Menopause is a natural and inevitable milestone in every woman’s life, marking the end of her reproductive years. This complex biological process often brings about a myriad of physical, emotional, and psychological changes, which can be challenging to navigate without the right information and support.
Throughout this article, we will dive into various aspects of menopause, from understanding its underlying mechanisms to recognizing common symptoms and potential treatments. We will aim to equip women with the knowledge they need to make informed decisions about their health and well-being during this significant life transition.
What is Menopause?
Menopause is a natural biological process that signifies the end of a woman’s reproductive years. Although often perceived as a single event, menopause is a gradual transition that encompasses various physiological changes. This article delves into the intricacies of menopause, providing clarity and insight to help demystify this significant phase in a woman’s life.
Menopause is marked by the permanent cessation of menstruation and the decline in the production of hormones such as estrogen and progesterone. This change occurs as a woman’s ovaries gradually decrease their function and ultimately stop releasing eggs.
What is the Age Range for Menopause?
The age range for menopause varies among women, but it typically occurs between the ages of 45 and 55, with the average age being 51. It is important to note that menopause can happen earlier or later, depending on various factors, including genetics and lifestyle choices.
Natural vs Induced Menopause: What’s the Difference?
There are two main types of menopause: natural and induced. Natural menopause is the result of the gradual decline in ovarian function over time, whereas induced menopause occurs due to medical interventions, such as a hysterectomy, chemotherapy, or radiation therapy, which directly or indirectly impact the functioning of the ovaries.
Causes of Menopause
While menopause is primarily associated with the gradual decline in ovarian function, various factors can contribute to its onset. We’ve identified four causes of menopause.
1) Natural decreasing production of oestrogen and progesterone
The ovaries start producing less oestrogen and progesterone when the woman is in her late 30s. By their 40s, the menstrual periods become irregular – with some longer or shorter, or heavier or lighter.
2) Surgical removal of the ovaries (Oophorectomy)
Expect immediate menopause if the ovaries are removed surgically. Periods will stop and the woman will experience other menopausal symptoms such as hot flashes with greater severity compared to a gradual natural decline in hormones.
3) Chemotherapy and radiation therapy
These cancer treatments can cause menopause, so the woman may experience hot flashes and other symptoms both during and after treatment. With chemotherapy, however, the cessation of menstruation is not permanent, so a woman can still take birth control measures. In the case of radiation therapy, expect the ovarian function to be affected if the radiation is being delivered directly to the ovaries.
4) Primary ovarian insufficiency
This is a condition wherein 1 per cent of women experience menopause before the age of 40. This develops due to the inability of the ovaries to produce normal levels of reproductive hormones as a result of genetics or an autoimmune disease. More often though, no cause of premature menopause can be identified.
Symptoms of Menopause
The symptom of menopause falls into three categories, namely physical, emotional, and social changes:
Physical Symptoms
– Hot flashes
– Night sweats
– Body aches and pains
– Dry skin
– Vaginal dryness
– Loss of libido
– Urinary frequency
– Sleeping problems
Emotional Symptoms
– Mood swings
– Depression
– Anxiety
– Inability to concentrate
– Loss of interest
– Persistent negative thoughts and self-blame
– Suicidal feelings
Social Changes
– End of childbearing period
– Retirement
– “Empty Nest Syndrome”
Treatment Options for Menopause
As each woman’s menopause journey is unique, finding the right treatment options to alleviate symptoms and promote well-being is paramount. Let us take a look at the types of treatment for menopause:
Hormone Therapy
Hormone therapy, also known as Menopause Hormone Therapy (MHT), is a common treatment for menopause symptoms. It involves taking small daily doses of oestrogen and progesterone under the guidance of a doctor. Traditionally, MHT was commonly recommended for menopausal women due to its effectiveness. However, recent findings have raised concerns about the safety of long-term MHT use.
While MHT can be beneficial for women in their 40s and 50s, it is crucial to carefully weigh the potential benefits against the associated risks. Studies have shown an increased risk of side effects, including blood clots and breast cancer, in women undergoing MHT. Therefore, the routine recommendation for long-term MHT use has changed.
Current guidelines now advise against routine MHT use, especially for extended periods. Instead, MHT may be considered for a short duration, typically around 3-6 months, in cases of severe menopausal symptoms. However, it should be noted that even in such cases, the potential risks and individual patient factors should be thoroughly evaluated.
