Answer by Assoc Prof Rukshini

Hi Siew Khum,

You are most welcome, and thank you for your question. I recommend that you seek consultation with an obstetrician and gynaecologist regarding your fibroids, if you have not had one.

Perimenopause is the transition period before a woman’s last period. Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period. The age range for perimenopause is generally about late 30s to early 50s, although most women become aware of the transition in their mid to late 40s. There is no way to predict what age a woman will hit perimenopause or how long this transition will last.

In Singapore, the average age of menopause is 49, so most women should expect symptoms to appear a few years before that.

Perimenopausal symptoms include hot flushes and night sweats, aches, pains, fatigue, or irritability as well as premenstrual symptoms such as sore breasts and bloating. These changes are usually caused by fluctuations in the production of hormones from the ovary.

The symptoms of perimenopause can be confusing as women are still having their periods and may not be aware of the hormonal changes. However, not all women who go through perimenopause or menopause would have symptoms that bother them significantly. But if these symptoms adversely affect a woman’s function, she should seek further assessment with a doctor.

3. Question by Glenna

Hi Assoc Prof Rukshini, hope you are well.

I am 42+ this year. I am suffering from lesser eggs than my peers (forget the medical terms) when I did my fertility test.

My menses have been irregular since early 2023. But almost every month will still come. However, since my last menses in mid Jan 24. I have missed my menses till now.

I feel hot at times and will wake up middle of the night almost every day.

It looks like menopause to me. But I wasn't sure. Could it be due to stress as my work is quite stressful.

Do I need to take any test to confirm? Thanks for your advice.

Answer by Assoc Prof Rukshini

Hi Glenna,

Thank you for your question. At 42 +, you are still too young to undergo changes that may suggest perimenopause. Premature and early menopause (menopause before the age of 45) is associated with medical conditions like osteoporosis and increased risk of heart disease.

Women with early menopause should undergo evaluation and treatment until the natural age of menopause to prevent the above-mentioned medical conditions.

Women with unusually early menopause (before 45 years old), should be
referred to a tertiary centre like KK Menopause Centre for further investigations.

4. Question by Auntie

Hi Dr,

How will menopause affect adenomyosis (& vice versa)? would there be no longer a need to continue dienogest medication or would a hysterectomy during menopause be necessary?

Answer by Assoc Prof Rukshini

Hi Auntie

Adenomyosis occurs when the tissue that normally lines the womb grows into the womb’s muscular wall instead. This causes thickening, breaking down and bleeding at each menstrual cycle. It can lead to an enlarged womb as well as painful and heavy menses.

Adenomyosis frequently fades or disappears after menopause. However, each woman’s condition may differ, hence I would recommend that you seek a consultation with your gynaecologist.

5. Question by Pet

Hi Dr!

Thank you for organising this forum. I'm going through early perimenopause and have all the symptoms (flushes, mood swings, insomnia, lethargy, skin issues, etc).

I have a few questions and it would help greatly if I can get some answers:

a) My gynae advised me to take more soy milk and tofu to help manage the symptoms. I've been doing so. Do they really help and are there any other sources of estrogen that could help?

b) Does this cause hearing loss? I've noticed that my hearing has been problematic especially in noisy conditions for the past year.

c) Does exercise help? If so, what kind of exercises help?

Thank you!

Answer by Assoc Prof Rukshini

Hi Pet

You are most welcome, and thank you for your questions.

Below are some advice and tips for managing perimenopausal or menopausal symptoms such as hot flushes, night sweats, poor sleep, mood swings and overall women's health:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

Perimenopause or menopause does not typically cause hearing loss. You may wish to see an ear, nose and throat specialist to uncover any underlying hearing issue.

For more information on physical activities to engage in, access our WISE (Women In all Stages Empowered) Health Guide: Stay Active.

6. Question by Chin

Dear Doctor,

What are the supplements that can help peri menopause weight gain and insomnia and mood swings? Thanks for your advice.

Answer by Assoc Prof Rukshini

Dear Chin

Not all women with perimenopausal symptoms require treatment. We encourage women to seek medical advice if they are experiencing moderate to severe menopausal symptoms.

Menopause hormone therapy (MHT) is the most effective treatment for typical menopausal symptoms such as hot flushes and night sweats, which has been widely used since the 1980s, and many women have benefited from it.

Data from a 17-year-period study shows that the five-year use of MHT in women in their 50s has several beneficial effects, such as reducing heart disease, fractures and all-cause mortality, including cancer mortality. MHT has been shown to be safe and effective in most women under the age of 60 with bothersome menopausal symptoms who are not at risk of breast cancer or blood clots. We encourage all women who have experienced moderate to severe menopausal symptoms to seek a detailed consultation to assess their suitability for MHT.

Some women may find relief from menopausal symptoms with herbal or alternative remedies, however most have not been studied or shown to be of benefit scientifically. The safety of these supplements is also not thoroughly studied and they can interact with other supplements/prescribed medications. It is not recommended that these treatments are taken for longer than six months.

