Menopause treatment can help women stay in the workforce

Sinar Daily

6 days ago

KUALA LUMPUR - Lim Ai Jing feels like she has been a bad daughter.
When her 54-year-old mother called her to complain that she was not sleeping well, Lim dismissed her concerns, thinking they were normal gripes.
"And initially, I took it lightly. But then now, when I read through everything, it's like, oh my god, this can be quite serious,' Lim, 29, told Bernama via Zoom.
The 'everything' she was referring to is her research on perimenopause, the transition phase when estrogen levels in women start declining, and menopause, characterised by the end of the menstrual cycle for good, and their long-term effects on women's health.
Long considered a natural process that did not require any intervention, experts are now calling for a paradigm shift: recognising early menopause care not just as a matter of individual well-being but as a crucial strategy to prevent non-communicable diseases (NCDs) and save Malaysia and its people significant money and misery.
Malaysian Menopause Society president Dr Ho Choon Moy said too many people in the country are unaware of how serious untreated menopause can be for women, and only addressing it after they have developed issues like diabetes.
"There's zero budget for menopause. Most of the budget (go to conditions) like diabetes, big budget, you know? I mean, they are like treating the fire, they're putting out the fire but (not) the root cause (which is menopause),' she said on the sidelines of the Asia-Pacific Menopause Federation 10th Scientific Meeting here recently.
WHAT IS MENOPAUSE?
Menopause marks not only the end of a woman's reproductive years but also her increased vulnerability to developing various diseases. The average age of menopause in Malaysia is 50.7 years, though women may start the transition process (perimenopause) 10 years earlier.
In the foreword of the Ministry of Health (MOH) Clinical Practice Guidelines for the Management of Menopause, then-Health Minister Khairy Jamaluddin, wrote this:
"Menopause, a natural biological process that is accompanied by estrogen deficiency, will affect every woman. As the average age of menopause in Malaysia is around 50 years, one-third of the lives of women are going to be without the hormone estrogen, making them susceptible to a multitude of problems, ranging from social to medical issues such as coronary heart disease, non-communicable diseases, osteoporosis and cancers.'
Dr Ho said providing early menopause care, such as Menopausal Hormone Therapy (MHT), is a worthwhile investment as it will prevent many diseases and complications later on.
"Menopausal Hormone Therapy has long-term benefits. We are talking about preventing diabetes, hypertension, high cholesterol, heart disease, osteoporosis and fractures,' she said.
"When you treat all these women who are having symptoms now, it is cardiac protective. It actually protects the heart, you know.'
According to the 2013-2019 National Diabetes Registry, published by MOH, women constitute the majority of diabetic cases in Malaysia at 57.1 per cent. The report did not specify at what age the women were diagnosed with diabetes, whether they were receiving MHT or whether they outnumbered men due to their longer life expectancy.
Studies on hip fractures among elderly patients admitted to teaching hospitals in Malaysia found that most of the patients were women due to their lower bone density from osteoporosis. The average stay at the hospital was five days.
"Give, like, free menopause hormone therapy in the government clinic. Okay, that will cut down (the government's) health expenses 10 to 20 years down the road,' Dr Ho added.
THE ECONOMIC BENEFIT
On top of healthcare savings, experts argue that providing early menopausal treatment can fuel economic growth by helping some women stay longer in the workforce.
In several international studies, issues surrounding menopause have been cited as a significant cause of women exiting the workforce during middle age. While Malaysia has announced strategies, ranging from childcare or eldercare assistance to three-month paid maternity leave, to keep women in the labour force, menopausal symptoms have not made much headway in penetrating mainstream consciousness.
The impact of menopausal symptoms on Malaysian women in the workforce is a profound, yet largely unacknowledged, reality. As a recent study led by prominent obstetrician/gynaecologist and menopause advocate Dr Premitha Damodaran highlighted, common menopausal symptoms among multiethnic working women in Malaysia include joint pain, sleep disturbances, brain fog, mood swings and digestive issues.
Lim, who works as a clinical psychologist at Sunway Medical Centre Velocity, said many of the symptoms can be debilitating, regardless of whether the women are working or not.
"The most destructive symptom (is) sleep disturbance, and also the most important one that we cannot ignore is the cognitive problem, that is, concentration issues (or brain fog),' she said.
Brain fog can make it difficult to concentrate, remember crucial information or make quick decisions, impacting productivity in roles that require sharp cognitive function. Hot flashes, another menopausal symptom, can lead to embarrassment and discomfort in professional settings, while chronic fatigue from sleep disturbances erodes overall well-being and focus.