Natural plant-based hormones, such as phytoestrogenic compounds found in tablets (e.g. menoflavon) for relieving menopausal symptoms, are generally regarded as safer than synthetic hormones. However, their effectiveness may be less significant in comparison to synthetic hormone options.
Ultimately, the decision regarding hormone therapy should be made in consultation with a healthcare professional, considering the specific circumstances, risks, and benefits for each individual patient. It is important to prioritise the overall well-being and health of menopausal women while minimising potential risks.
Non-Hormonal Treatments
There are non-hormonal treatments for hot flashes. The anti-epileptic medication Gabapentin has been found effective in reducing menopausal hot flashes. The anti-hypertension drug Clonidine is also good for treating hot flashes and reducing night sweats.
The use of antidepressants is the ideal choice for menopausal depression because they are relatively safer than MHT. The drugs commonly used are Serotonin Reuptake Inhibitors (SSRI), such as Sertraline, Paroxetine, Fluvoxamine, and Escitalopram. Escitalopram has also been found to be effective with hot flashes. Other medications that may be prescribed are Mirtazepine and Venlafaxine.
Lifestyle Changes
There are some self-help strategies that you can take, especially for the relief of the discomfort of hot flashes. Always eat a healthy diet and exercise regularly. These strategies include the use of a fan or facial spray, dressing in loose and light clothing, drinking cool beverages, as well as avoiding spicy food, red meat, caffeine and alcohol. To help relieve the emotional burdens of menopause, you can try stress reduction techniques, such as yoga and meditation.
Emotional and Social Changes During Menopause
Emotional and psychological problems may be noted especially during the menopausal stage. Women are especially vulnerable due to fluctuations in their hormone levels interplaying with psychological/emotional factors.
Because they perceive that they are no longer fertile, women experience loss of identity and purpose. With the end of their reproductive functioning, they feel that they have lost their sense of womanhood.
This may be further aggravated by social changes, such as the children growing up and leaving home (“empty nest syndrome”). Women may also end up feeling depressed if they are experiencing marital difficulties.
Prolonged depression and anxiety during menopause are not normal and affected women are advised to seek medical consultation in order to regain their emotional stability. They should also seek out support and guidance from other women who are experiencing the same menopausal symptoms. It is advised that women continue to stay socially active and engaged, so that they can better adapt to the changes of menopause.
Living Your Best Life After Menopause
Going through menopause involves embracing the new chapter of your life, taking care of your physical and emotional health, and finding fulfillment and connection in your post-menopausal years. By accepting the changes that accompany menopause and proactively nurturing your well-being, you can create a strong foundation for a vibrant, fulfilling future.
If you believe you are experiencing symptoms of menopause, it is best to schedule a visit with an O&G specialist.
Reviewed by Dr Phua Soo Mear and Dr Loke Kah Leong on 18 July 2023.
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Dr Phua Soo Mear
Obstetrics & Gynaecology
Gynae Health Clinic Pte Ltd
A wholly owned subsidiary of 
Singapore Women’s & Children’s Medical Group
Blk 211 Hougang Street 21
#01-289
Singapore 530211
Tel: +65 6282 8960
Dr Phua Soo Mear is a medical specialist in Obstetrics & Gynaecology with almost 30 years of experience. Dr Phua Soo Mear graduated from National University of Singapore in 1983 with the degree of MBBS. He was awarded the Ministry of Health specialist traineeship in Obstetrics and Gynaecology in 1986. Dr Phua passed the Membership examination of the Royal College of Obstetricians & Gynaecologists in 1989. He was awarded Fellow of the Royal College of Obstetrician & Gynaecologist in 2003. Dr Phua worked in the O&G departments at the former Toa Payoh General Hospital and Kandang Kerbau Hospital from 1986 to 1992. He started the Gynae Health Clinic at Kovan in 1993.
Dr Loke Kah Leong
Obstetrics & Gynaecology
Singapore Women’s Clinic (Tampines) Pte Ltd
A wholly owned subsidiary of Singapore Women’s & Children’s Medical Group
Blk 821 Tampines Street 81
#01-216
Singapore 520821
Tel: +65 67863188
Dr Loke Kah Leong is an Obstetrics & Gynaecology specialist with extensive years of experience in the management of obstetrics and gynaecological conditions and practices at Singapore Women’s Clinic (Tampines). He has been in private practice since 1991 and provides general obstetric and gynaecological services. These include preconception health screening, antenatal care, pre-natal diagnosis, ultrasounds, pap smears, female fertility issues, contraception, and management of common gynaecological problems.