Black Cohosh: This North American traditional herb can help hot flushes although not as well as MHT. Black cohosh does not help with anxiety or low mood, but it can interact with other medicines and there are unknown risks regarding its safety.

Isoflavones and soya products (plant substances found in the diet including red clover supplements): phytoestrogens (isoflavones) which are found in soya products/supplements and red clover can bind to estrogen receptors in the body and increase the effects of estrogen in the body. There are very many studies looking at the effectiveness of these in menopausal hot flushes, but the results have been mixed. They are not recommended in patients with breast cancer.

Acupuncture: Women often report reduction of hot flushes and night sweats with acupuncture, although clinical trials disappointingly show no difference between true and sham acupuncture (sham acupuncture is when the patient receives needling, but not into true acupuncture points).

7. Question by Adeline

Hi Dr,

Is it true that if a woman has not menopause after age 55, it isn’t so good?

I am 53. Still having regular menses. I have fibroids. Hoping menopause sets in to reduce fibroid size. Thank you.

Answer by Assoc Prof Rukshini

Hi Adeline

In Singapore, the average age of menopause is 49 years old. Some women can experience menopausal symptoms for five or six years before their final menstrual period. 

Currently, there is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last. Women who have later menopause do have, on average, better bone and heart health as compared with women with early menopause. So it is not true that it is not good to have a later menopause.

The size of fibroids usually stabilises and even reduces after menopause.

8. Question by Ms Low

Hi Doctor,

How do I know if I've menopaused? After several months of not getting a period, I had one three weeks ago, lasting 4 days. Then just last week, I had very faint spotting one evening.

I'm not sure what to make of this.

In my teenage and early adult years, my period was not consistent. I was diagnosed with PCO as young adult. Should I be concerned? Thank you.

Answer by Assoc Prof Rukshini

Hi Ms Low

Polycystic ovarian syndrome, known as PCOS, involves multiple organs and/or body systems through hormonal imbalances and metabolism dysfunction. It is possible for women with PCOS to experience menopause a few years later.

Perimenopause is the transition period before a woman’s last period. Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period. Women usually experience lighter periods before the periods stop completely.

However, if you resume having periods after 12 months or more of not having periods (due to menopause), or have spotting after sexual intercourse, you should see a doctor for evaluation.

9. Question by Karen

Dear Dr,

Does taking HRT increase the risk of cancers? Can mild osteoarthritis in the knee be fixed by HRT? If menopause started at 55, is it advisable to start take HRT at 62? Thank you.

Answer by Assoc Prof Rukshini

Hi Karen

Data from a 17-year-follow-up study shows that the five-year use of Menopause hormone Therapy (MHT) in women when they were in their 50s has several benefits: reducing heart disease, fractures and all-cause mortality, including cancer mortality later in life when these women reached their late 60s and 70s. This benefit was not seen in older women who started MHT in their 60s and 70s.

MHT can be used to treat bothersome hot flushes in women undergoing perimenopause and menopause. MHT is shown to be safe and effective in most women under the age of 60 with bothersome menopausal symptoms, who are not at risk of breast cancer or blood clots. It is not recommended to start MHT in women over 60 years of age.

Osteoarthritis affects women as they age. Recent studies have shown that the menopause is associated with the start and progression of osteoarthritis. However, we do not recommend MHT as a treatment for osteoarthritis.

10. Question by Siew Poh

Dear Dr,

There are many health screening packages in the market that include an ultrasound of the pelvis. Once a woman is post-menopausal, should she consider doing one as part of routine screening, or should she consider it only if indicated based on her medical history or if symptoms develop which calls for one? Thank you.

Answer by Assoc Prof Rukshini

Hi Siew Poh

An ultrasound of the pelvis for a postmenopausal woman is typically ordered when there is a need to assess her gynaecological organs for diagnosis of gynaecological conditions. Hence it is not a routine screening, but a human papillomavirus (HPV) test and pelvic examination are routine screenings. 

Your doctor will be able to advise you when you should go for an HPV test and pelvic examination if you require a pelvic scan.

11. Question by Anna

Dear Dr,

Is hormone replacement therapy needed for women who are experiencing menopause? Is it safe to undergo that kind of therapy? Thanks.

Answer by Assoc Prof Rukshini

Hi Anna,

Menopause hormone therapy (MHT) is the most effective treatment for typical menopausal symptoms such as hot flushes and night sweats, which has been widely used since the 1980s, and many women have benefited from it.

Data from a 17-year-follow-up study shows that the five-year use of MHT in women when they were in their 50s has several benefits: reducing heart disease, fractures and all-cause mortality, including cancer mortality later in life when these women reached their late 60s and 70s. This benefit was not seen in older women who started MHT in their 60s and 70s.

