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​Menopause: What is it

Menopause is an important health milestone in the life of a woman. It is a natural event characterised by the permanent cessation of menses due to the loss of function of the ovaries. Most women breeze through this lifestage with little or no issues while some have bothersome symptoms that require medical assistance.

How do we diagnose menopause?

Natural menopause is defined by the permanent cessation of menstruation for 12 consecutive months. The diagnosis is retrospective and laboratory tests are only required to exclude other medical reasons that may mimic menopause symptoms. Conditions that may mimic the symptoms of menopause include thyroid problems, tumours, certain medications etc.

What is the average age for natural menopause?

In Asian countries, the average age is between 45 and 50 years.

What are the factors that can affect the age of natural menopause?

Genes are important in determining the age of menopause. Smoking has been shown to bring forward the age of menopause by about 2.5 years. Chemotherapy and surgery involving the pelvic organs can also cause one to reach menopause at an earlier age.

Symptoms of Menopause

It is known that progression through the menopause transition is associated with sleep disturbances. However, there appears to be a strong association with hot flushes. In fact, after correcting for hot flushes, there seems to be no effect of menopause transition on sleep.

Other factors that can affect sleep include depressed mood, anxiety, joint pain, backache, stress, caffeine intake. Hence, the management of problems of sleep includes sleep hygiene and addressing some of the other potential causes that can affect sleep.

Hot Flushes
The usual experiences of hot flushes are short-lived, lasting between 5 to 10 minutes each episode. Anyone experiencing ‘hot flushes’ of more than 30 minutes at one stretch should seek medical advice to exclude other medical conditions. Hot flushes can start about two years before the final menstrual period and peak about a year after the final menstrual period.

It is common for women to blame menopause for their mood swings. However, in large community studies, there appears to be no association. In a group of women with previous history of depression or life stressors, menopause can trigger depression. Sleep disturbances can also serve as a trigger for mood changes during the menopause transition.

Management of Menopause

Lifestyle Modifications

Sleep Hygiene

Improving sleep hygiene often can reduce the disturbances in sleep during menopause transition. This would include avoiding stimulants like excessive caffeine, creating a conducive sleeping environment by setting aside the bedroom only for sleep and not other activities like watching the TV, playing games on smartphones or tablets.

Regularise sleep by getting to bed at the same time everyday. Avoid exercise near bedtime as it can delay the time needed to get to bed.


Exercise is important in improving health and in reducing many chronic diseases like diabetes mellitus and hypertension. Maintenance of muscle strength can also reduce the risk of falls and hence fractures as well as reduce the likelihood of body aches which are commonly experienced in Asian women. Improve on sleep hygiene for better sleep during menopause transition.

Maintenance of a healthy body weight may also reduce the incidence of hot flushes as there will be less body fat to insulate the body.

Active Social Life

Maintaining an active social life by connecting with friends can improve mood and provide a source of support during this change in the stage of life where many new challenges may surface. It has also been shown that women who are socially active have less chance of getting dementia.

Stress Management

While it may be near-impossible to avoid stress in the modern society, techniques to reduce stress in life, such as mind-body therapies, yoga, tai-chi, meditation, etc can reduce the effect of stress on the mind and hence the body.

Medical Treatment

Hormone therapy remains the most effective treatment for hot flushes. However, the benefits must be weighed against risks of breast cancer, heart attack and strokes for individuals. Bio-identical hormones have been touted as ‘natural’ and ‘safe’. However, there is no current evidence that it is safer than approved hormone therapies.

Non-hormonal Therapies

Anti-depressants and some other medications have been used in women where hormone therapy is contraindicated with some limited success. Phytoestrogens have inconsistent results with potential for causing the inner lining of the uterus to thicken in one long-term study over five years.

For black cohosh, in a review, there appears to be no conclusive evidence in the efficacy. Evening Primrose has also not been shown to be effective. As for Vitamin E, there is limited data to support its use in menopause and in some studies, it could potentially cause more severe flu symptoms.

Take Stock of Your Life

The aim for women reaching menopause would be to maximise her quality of life. These include:

  1. Know your risks. Find out from your family members and determine if there are certain diseases that are more common in your family.
  2. Prevention of illness through appropriate vaccines. E.g. Flu vaccine or herpes zoster vaccines.
  3. Reduction of risk of chronic diseases like hypertension, diabetes mellitus, hyperlipidaemia and osteoporosis through healthy eating and exercise.
  4. Early detection of chronic diseases and cancer through regular screening. (See table below)

Menopause is an important health milestone for women to reassess their health. A healthy lifestyle is the cornerstone for maintaining the health and quality of life of menopausal women.