Associate Professor Rukshini Puvanendran, Co-Director of KK Menopause Centre and Head and Senior Consultant from the Family Medicine Service at KK Women's and Children's Hospital (KKH), answers your questions on menopause.

This forum is open from 1 Apr to 26 Apr 2024.

To submit a question, simply email it to singhealth.healthxchange@singhealth.com.sg

Please allow up to two weeks for us to answer your questions. We reserve the right to pick which questions to answer and to close the forum early. You will be notified via email if your question is answered. All answered questions will be shown on this page.

Before submitting a question, do have a look at all the questions and answers posted in the forum so far so as to avoid submitting repeated questions. Your understanding is appreciated.

Menopause is sometimes called ‘the change of life’ as it marks the end of a woman’s reproductive life.

Menopause is a natural biological process where the ovarian function gradually declines and permanently stops due to ageing, or when both ovaries are surgically removed.

In Singapore, the average age of menopause is 49 years old.

Some women go through this period with little to no issues at all. However, others may experience hormonal changes that result in:

  • Hot flushes, 

  • Sleep disturbance, 

  • Mood disorder and 

  • Sexual dysfunction

While most are aware of menopause, many do not fully understand it. There are many misconceptions and stigma in the community.

This ‘Ask the Specialist’ Q&A forum is your chance to ask Assoc Prof Rukshini any question on menopause. She can even help to demystify misconceptions you may have on the topic, so don't hesitate to ask her now!

About Assoc Prof Rukshini Puvanendran

Associate Professor Rukshini Puvanendran is Co-Director, KK Menopause Centre and Head and Senior Consultant, Family Medicine Service, at KK Women’s and Children’s Hospital (KKH).

Assoc Prof Rukshini specialises in midlife women’s health including menopause and osteoporosis. She also has an interest in chronic disease management and weight optimisation, especially in women keen to conceive and women with polycystic ovarian syndrome.


Ref: H24


Questions and answers on menopause

1. Question by Battie

Dear Dr Rukshini,

I am 56 years old this coming June.

Understand I have passed the average women menopause age group and I hope I take it as a good indication of my healthy life style which contribute to this delay.. but I am not sure whether am I correct?

My mom have her menopause at 53 years old, and my sister around 50 years old. 

I have routine health check-up done. Would like to know how to prepare myself better for menopause transition. Thank you for your attention.

Answer by Assoc Prof Rukshini

Hi Battie,

It is great that you are doing regular health check-ups! Keep it up!

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. However, women who menopause at a later date have, on average, better bone and heart health than women who have early menopause.

You are already preparing for the menopause transition by asking this question – the first step is equipping yourself with knowledge! Menopause is not a disease and is a natural biological phase in a woman’s life. It marks the end of your reproductive phase, but also a new beginning for you to take charge of your life – emotionally, mentally, and physically.

If you have menopausal symptoms that affect your life, step forward to seek medical help. We also hope to create awareness that it is very normal for health changes to occur during the menopause transition but help is available to help them cope better. An optimal management of menopause and transition will greatly contribute to healthier ageing and better quality of life.

For more information on how to keep healthy after 50 years, access our WISE (Women In all Stages Empowered) Health Guide: The Later Years.

2. Question by Siew Khum

Dear Prof. Dr. Ruksini,

Thank you for spending time to answer my questions.

I am 54 single and have a number of fibroids with the biggest about 7cm.

I have been having heavy flow since 2021 after my 1st COVID jab till Jan 2024 which lasted around 7 to 10 days. My period cycle is about 15 to 22 days previously till this year. I missed my period in September and November 2023. I also missed in Feb 2024. It came back recently starting with spotting 2 to 3 days then very light for 2 days and seems stops again.

My puberty was at age 10 or 11 and used to have bad cramps during adolescent age. My younger days till mid 40s, the cycle was 35 days lasted for 4 to 7 days.

Grateful for your advice. Am I starting my peri menopause and what to expect. I feel very hot recently can't sleep well but may not be sweating. When or how long is menopause from this stage? My mum's menopause at 49 while my younger sister last year at 52.

Do we need to remove fibroids or removal of the womb? Will they become harmful or are they shrinking as I'm missing my period? Can I use acupuncture to treat fibroids or any non-invasive treatment?

Thanks again for your advice.

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.