MHT has been shown to be safe and effective in most women under the age of 60 with bothersome menopausal symptoms who are not at risk of breast cancer or blood clots. We encourage all women who have experienced moderate to severe menopausal symptoms to seek a detailed consultation to assess their suitability for MHT.

12. Question by CKC

Hi Associate Professor Rukshini,

I have consulted doctors and the doctors recommended black cohosh to relieve my pre-menopausal symptoms (PMS). They asked to buy over the counter. There were too many types and brands and with different mg. Should I get the pure ones or those with add other supplements?

Answer by Assoc Prof Rukshini

Hi CKC

Some women may find relief from menopausal symptoms with herbal or alternative remedies. However most have not been studied or shown to be of benefit scientifically.

Black Cohosh is a North American traditional herb that can help with hot flushes although not as well as menopause hormone therapy. Black cohosh does not help with anxiety or low mood. The safety of these supplements has not been thoroughly studied and they can interact with other supplements/prescribed medications. 

Furthermore, it is important to understand that supplements like Black Cohosh are not evaluated by the Health Sciences Authority. It is not recommended that these treatments are to be taken for longer than six months.

13. Question by Grace

Hi Dr,

I stopped having menses when I’m 43, and my mum stopped her menses around 45 years old. Is it too early? What are some of the things we need to take note? Thank you.

Answer by Assoc Prof Rukshini

Hi Grace,

Premature and early menopause, menopause before the age of 45, is associated with medical conditions like osteoporosis and increased risk of heart disease. Women with early menopause should undergo an evaluation and treatment until the natural age of menopause to prevent the above-mentioned medical conditions.

Women with early menopause (before 45 years old), should be referred to a tertiary centre like KK Menopause Centre for further evaluation and treatment.

14. Question by Ginny

Hi Dr,

I’m 53 and entering menopause, my last period was in June 2023 and have been experiencing hot flushes sweating day and night since, however manageable.

Recently, the night sweats are heavier and I’m experiencing a dreadful sore/ache in my left chest/rib above my left breast that moves to the back rib and underarm as well. I did an ECG test at a polyclinic and readings normal. The soreness /ache comes and go.

I read about decreasing of bone density due to menopause but my concern is about the soreness/ache I’m experiencing in my chest/ribs is it due to menopause? Should I get an X-ray done? Thank you.

Answer by Assoc Prof Rukshini

Hi Ginny

Night sweats and body aches are common symptoms of menopause. It is good that you had an evaluation done at the polyclinic to exclude other causes of the body aches. Women whose symptoms are affecting their quality of life, may be referred to a tertiary centre like KK Menopause Centre.

At our centre, specific treatment is tailored according to a patient’s symptoms and diagnosis, after conducting relevant investigations.

15. Question by Mah Ivy

Dear Doctor,

I'm 47 years old and haven't had my period in over 2 months. (I never miss a period before) I also have hot flashes multiple times a day. These cause me to suspect that I'm entering menopause.

Is there any test that can confirm if I am going through menopause?

In addition, I have a 4cm fibroid in my uterus, which caused heavy bleeding. If I am in menopause, do I still need to go for a checkup?

Answer by Assoc Prof Rukshini

Hi Mah Ivy

You can still become pregnant even in your late 40s. If you have confirmed that you are not pregnant, it is likely you are experiencing symptoms of perimenopause.

Perimenopause is the transition period before a woman’s last period. Hot flushes are a common symptom of menopause. Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period. Menopause is not a clinical diagnosis and for women in their late 40s and 50s, tests are not required to determine if they are going through menopause.

However, not all women who go through perimenopause or menopause would have symptoms that bother them significantly. But if these symptoms adversely affect your function, you should seek further assessment with a doctor.

You should see a gynaecologist to seek advice on management of your fibroid and heavy menses.

16. Question by Fennie

Hi Doctor, I will like to ask:

How to manage hot flushes? Are there any ways to relieve hot flushes?

Is there any food that will trigger hot flushes so I should avoid it?

Thank you for reading my email.

Answer by Assoc Prof Rukshini

Hi Fennie

Below are some advice and tips for managing perimenopausal or menopausal symptoms such as hot flushes, night sweats, poor sleep, mood swings and overall women's health:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

17. Question by Virginia

Hello Dr,

If I am 56 and still no menopause, is that normal? If I also have adenomyosis and fibroids, am I at risk of uterine cancer if my menopause does not come soon? Thank you.

Answer by Assoc Prof Rukshini

Hi Virginia

Although most women undergo menopause before age 55, some women do experience later menopause. This can be in the late 50s and a few women can even menopause in the early 60s. Women who experience later menopause have better bone and heart health as compared with women who have early menopause. At present there is no way to predict the exact age you will menopause. However, genetic factors do play a role in determining your age of menopause.

Symptoms of uterine cancer include unusually heavy periods, periods getting more frequent or lasting for longer than what is normal for you. Another symptom is menstrual bleeding after a woman has gone into menopause. 