These symptoms have a carry-over effect. Striking women between the ages of 45 and 55, some of the symptoms have been severe enough for many women to report reduced productivity, leading them to decline promotions, reduce their working hours and resign early, according to studies conducted in the United Kingdom and Ireland.
This translates to a significant loss of experienced talent, invaluable institutional knowledge and leadership potential, particularly among women aged 45 to 60, who are often at the prime of their professional lives.
"You know, they have a lot of experience (by then). If they go, it's really a waste of resources,' said Dr Ho.
"(When we treat women's menopause symptoms) because they are healthy, they can continue working. They don't have to retire (early). And this will boost the economy of the country, the female workforce.'
Malaysia's female labour participation rate (FLPR) was 56.4 per cent as of May 2025, an increase from 56.2 per cent in 2023, according to the Department of Statistics Malaysia. Singapore had 62.6 per cent FLPR and Thailand 60.6 per cent FLPR in 2023. There is scant data in the Asia-Pacific region on whether menopausal symptoms are a significant factor for women exiting the workforce.
Menopause also increases the chance of developing mental health issues like anxiety and depression, while other physical symptoms like vaginal dryness, which makes sexual intercourse painful, may exacerbate the anxiety and depression. Mood swings and irritability may also affect family and social relationships, and cause them to break down.
"(Women experiencing menopause) easily get hot-tempered. Easily irritable. Become moody. Mood is unstable. Feel offended easily. Feel sad easily. This is what can sometimes cause problems between the husband and wife,' said Prof Dr Nik Hazlina Nik Hussain, vice president of the Malaysian Menopause Society.
She said open and honest communication between a husband and wife is crucial so that the wife will feel supported to go seek help to alleviate her menopausal symptoms. The same goes for husbands, who may be suffering from erectile dysfunction.
AVAILABLE BUT UNPOPULAR
MHT, an umbrella term that covers all hormonal treatments including contraceptives and hormonal replacement therapy (HRT), is the recommended treatment for relief of menopausal symptoms. For instance, the Clinical Practice Guidelines Management on Menopause Care states that estrogen therapy may be cardio protective when started within 10 years of menopause or for women less than 60 years of age compared to older postmenopausal women.
Despite acknowledging the benefits of MHT in preventing cardiovascular diseases, the guidelines do not recommend it for primary or secondary prevention of coronary heart disease in women.
Other factors also influence the low uptake of MHT in the Asia-Pacific region. Studies have cited factors such as cultural stigma and taboo, and misinformation and fear.
Dr Nik Hazlina said the ignorance is often generational and women, especially those in rural areas, tend to see menopause as a natural part of ageing and something to be endured.
"Although menopause is a natural physiological process, it can produce debilitating symptoms,' she said.
This ignorance is not only rife among the public but also among the medical and healthcare sector, even in gynaecology.
One woman, who asked to be identified as Nadirah, told Bernama that an oncologist acquaintance warned her to only take her hormonal replacement therapy (HRT) for five years for fear of developing breast cancer.
Dr Ho was not surprised to hear Nadirah's story, saying that she has seen patients who had been put on MHT by one doctor, only to be taken off it by another.
"And the patient came to see me, saying 'Doctor, I'm confused, my GP (general practitioner) gave me MHT, but the gynaecologist asked me to stop',' she said.
While there are small risks to going on MHT, menopause experts said the risk is largely dependent on the type of treatment.
For example, taking combined HRT - estrogen and progesterone - increases the breast cancer risk slightly - by about 0.4 percent according to the Health Services Executive, Ireland's national public health and social care provider - over those not taking it. But taking estrogen-only MHT, especially for women with no uterus, will not increase breast cancer risk.
There is also non-hormonal menopause care, usually recommended for women breast cancer patients or women with a family history of cancer, if they are concerned about developing breast cancer. But they are only for symptom relief and will not protect against cardiovascular diseases, osteoporosis and other NCDs.
Dr Ho blamed patriarchy for the lack of awareness of menopause's effects among doctors whom the public relies on for medical and health information
"We need to really educate doctors. I mean, in medical school, they only have like one small chapter on menopause, that's all. They don't really concentrate on menopause,' she said.
Lim agreed. She said when she was doing her degrees to qualify as a clinical psychologist, the curriculum did not consider menopause as a root cause for any mental health issue.
"They asked us to look into hypothyroidism because it (presents) similarly as anxiety symptoms. We were always told to look for bipolar, for other physical issues. But no one asked us to look at menopause,' she said.
When asked what she planned to do with her newfound knowledge on menopause, she said she would start by taking her mother's complaints seriously.
"I think it's time for me to sit down and talk with her about this and see how I can help with her sleep,' she said, smiling. - BERNAMA