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.
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
that may mimic the
symptoms of menopause
include thyroid problems,
In Asian countries, the average age is
between 45 and 50 years.
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.
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.
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
Hot flushes can start about two years
before the final menstrual period
and peak about a year after the final
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
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
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.
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
It has also been shown that women
who are socially active have less
chance of getting dementia.
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
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
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
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.
The aim for women reaching
menopause would be to maximise her
quality of life. These include:
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.
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