Do consult a doctor if you are having these symptoms as you will require evaluation.

18. Question by Sonya

Dear Assoc Prof Rukshini,

I am writing to seek some clarification regarding menopause and its timing.

I recently had a conversation with my boyfriend, which has left me feeling quite distressed. He expressed concerns about my age, particularly regarding the possibility of menopause affecting my ability to conceive. I am currently 47 years old and will be turning 48 this December. My mother, who is over 55, has already gone through menopause.

Given this familial history and my age, my boyfriend believes that I may be nearing menopause, which has led him to reconsider our relationship based on his desire to have children. His perspective has left me feeling uncertain and anxious about my reproductive health.

I understand that every individual's experience with menopause can vary, but I would greatly appreciate your insights or any information you can provide regarding the correlation between familial history of menopause and its onset in subsequent generations.

Additionally, I would like to understand if there are any tests or indicators that could help determine the likelihood or timing of menopause in my case. Knowing more about this would not only ease my concerns but also provide clarity for any future decisions regarding family planning.

Thank you for taking the time to consider my inquiry. I look forward to your guidance and expertise on this matter.

Answer by Assoc Prof Rukshini

Hi Sonya

I am sorry to hear of your distress.

In Singapore, the average age of menopause is 49 years old. Some women can experience menopausal symptoms for five or six years before their final menstrual period. Currently, there is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last.

We encourage women to start a family earlier than later as there are risks associated with advanced age pregnancies. Additionally, women are less fertile in their 40s as compared to their 20s and 30s.

Hormonal fluctuations which occur during perimenopause can affect fertility. Issues can include irregular menses which can lead to challenges in predicting the ovulation period; women who are conceiving at an advanced age may also have decreased egg quality or ovarian reserve and face pregnancy complications including miscarriage.

Do consider a consultation with a fertility specialist to discuss this matter further. They will be able to do tests to assess your fertility which will enable you to have more clarity and make a more informed decision.

19. Question by Lynette

Dear Prof Rukshini,

I’m 53 and have missed about three periods since two years ago, the last one I missed being last month.

This month I got my period again but it was perhaps the most stress and anxiety I have experienced that I remember— a faster than usual heart rate and trouble with sleep as well as sense that something bad is going to happen.

May I know if this is a symptom of menopause, how do I cope with it and when will it be over?

Answer by Assoc Prof Rukshini

Hi Lynette

Perimenopause is the transition period before a woman’s last period. Women experience perimenopausal symptoms before menopause, which is defined as 12 months without a period. The age range for perimenopause is generally about late 30s to early 50s, although most women become aware of the transition in their mid to late 40s. There is no way to predict what age a woman will hit perimenopause or how long this transition will last.

In Singapore, the average age of menopause is 49, so at 53 it is perfectly normal to expect these symptoms.

The symptoms of perimenopause can be confusing as women are still having their periods and may not be aware of the hormonal changes. Trouble with sleep, awareness of heart beating as well as anxiety and feelings of impending doom have been described during the perimenopause period, and is thought to be due to hormonal fluctuations affecting the body. However, these symptoms are non-specific and can also be due to other physical conditions, for example, thyroid disorders. Do consult with your doctor for further evaluations. Your doctor can exclude other causes of your symptoms as well as advise on specific treatment.

If other causes have been excluded by your doctor, do consider the lifestyle practices listed below. If lifestyle changes do not help and menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a tertiary centre like the KK Menopause Centre.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

20. Question by Sock Eng

Dear Associate Professor Rukshini Puvanendran,

I am reaching out to inquire about menopause-related sleep disturbances. As a woman navigating through this phase of life, I have been experiencing significant challenges with sleep, often finding myself waking up multiple times throughout the night, disrupting my ability to get a restful night's sleep.

My age 52, and my last menstrual period was in May 2022.

I am seeking information and advice on managing these sleep disturbances associated with menopause. Specifically, I would appreciate insights on strategies or treatments to alleviate this issue, as well as any recommendations for lifestyle adjustments or natural remedies that may prove helpful.

If possible, I would be grateful for any resources or references you could provide to further educate myself on this topic.

Thank you in advance for your assistance and expertise.

Answer by Assoc Prof Rukshini

Hi Sock Eng

Below are some advice and tips for managing menopausal symptoms such as hot flushes, night sweats, poor sleep, mood swings and overall women's health:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

For more information on how to keep healthy in later years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

21. Question by Suzanne

Hi Dr,

I’m 49 this year and I’ve had peri-menopause symptoms for the last 3 years. I feel that it’s getting worse, with hot flushes happening more frequently. Used to be once a year when it first started, now I’m thinking it’s 2x a week. I’m not even sure if it’s because the weather is so hot now.

What are the coping mechanisms I should adopt?

What exercise regimes should I enforce? I’m exercising once / twice a day now, with exercises ranging from walking, jogging, HIIT, weights, yoga, stretching, etc.. Is there a more scientific way of measuring and managing what I should do? I’m using iWatch today to track what I do daily.

