Menopause begins when the menstrual cycle ends, and along with it, the ability to get pregnant. It is a natural phase of life for women, a rite of passage into the third phase of life.

Natural menopause is diagnosed after menstruation stops for 12 consecutive months. Laboratory tests are only done to rule out other medical causes that may mimic menopause symptoms. These can include thyroid problems, tumours, and medication such as niacin, calcium channel blockers and nitroglycerin.

Menopause in Asia

In Asia, menopause usually occurs in women between the ages of 45 and 55. The average age at which it hits women in Asia is 50, while in Singapore, it is 49.

Menopause can occur earlier. This is linked to genes, smoking (which brings it forward by about 2½ years), chemotherapy and surgery involving the pelvic organs.

In 2012, close to 30 percent of Singapore’s female population was aged between 45 and 65 years. As about 50 percent of women going through menopause will experience some symptoms, the number of women seeking consultation for issues relating to menopause is expected to be substantial.

Dr Ang Seng Bin, Head and Consultant Family Physician of the Family Medicine Service and Menopause Unit at KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group, said that in recent years, KKH has seen a 30 per cent rise in women seeking consultation for issues relating to menopause, particularly hot flushes, irritability and sleep disturbance. More women are also having hot flushes compared to those in previous studies.

Sex after menopause

Lower oestrogen levels in menopause can affect a woman’s sexual functions. This can lead to painful intercourse and problems with intimacy, libido and sexual desire. Vaginal dryness can occur, and it worsens with time.

One’s primary care physician should make a thorough holistic assessment of a patient’s sexual, medical and psychosocial history, said Dr Ang, who is also Adjunct Assistant Professor, Duke-NUS Graduate Medical School, and Associate Program Director, SingHealth Residency Family Medicine Program. Measures can be taken to improve psychological well-being and intimacy, while medication and substances that aggravate vaginal dryness should be avoided. The use of vaginal lubricants and topical oestrogen can also be considered.

Hot flushes

Hot flushes can begin about two years before the final menstrual period and peak about a year after it. They are usually short-lived, lasting between five to ten minutes per episode. The frequency can vary from once every few days, to two to four times an hour. Hot flushes also vary in severity, and so require different types and combinations of intervention.

Managing stress and exercising regularly improve symptoms of mild to moderate hot flushes. Women with severe symptoms, or those who do not see improvement with lifestyle management, may consider hormone therapy, the most effective treatment for hot flushes. Those who have hot flushes that last for more than 30 minutes each time should seek medical advice to exclude medical conditions such as hyperthyroidism.

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Irritability and sleep disturbance

Severe hot flushes can also disturb sleep and cause irritabilit​y. Menopause can also trigger depression in women with a previous history of depression or negative reactions to life stressors.

To deal with sleep disturbances and irritability, one should try to improve sleep hygiene, manage stress, use mind-body therapies and maintain an active and supportive social life. Primary care physicians can help patients identify and address other potential causes including depression, anxiety, joint pain, backache, stress and caffeine consumption.

If symptoms affect a menopausal woman’s life and daily activities, she should see a doctor. These symptoms can include post-menopausal or unexplained vaginal bleeding, a pelvic mass, or any other medical issue that may require surgical intervention.

Ref: O18