KKH MCHRI launches Singapore’s first set of Menopause Management Guidelines

• Menopause diagnosis in women over 45 based on patient history
• Reaffirms safety and efficacy of menopause hormone therapy 
• Protecting population from severe long-term menopause risks

20 February 2026, Friday, Singapore – The KK Women's and Children's Hospital (KKH) Maternal and Child Health Research Institute (MCHRI) today launched Singapore's first set of Guidelines on Management of the Menopause Transition.

Unveiled by Ms Sim Ann, Senior Minister of State for Home Affairs & Foreign Affairs and Adviser, People’s Association Women’s Integration Network Council, the Guidelines provides a framework to standardise care for this important stage of women's health.

“Despite its significant impact on long-term health and quality of life, menopause transition remains one of the most overlooked phases in a woman’s life. It is often under addressed – not only by women themselves, who may view their symptoms as inevitable, but also within healthcare settings where clinical approaches can be inconsistent,” said Associate Professor Rukshini Puvanendran, Co-Director, KK Menopause Centre and Head and Senior Consultant, Family Medicine Service, KKH.

“These Guidelines are crucial in closing that gap. By establishing a clear, evidence-based framework, we are putting the necessary systems in place to ensure that menopause is recognised as a priority. Our goal is two-fold: to encourage women to be more aware and upfront in seeking help, and to better equip healthcare professionals who manage these patients in their practices, with the tools to provide effective, tailored care.

“With Singapore projected to become a super-aged society by 2030¹, women are spending a third of their lives post-menopause. Providing standardised, timely care is essential to ensuring our population ages with optimal health,” added Assoc Prof Rukshini.

Menopause, which typically occurs at age 49 in Singapore², marks the end of a woman's reproductive years when menstrual periods stop. During this phase, declining estrogen levels can trigger widespread changes throughout the body.

Every woman matters, every journey counts
Recognising that every woman's menopause experience is unique, the Guidelines include tailored recommendations for women with diverse needs. Some of the highlights are:

Diagnosis: Menopause is diagnosed by 12 consecutive months of the absence of menstruation accompanied by typical symptoms. For most women over the age of 45, it is primarily diagnosed based on patient history instead of laboratory testing. Further investigations may be needed for women under 45 years and older women with atypical symptoms to ensure accurate diagnosis and appropriate intervention.

In Singapore, the top five symptoms during this transition are:

• new-onset musculoskeletal symptoms (joint and muscle aches)
• disturbed sleep
• sexual health and urinary symptoms (urgency or frequency)
• physical and mental exhaustion and
• asomotor symptoms (hot flushes and night sweats)

This differs from the Western population where hot flushes and night sweats are the most commonly reported symptoms.³

Reaffirming the safety and efficacy of menopause hormone therapy (MHT): The Guidelines reaffirms MHT as safe and effective for treating bothersome vasomotor symptoms such as hot flushes and menopause-related mood issues, and for preventing and treating postmenopausal osteoporosis. For most women experiencing these symptoms who are under 60 or within 10 years of menopause, and who can safely use MHT, the benefits significantly outweigh the risks.

This clarifies decades-long misconceptions about MHT, and follows the recent removal of broad black box warnings from MHT products by the US Food and Drug Administration⁴.

Safeguarding the population from serious long-term health risks: Women facing early menopause - whether naturally, from medical treatments such as chemotherapy, or surgical procedures like ovary removal - require specialised management to mitigate the symptoms and conditions that can emerge earlier than expected. The loss of estrogen early in life presents risks to long-term cardiovascular, bone and brain health.

The Guidelines also emphasises that healthcare professionals should counsel at-risk women about the possibility of fertility loss and discuss available options.

Bringing intimate health into the open: The Guidelines addresses highly prevalent but frequently unreported symptoms that impact a woman’s quality of life. Intimate health concerns such as vaginal dryness, painful intercourse, and urinary issues affect many menopausal women but often remain undiscussed due to social stigma or cultural taboos. To bridge this gap, healthcare professionals are encouraged to proactively screen for these symptoms and provide clear treatment pathways, including safe vaginal estrogen therapy and holistic approaches to sexual health concerns.