What types of food should I take more of or less of? Balanced diet is good enough? Should I be eating less so I don’t gain weight?

What’s the ideal weight composition? I’m using a weighing machine that tells me I’m fat.

Appreciate your specific and clear advice. Thanks.

Answer by Assoc Prof Rukshini

Hi Suzanne

Below are some advice and tips for managing menopausal symptoms such as hot flushes, night sweats, poor sleep, mood swings and overall women's health:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

For more information on how to keep healthy in later years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

22. Question by J Loh

Hi Dr,

Is there any supplement that one can take when in the process of menopause to help ease the discomfort of the hormonal changes taking place such as mood swings, hot flushes and difficulty to get to sleep.

How different is the menstrual cycle during the menopause period? It's so unpredictable on when it will come. Thank you.

Answer by Assoc Prof Rukshini

Hi J Loh,

Perimenopause is the transition period before a woman’s last period. Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period. 

The age range for perimenopause is generally about late 30s to early 50s, although most women become aware of the transition in their mid to late 40s. There is no way to predict what age a woman will hit perimenopause or how long this transition will last.

In Singapore, the average age of menopause is 49, so most women should expect symptoms to appear a few years before that.

The symptoms of perimenopause can be confusing as women are still having their periods and may not be aware of the hormonal changes. The most common symptom of perimenopause is changes to the menses. This may lead to shortened or lengthened cycles.

However, not all women who go through perimenopause or menopause would have symptoms that bother them significantly. But if these symptoms adversely your function, you should seek further assessment with a doctor to assess suitability for menopause hormone therapy.

23. Question by Shana

Hi Associate Professor Rukshini Puvanendran,

Thank you for your time. Please find my few queries below:

a) My menstruation has stopped for quite a few years but there are still days when I feel the "hot flush" symptom, how long will that last?

b) How many years does "menopause effects" lasts?

c) Is there a central place where I can find some quite comprehensive and accurate/scientific literature on menopause and its effects and management?

Thank you.

Answer by Assoc Prof Rukshini

Hi Shana,

Currently, there is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last. Not all women who go through menopause, have symptoms that bother them significantly. But if they affect her function, she should seek further assessment with a doctor.

If you feel that your hot flush symptom is unmanageable despite adopting the following tips, you may wish to seek a consultation with a doctor:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

For more information on how to keep healthy in later years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

24. Question by Munira

Hi Dr,

I have just turned 50 years old. I had done my hormones test to check if I am in perimenopause phase. But that was a while ago. Is there any way I can know for sure now?

I am on levothyroxine and have been on medication for the same for 23 yrs. But I feel that my heat tolerance has gotten worse lately. Also have a mild choking sensation in my throat occasionally. Please advise. Thanks.

Answer by Assoc Prof Rukshini

Hi Munira,

Most women in Singapore menopause around the age of 49. As hormone levels fluctuate during perimenopause, hormone testing can be inaccurate. Therefore, we do not recommend routine hormone testing to ‘diagnose’ menopause for a woman who is in her late 40s or 50. A woman usually has reached menopause if she does not have her periods for 12 consecutive months.

Heat intolerance can be due to imbalance of thyroid hormones or due to perimenopause. As you are on levothyroxine, you should be on a follow-up with your doctor. The blood thyroid hormones are very useful to ensure your thyroid hormones are balanced.

Regarding the choking sensation you have in your throat, do consult with your doctor to evaluate the cause.

25. Question by Cindy

Hi Dr,

I'm 47 this year. I used to have very irregular period when I was younger. I never knew when my period will come and it's very normal for me to have cycle ranging from 30 days to 50 days.

However, since 5 years ago, my period suddenly became very regular and I'm now having a 28 days cycle. I read about hot flushes but I'm not sure if I'm experiencing it. I feel hot even after taking a shower but I'm cold in an aircon room.

May I ask whether I'm having menopause soon as my menstrual cycle suddenly changed and I'm beginning to get hot flushes? How do I know if I'm going to have menopause soon and do I need contraception at my age as I read a woman after age 45 will not conceive naturally. Thank you.

Answer by Assoc Prof Rukshini

Hi Cindy,

It is not unusual for women who have irregular cycles to have regular cycles when they reach their 40s. However, regularity of cycles is not a symptom of menopause.

You are likely experiencing perimenopause, the transition period before a woman’s last period. Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period. There is no way to predict what age a woman will hit perimenopause or how long this transition will last.

Regarding contraception, although fertility does decline in the late 40s, women can still get pregnant. There are both maternal and fetal risks associated with advanced age pregnancies. As such, I would strongly urge you to continue to use contraception until at least one year after your final menstrual period as you do still have chance of a natural conception.

26. Question by Cathy

Hi Dr,

Thank you for this opportunity to ask about menopause.

