old. Lately I have always experienced cramp in my both legs. Is this part of menopause effects? What can I do to lessen the cramp? Thank you.

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

Cramps are not the usual symptoms experienced during menopause. I would suggest that you seek medical attention and find the root of the problem.

Question by tzz

Dear Dr Ang, please advise on a guideline on food, diet and nutrition intake for menopause woman.

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

There is no special diet for women experiencing menopause. In fact, everyone should adopt the healthy diet advocated by HPB using the healthy plate. This includes taking more whole grain products/brown rice, reducing intake of sugar and oil. Fermented beans, such as miso soup, tempeh, and soy products like beancurd are high in phytoestrogens and may reduce the menopausal symptoms if one consumes them on a regular basis before reaching menopause.

Also, there is a need to ensure adequate calcium intake of 1000mg elemental a day. You can find calcium calculat​or on the HPB website. This is to reduce the chances of bone loss.

Question by suzena

If I have been having regular periods, and suddenly the pattern changes to very irregular, does it mean I am beginning to experience menopause? Or is it just hormonal imbalance? Will taking hormonal medication help to delay menopause? Or off the counter menopausal supplements that claim to delay menopause? Are there long-term side effects if I were to take hormone supplements?

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

If you are experiencing irregular periods, I would suggest that you seek the opinion of a health professional to exclude other causes.

Taking hormones does not delay menopause. However, it can delay some of the effects of menopause. However, this has to be weighed against the risk of breast cancer, strokes and heart attacks. Off counter supplements like isoflavones, black cohosh has not been shown to delay menopause. Some may alleviate some of the menopause symptoms but long-term safety data is lacking with some studies showing some potential harms.

Question by rsim

Are there methods to avoid physical and psychological changes of menopause? Is it that all women will face/experience the uncomfortable physical and mental effects? Is there treatment or medication to ease menopause bad effects?

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

Most women will go through menopause without problems. Studies have shown that menopause itself does not significantly cause psychological issues in women. As one transits through menopause, loss of bone and muscles is accelerated. However, with regular weight bearing and balance exercise, this can be reduced. Psychological issues experienced during menopause can be managed by a family physician or psychologists if needed.

Question by s1206288e

I am 55 years old and have stopped my periods for years now. I believed I am already menopause. I still have the breast tenderness (some kind of pain) feeling now. It is normal. Thanks

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

If you are getting regular mammogram and they are normal, then it is likely that the breast tenderness experienced every month is normal

Question by healthy1805

Will there be menopause problem after one had a peri-hysterectomy done about 8 years ago? No hot flashes but always have giddiness problem associated with uncomfortable feeling on my head especially feeling extremely sleepy and tired most of the time. Consulted the ENT and Neuro doctors, no conclusion for the cause of giddiness. Is the giddiness a sort of menopause problems? What should I do? Tks

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

Menopause is not a common cause of giddiness. Seek the advice of a family physician. If needed, you could seek the aid of a menopause practitioner.

Question by anitat2809@gmail.com

When menopause occurs early in a woman like in her early 30s, she will die young, like late 30s? And will there be many ailments accompanying an early menopause due to hormonal changes.

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

Premature menopause in 30s does not cause death in late 30s. The risk of chronic disease like heart disease, osteoporosis is increased for someone with premature menopause. Hence, if not contraindicated, hormone therapy should be given. However, if it is contraindicated, you need to be closely monitored and managed as there are other methods to treat the issues that come with premature menopause.

Question by Jenny

I have Uterine Fibroid and Dr. has advised to have surgery.

Last Nov.'10, I underwent laparoscopic myomectomy and dilatation and curettage.

The next visit on 3 Dec '10, Dr. had prescribed 6 months Sunolut ie. taken up to Jun '11. My menses did not turn up after completion 6 months of Sunolut dosage.

Finally, I have accepted that I am menopause now. Is my operation and Sunolut dosage affected menopause early. What type of food/vitamins will you recommend to me?

Looking forward to your professional advice.

Answered by Dr Ang Seng Bin Head & Senior Family Physician Family Medicine Service, KK Women's and Children's Hospital

It is very hard to determine whether your operation or Sunolut caused early menopause as they are not known to do so. Please refer to my earlier responses for advice on food and nutrtion.

Ref: T12​​