Foundation of care for all women: The Guidelines emphasises lifestyle optimisation as the essential cornerstone for every woman navigating menopause. Proactive habits including maintaining a healthy diet, regular exercise, weight management, not smoking, minimising alcohol intake, stress management, and improving sleep – are important first line defence in reducing symptom severity, and mitigate long-term risks of cardiovascular disease and osteoporosis.

(Refer to Annex A for the complete set of Guidelines)

KKH studies: from evidence to action

Two KKH studies conducted in 2025 revealed substantial challenges in menopause care in Singapore⁵:

The first study, involving 1,461 women aged 45 to 65 years, found:

• Almost all women experienced at least one of 29 common menopausal symptoms (refer to Annex B)
• 70 per cent of women (1,022) experienced moderate to severe menopausal symptoms, yet 70 per cent of these women have not sought medical attention.
• Top five moderate to severe symptoms were weight gain, difficulty sleeping, head and/or neckaches, vaginal dryness, joint and muscle aches.

A second study involving 262 healthcare professionals who see female patients in the

same age group revealed:  

• 60 per cent of these healthcare professionals saw patients with menopausal symptoms on a daily or weekly basis.
• 90 per cent were not very confident in diagnosing and treating menopausal symptoms, citing reasons such as lack of training, knowledge and time.
• Women typically sought help only for well-recognised symptoms like hot flushes, night sweats, and sleep disturbances.

The Singapore Guidelines on Management of the Menopause Transition serves to address this disconnect in menopause care. Developed by a multi-speciality expert panel including gynaecologists, family physicians, endocrinologists, psychiatrists, oncologists, nursing and patient advocacy groups in Singapore, the Guidelines will be disseminated through partner organisations including the College of Obstetricians and Gynaecologists Singapore.

The Guidelines joins other evidence-based resources tailored by KKH MCHRI for the region’s multi-ethnic Asian population, covering areas such as gestational diabetes, perinatal nutrition and mental health, sexual health for women of reproductive age, child health and development.

¹Population trends: longevity

²1 Loh, F. H., Khin, L. W., Saw, S. M., Lee, J. J. M., & Gu, K. (2005). The age of menopause and the menopause transition in a multiracial population: A nation-wide Singapore study. Maturitas, 52(3-4), 169-180. https://doi.org/10.1016/j.maturitas.2004.11.004 

³Symptoms | The Menopause Society; Menopause, Women’s Health, and Work | Women’s Health | CDC

⁴HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy | FDA

⁵Phaik Ling QUAH, Rukshini PUVANENDRAN, Dypti LULLA, Farah Safdar HUSAIN, Jean-Jasmin Mi-Li LEE, Seng Bin AN, Kok Hian TAN, (2026). Menopausal Health in Singapore: A Survey of Women’s Menopause-Specific Quality of Life, and Knowledge, Attitudes, and Practices Among Women and Healthcare Professionals. Singapore Journal of Obstetrics & Gynaecology, 57 (1).

Annex A - Overview of the Singapore Guidelines on Management of the Menopause Transition

To access the Guidelines, please visit www.for.sg/menopause-guidelines.

Annex B – KKH study involving 1,461 women aged 45 to 65 years: Top 29 moderate-to-severe menopausal symptoms, from most to least commonly experienced

1. Weight gain
2. Difficulty sleeping
3. Head and/or neckaches
4. Vaginal dryness
5. Joint and muscle aches
6. Avoiding intimacy
7. Feeling tired or worn out
8. Hot flushes
9. Decrease in sexual desire
10. Feeling a lack of energy
11. Low backache
12. Dry skin
13. Sweating
14. Frequent urination
15. Feeling bloated
16. Being dissatisfied with my personal life
17. Decrease in physical strength
18. Involuntary urination when laughing or coughing
19. Decrease in stamina
20. Night sweats
21. Changes in appearance, texture, or tone of my skin
22. Feeling anxious or nervous
23. Feeling depressed, down or blue
24. Feelings of wanting to be alone
25. Experiencing poor memory
26. Flatuence (wind) or gas pains
27. Accomplishing less than I used to
28. Being impatient with other people
29. Increased facial hair