I am 46 years old and currently undergoing surgical menopause as I had major debulking surgery from ovarian cancer.

For women going thru surgical menopause, what can they do to minimise symptoms such as hot flushes? What other supplements should they take to minimise further effects from early menopause?

What should they look out for?

Thank you and I hope that my question can be answered.

Answer by Assoc Prof Rukshini

Hi Cathy,

Women who have undergone surgical menopause often have severe hot flushes and other symptoms of menopause as their hormone levels drop swiftly.

Some good lifestyle tips are listed below. If they do not relieve the hot flushes, do seek help at a tertiary centre like the KK Menopause Centre to help with your symptoms.

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

As for supplements, after surgical menopause, you are at increased risk of bone loss. Do increase your intake of calcium-rich foods. You may require a vitamin D supplement if your vitamin D levels are low.

27. Question by Freda

Hi Dr,

My estradiol level is 2584 and progesterone is 0.893.

I’m turning 47. What does the above result mean? Thanks.

Answer by Assoc Prof Rukshini

Hi Freda

You may wish to seek a consultation with your doctor who had ordered the hormone test, to make a more meaningful interpretation along with your other investigation results including medical history and physical examination.

28. Question by Herwani

Dear Dr,

I am turning 50 and have menopause symptoms (hot flushes, insomnia, mood changes) but what is most concerning to me is the brain fog as it affects my ability to function as before at work. What can I do to overcome this? Will my menopause symptoms get worse as I grow older or will it stop? Appreciate your advice, thank you.

Answer by Assoc Prof Rukshini

Hi Herwani,

Currently, there is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last. Not all women who go through menopause, have symptoms that bother them significantly. But if they affect her function, she should seek further assessment with a doctor.

If you feel that your brain fog is affecting your function despite adopting the following tips, you may wish to seek a consultation with a doctor:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

For more information on how to keep healthy in later years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

29. Question by Jasmine

Hi Doctor,

I am 49 years old. My mensuration days has reduced from 7 to 3 days. The last cycle which ended on 29 April 2024 only lasted for 3 days. For this particular cycle, it was the first time that I experienced brown bleeding only with no visible red blood discharge.

I am taking epileptic medication to manage my seizures since I was 15 years old. I have seen the therapist at a hospital twice for my knee pains. The last appointment was in late March 2024. It was diagnosed as arthritis, but no medication was prescribed.

There is knee pain on both left and right. The right knee was especially bad that I have to move slowly to avoid falling down.

Please advise if any medication can be taken to alleviate pain. I am particularly concerned if I am able to walk in future and how it will impact my ability to work.

Deeply appreciative your advice. Thank you.

Answer by Assoc Prof Rukshini

Hi Jasmine,

Perimenopause is the transition period before a woman’s last period. Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period. The age range for perimenopause is generally about late 30s to early 50s, although most women become aware of the transition in their mid to late 40s.

There is no way to predict what age a woman will hit perimenopause or how long this transition will last.

In Singapore, the average age of menopause is 49, so most women should expect symptoms to appear a few years before that.

The symptoms of perimenopause can be confusing as women are still having their periods and may not be aware of the hormonal changes. The most common symptom of perimenopause is changes to the menses. It is not unexpected that at 49 years old, your periods are getting shorter and lighter.

I am sorry to hear about your arthritis and knee pains. You might want to raise these concerns with your attending doctor and therapist.

30. Question by Serene

Hi Dr,

Is tension headache and extreme fatigue part of menopause?

What is a good diet to go on to gain energy and for general wellbeing during perimenopause and menopause period.

I am turning 55 this year and my last menses was in December last year. Thanks!

Answer by Assoc Prof Rukshini

Hi Serene

Tension headache and extreme fatigue are not typical symptoms of menopause. However, poor sleep is a symptom of menopause. Women who are experiencing poor sleep often have tension headaches and fatigue.

However, you should consult a doctor to rule out other causes of fatigue like anaemia (lack of blood) and thyroid disorders as well as to evaluate your headaches.

We advise a healthy balanced diet for general well-being during the perimenopause and menopause periods. Maintaining a well-balanced diet rich in vegetables and calcium, whole grains, and lean protein can keep you healthy and improve your general well-being.

For more information on how to keep healthy in later years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

31. Question by SY

Dear Doctor,

I am at menopause now. Occasionally experiencing Hot flushes, sleep disturbance. I have osteopenia.

Please advise what supplements and food intake is advise for the above. What type of exercises is good for my age 51? Thank you for your kind advice.

Answer by Assoc Prof Rukshini

Hi SY,

If your osteopenia (loss of bone density) is not currently being managed by a doctor, please seek medical advice as it may lead to osteoporosis (severe bone loss) and increase the risk of fractures.

Below are some advice and tips for managing perimenopausal or menopausal symptoms such as hot flushes, night sweats, poor sleep, mood swings and overall women's health:

• Light clothing and use portable fans. Wear thin/light and breathable clothing can help to keep you comfortable during hot flushes, especially in humid environments like Singapore. Portable fans can provide quick relief when hot flushes strike.

