Menopause: What to expect

While you may know what menopause is, you might be wondering “when does menopause start?” and “what can I expect when it does?” Here, DR JUNE TAN SHEREN from Osler Health International explains what happens to the body during menopause and the stages that come with it: premenopause, perimenopause and postmenopause. Plus, expert tips for managing menopause symptoms.

What is menopause?

Menopause is a natural, normal event. It occurs when your ovaries stop producing eggs, resulting in lower levels of oestrogen and other hormones. These low levels of oestrogen can affect different systems in the body such as your bones, heart, brain, skin, genital area and urinary system. The stage of menopause is usually confirmed when a woman has not had her period for 12 consecutive months.

When does menopause start?

If you’re wondering, “When does menopause start?”, the answer isn’t exactly straightforward. It really depends on the woman. The average menopause age is 51 years. However, it can occur at any time between 45 and 55.

Menopause is considered premature when it occurs before a woman turns 40. Early menopause may run in the family but can also be caused by an underlying medical condition.

What is premenopause and is it the same as perimenopause?

Both are the transition periods that precede menopause. Premenopause is the time in your life before any menopausal symptoms occur. Perimenopause is when you experience menopausal symptoms due to your hormone changes, but still get your period.

Changes in the timing of a women’s menstrual period are usually the first sign of perimenopause. Most patients find their cycles getting shorter or longer, or periods getting lighter or heavier.

However, while menstrual changes are very common, it’s important to be aware that these changes are not always menopausal. I ask my patients many questions about the changes they’ve observed and often will perform a gynaecological examination. If there are any red flags, it’s necessary to exclude other causes of menstrual changes. Uterine fibroids for example, are common in this age group and can cause excessively heavy periods.

What symptoms do you find mostly with your patients in Singapore?

Hot flashes and night sweats are frequently reported. Many women ask if they are feeling hot just because of our weather here in Singapore, while others report drenching night sweats despite turning the air-conditioning to the max. Also, many don’t realise that the glass of wine at dinner is likely to worsen hot flashes at night. The severity of symptoms is variable and tends to fluctuate as well.

What other symptoms can be expected?

The most common symptoms include:

• anxiety or mood changes;
• brain fog – including memory problems and poor concentration;
• difficulty sleeping;
• joint pains;
• vaginal dryness;
• loss of libido;
• weight gain; and,
• overactive bladder or bladder discomfort.

Of course, each woman’s experience is different. Not all these changes are hormone-related, and most are expected to resolve after menopause.

What kinds of treatments exist?

One of the most common questions I get is, “Does menopause need to be treated if it’s a natural process?” My answer is, “Indeed, it is normal and natural, and no treatment is needed if a woman going through menopause does not have troubling symptoms.”

However, if there are unusual, troublesome or debilitating symptoms that affect your wellbeing, it’s important to see your doctor for a proper evaluation. There are effective treatments for some symptoms ranging from herbal, natural remedies to hormone replacement therapy. Consult your doctor about which is best for you, as some treatments may not be suitable depending on your medical and family history. Treatment that is individualised ensures the most effective and safest outcome.

What are your top tips for managing menopause symptoms?

Keeping well and staying well, both physically and mentally, goes a long way in successfully managing menopause. In fact, mental wellbeing is an essential aspect here, and something that needs to be worked on continuously. Four more important ways to manage menopause symptoms include:

#1 Adopting a healthy lifestyle and diet

This not only helps to alleviate symptoms, but also achieves good physical and mental health, cardiovascular health and bone health. Good nutrition should include adequate calcium, iron and B12 in the diet.

#2 Exercising regularly

Exercising regularly not only helps manage menopause symptoms, but also reduces cancer and cardiovascular risks, and helps prevent osteoporosis.

#3 Reducing alcohol intake and stop smoking

Lowering your alcohol intake can reduce symptoms of menopause, and  lower cancer and osteoporosis risks. Quitting smoking is also key.

#4 Getting quality sleep

Achieving good quality sleep can be challenging. However, it’s an important first step in ensuring a good sleep routine.

Got more questions about menopause?

For more information on menopause and perimenopause, speak with your physician. Dr June Tan Sheren has been seeing women from the international community for their menopause for many years.

Excellent resources can also be found on the websites for The North American Menopause Society, Australasian Menopause Society, Menopause Matters  (in association with the British Menopause Society) and NIH (National Center for Complementary and Integrative Health).

Osler Health International
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