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Think menopause symptoms start at 50? Debunking myths about the change
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In Singapore, women typically reach menopause at the average age of 49, or between 45 and 55.
SINGAPORE – There are prevalent misconceptions about menopause, including confusion about when it occurs, what symptoms are 'normal', and how long they last.
Some, for instance, may not know that women can spend several years in perimenopause – the period leading up to menopause – with symptoms such as joint pain and hot flushes.
Fatigue, mental health issues and memory lapses may also occur during perimenopause, but women, who would still be having their periods – although irregularly – could mistake these symptoms as normal signs of ageing.
Many also do not realise that the hormonal changes that start from perimenopause affect not only the woman's reproductive organs, but also her whole body, said Associate Professor Rukshini Puvanendran, co-director of the KK Menopause Centre at KK Women's and Children's Hospital.
The centre, launched In October 2023, is a multi-speciality practice comprising gynaecology, family medicine, dermatology and mental health specialists. It has been managing an average of 60 new cases a month.
The number of women with perimenopausal and menopausal symptoms seeking help is expected to rise due to increasing awareness and an ageing population, said Prof Rukshini, who is also the head and senior consultant at KKH's Family Medicine Service.
She discusses perimenopause and debunks some of the myths surrounding it in the Aug 6 episode of the ST Health Check podcast hosted by senior health correspondent Joyce Teo.
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Myth #1: I won't have menopause symptoms till I am 50
In Singapore, women typically reach menopause at the average age of 49, or between 45 and 55. This is the point when menstrual periods have ceased for 12 consecutive months, a result of declining hormone levels.
However, a woman is in perimenopause when her periods become irregular and she has signs of low oestrogen levels such as hot flushes or night sweats, provided there is no other diagnosis. These symptoms typically surface a few years before menopause, but they can last up to 10 years prior to that.
Perimenopause generally happens around the early 40s to early 50s, although most women become aware of the transition in their mid- to late 40s. Some women may even experience symptoms as early as their late 30s.
Perimenopause is typically diagnosed based on symptoms. Given the fluctuation in hormone levels, a blood test may not always provide more insights than the symptoms, said Prof Rukshini.
Myth #2: Hot flushes is the top menopausal complaint
Hot flushes and night sweats are the commonly known signs of menopause, but they are not the most reported issues here.
In Singapore, researchers have found that aches in the muscles and joints are the top menopausal complaint among women, affecting between 30 and 40 per cent of them.
This was established in 2023 in two studies conducted by the National University Hospital and the National University of Singapore Yong Loo Lin School of Medicine under a longitudinal study of midlife women in Singapore called the Integrated Women's Health Programme.
Not every woman will complain of aches or hot flushes. Some women experience numerous symptoms that significantly impact their daily lives, while others may have very few or mild symptoms.
Myth #3: Perimenopause only affect the reproductive system
Hormonal changes during perimenopause can affect a woman from head to toe – from her skin, brain, teeth, heart and bones to her muscles and emotions. It may leave women feeling vulnerable and uncertain.
There can be physical symptoms such as night sweats, sleep disturbances, memory problems and vaginal dryness, as well as emotional symptoms such as unexpected mood swings, depression and decreased sex drive. Hormonal changes can even impact bone and joint strength.
Some women may also have heart palpitations or the feeling that their heart is racing. Prof Rukshini had a patient who had palpitations even though her heart rate, which she had measured with her wearable device, was normal.
The patient, a doctor, sought help from a cardiologist, who found nothing amiss after giving her a full cardiac evaluation. She later went to see Prof Rukshini for her hot flushes, and after going on hormone replacement therapy felt that her palpitations went away.
Myth #4: Menopause lasts for a few years
Once a woman has reached menopause, she is in it for the rest of her life, said Prof Rukshini. This is also called the post-menopausal stage of her life, and women today are probably spending more than one third of their lives in post-menopause.
Menopause symptoms are at their highest intensity during perimenopause. Symptoms, such as hot flushes, usually end within five years after the final period, though some women experience them well into their 60s, she said.
Other symptoms of low oestrogen levels, such as vaginal dryness, pain during sexual intercourse, bone loss, and skin and hair dryness, will continue throughout life as the body is unable to produce adequate estrogen.
Myth #5: Painful sex and urinary tract infections are a part of getting older
Some women experience painful sex, frequent urinary tract infections or urinary incontinence after menopause. Symptoms associated with changes in the genital and urinary systems are collectively known as the genito-urinary syndrome of menopause.
The syndrome can be safely treated with vaginal oestrogen in the form of a cream or a tablet. Unlike menopausal hormone therapy, vaginal oestrogen has a much lower dose of the hormone.
Prof Rukshini has patients as old as 90 on this treatment to prevent vaginal pain and discomfort. Their urinary incontinence symptoms will also improve and they have less frequent urinary tract infections.
Myth #6: Menopausal hormone therapy (MHT) will give me breast cancer
Women who reach menopause early are usually treated with MHT until the natural menopause age of 49. There is data to show that women in early menopause who are not treated will have worse health outcomes like heart disease, strokes and osteoporosis, said Prof Rukshini.
MHT is the most effective treatment for vasomotor symptoms (hot flushes and night sweats) and genito-urinary syndrome of menopause (vaginal dryness and associated urinary symptoms).
It has been shown to be generally safe for most women below the age of 60 who have bothersome menopausal symptoms, when given within 10 years of the menopause.