• Air conditioning. Keeping your living space cool with air-conditioning or good ventilation can help regulate your body temperature and reduce the discomfort of hot flushes.

• Regular exercise. Regular physical activity can help regulate hormones, improve mood and enhance general well-being. Exercise also promotes better sleep and alleviates some menopausal symptoms.

• Avoid trigger foods. Some foods like fried and spicy dishes can trigger hot flushes in some individuals. Reducing or eliminating these foods from your diet may help to manage your symptoms.

• Sleep well. Establishing good sleep habits such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can improve the quality of your sleep and reduce night sweats.
  

• Relaxation therapy. Techniques like deep breathing, meditation, and yoga can help to calm your mind and reduce stress, which can worsen menopausal symptoms like hot flushes, mood swings and sleep disturbances.

• Maintain a healthy body weight. Maintaining a healthy body weight promote overall health and can help manage menopausal symptoms. It can be achieved through healthy and balanced diet and regular exercise.

• Healthy balanced diet. Maintaining a well-balanced diet rich in vegetables, whole grains and lean protein can keep you healthy and improve your general well-being. Increase intake of calcium-rich foods.

• Seek professional help. If menopausal symptoms significantly impact your quality of life, please do not hesitate to seek medical advice from a healthcare professional. They can provide personalised treatment options and guidance.

• Share your concerns. Talking to friends, family members, or healthcare professionals about your menopausal experiences can provide emotional support and valuable insights.

• Social support. Social support is crucial for emotional well-being. Spending quality time with loved ones and joining a support group can provide a sense of belonging and reduce stress. KKH Menopause Interest Group, “Dynamite Daisies”, provides additional resources and support to women undergoing menopause transition.

It is important to know that each woman experiences menopause differently. It is essential to consult a healthcare professional for personalised advice and treatment options such as menopause hormone therapy, if necessary.

For more information on how to keep healthy in later years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

32. Question by Karen

Hi Associate Professor Rukshini, greetings.

My name is Karen. I’m 57. I totally stopped menstruating at 55. From then onwards, I feel tired easily. I could put down what I was doing, be it reading the papers, doing house chores or my paper works. I find it a waste of time completing these tasks further as my eyes cannot open, my concentration is not there. I wonder if this is due to menopause or Covid.

I got Covid twice, in 28/02/2022 & 04/12/2023. During my 1st Covid, the fatigue symptom was really bad. When I wake up in the morning, before I could finish brushing my teeth, my eyes start closing, my body feels tired. I would quickly make my way back to my bed before I collapse.

Sometimes I would force myself to eat something so as to give myself the energy I needed. After eating, I would head for my bed again.

I work from 3 to 8 pm, so I have the luxury to sleep as much as I desire before starting work.

Things start getting better now, the sleepiness symptoms is lesser but still there. So, is this part of menopause? If yes, what can I do to reduce the feeling of sleepiness? How long will this symptom last?

Thank you for kind attention.

Answer by Assoc Prof Rukshini

Hi Karen,

As you have stopped having your menstruation at age 55, you are currently menopausal.

Fatigue and sleepiness are non-specific symptoms and could be due to several causes including anaemia, thyroid imbalances, fibromyalgia, long COVID, or even sleep disorders like obstructive sleep apnoea that can lead to lack of quality sleep.

I will suggest that you consult with a doctor to get an evaluation of your symptoms as treatment will depend on the underlying issues. I hesitate to say that your symptoms are purely due to menopause.

33. Question by Sumathi

Dear Dr,

I am 55 years old, I reached menopause quite early around the age of 48. I am one of the lucky few who hardly experienced any menopausal symptoms. My mum also did not. Hence, I did not take any hormone therapy.

However, lately, I am feeling more aches in my joints and tendons. Wondering if menopause is aggravating the situation or is it part of growing old.

I am taking calcium, Vitamin D, Vitamin B and fish oil. I have done the blood test. I was deficient in Vitamin D but do not have arthritis.

My questions are:

• Do I need the HRT?

• Can I still take it?

• Are there anything else I can do to help the situation ? (other than losing weight)

Looking forward to your reply.

Answer by Assoc Prof Rukshini

Dear Sumathi,

Body aches and joint pains are common menopausal symptoms. However, they can be due to ageing or can be symptoms of other health issues including vitamin D deficiency, side effects of certain medications, and even inflammatory illnesses. Being overweight and obese can also result in aches and pains.

It is best that you consult with your doctor to evaluate the cause of your aches and pains so that you will receive the most appropriate treatment. Do optimise your vitamin D levels due to the deficiency.

However, losing weight (if you are overweight or obese) and including stretching exercises like Yoga and Pilates can help to alleviate the joint and tendon aches.

34. Question by Karen

Dear Dr,

Thanks for answering questions in this forum.

a) The Straits Times recently reported that the most prevalent symptom of menopause in women was joint pain. Who is the professional that should be taking care of joint pain associated with onset of menopause? I’ve known of people being sent to the orthopaedic doctor who then asked them to go for MRI.

b) Is it helpful/useful gettng hormone levels tested so that one knows their estrogen, progesterone, testosterone, vit d levels. Would using estrogen/progesterone topical creams help to supplement if levels are low?

c) Lastly what is your opinion on HRT? There seems to be conflictng studies and opinions on this. Is there a difference between synthetic and bio identical HRT? You mentioned MHT in your responses to other questions. Is it the same thing, just different name? Is there a treatment which does not cause issues further down the line e.g. breast cancer? Thanks!

Answer by Assoc Prof Rukshini

Dear Karen

Body aches and joint pains are common menopausal symptoms. However, they can be due to ageing or are symptoms of other health issues including degeneration or injury to a joint or even vitamin D deficiency, as well as inflammatory illnesses if they are involving multiple joints.

It is best that you consult with your doctor to evaluate the joint pain so that you will receive the most appropriate assessment and treatment. Your doctor will be able to advise on further tests and referrals if required.

As part of the evaluation of women under the age of 45 with unusually early menopause, we do advise checking a woman’s hormone levels. However, if a woman is having menopause symptoms at the appropriate age, around natural age of menopause, hormone testing is not routinely done.

Advances in menopause hormone therapy (MHT) continue to evolve. There are newer estrogen and progesterone preparations that are like natural (body-similar) hormones. Estrogen comes in oral or transdermal (skin applications) forms. Transdermal preparations have lower risk of thrombosis (blood clotting), and doctors can tailor the treatments according to the woman’s needs. However, at present in Singapore we do recommend oral progesterone preparations.

MHT or hormone replacement therapy can be used interchangeably. Regardless its term, MHT is the most effective treatment for typical menopausal symptoms such as hot flushes and night sweats, which has been widely used since the 1980s, and many women have benefited from it.

Data from a 17-year-period study shows that the five-year use of MHT in women in their 50s has several beneficial effects, such as reducing heart disease, fractures and all-cause mortality, including cancer mortality. MHT has been shown to be safe and effective in most women under the age of 60 with bothersome menopausal symptoms who are not at risk of breast cancer or blood clots. We encourage all women who have experienced moderate to severe menopausal symptoms to seek a detailed consultation to assess their suitability for MHT.

Non-hormonal alternatives such as selective serotonin (targeting the levels of mood-regulating hormones) and norepinephrine reuptake inhibitors (medications used to treat various mental health conditions by increasing the levels of specific mood-regulating hormones) that target menopausal symptoms without hormonal effects are also available for women who may not be suitable for MHT.

35. Question by HC Tan

Hi Dr,

I experienced frozen shoulders in both arms in 2023. Could you clarify if menopause is a contributing factor, or if there might be another cause?

Additionally, I'm curious about the recommended treatment options and whether full recovery is possible over time.

Answer by Assoc Prof Rukshini

Hi HC Tan

Menopause does not typically cause frozen shoulders. However, frozen shoulder tends to affect women around the time of menopause at about ages of 40 to 60.

You may wish to see an orthopaedic doctor for further assessment.

36. Question by Jas

Dear Dr Rukshini,

I am 53 years old now. I will like to check on this,

I was having my menses regularly until Aug 22, and it went MIA and returned in Dec 23 n came in January 24. Now it has gone MIA again. While I enjoyed the 'menses-free', but my worry is getting pregnant. My question is, does my husband need to put on condom when we have intercourse?

Answer by Assoc Prof Rukshini

Dear Jas

It seems to me that you did not have a period for more than 12 months (August 2022 to December 2023) and then had a period. This is considered post-menopausal bleeding. This is not a typical symptom of menopause. You should get an evaluation for post-menopausal bleeding by a gynaecologist.

Regarding contraception, although fertility does decline in the late 40s, women can still get pregnant. There are both maternal and fetal risks associated with advanced age pregnancies.

As such, I would strongly urge women to continue to use contraception until at least one year after the final menstrual period as there is still have chance of a natural conception.

37. Question by Vee

Dear Prof,

In 2023, I experienced full period fortnightly and after 6 months, it was too disruptive and decided to use Mirena. My symptoms include fatigue, on/off dry skin and vertigo at times.

I read lots about HRT and would like to know if it is advisable to take bio identical HRT, now that I am on Mirena. Thank you.

Answer by Assoc Prof Rukshini

Dear Vee,

Menopause replacement therapy (MHT) also known as hormone replacement therapy (HRT), is used for symptoms of perimenopause and menopause. MHT is prescribed if you are affected by these symptoms. However, as you have abnormal uterine bleeding, you would need to be assessed further for suitability of MHT. Please discuss this with your gynaecologist.

Ref: H24