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How much do you know about menopause or its symptoms? This is a question women should concern themselves with because it’s a stage they’re bound to enter sooner or later. It’s a reality that must be lived, even though it’s not always wrapped in a bow.

As some women have shared, the road to menopause can be a struggle. But, you can choose not to turn it into a dreadful experience. The changes that your body is expected to go through is manageable, but to gain the upper hand, the key is to understand these transformations and how it can be dealt with.


The process that leads to menopause doesn’t happen overnight, rather it involves gradual changes. So, before you reach that stage, your body goes through a transitional phase called the perimenopausal period.

This prelude takes an average of three years and even stretches up to a decade in some women. It may kick in your late 30s and 40s as a result of declining ovarian function causing your estrogen levels to fluctuate. 

This hormonal see-saw can last for years and may result in a more symptomatic period for women. During this time you may start to notice irregularities in your menstrual cycle, but it can also cause other symptoms such as: 

A guide to Perimenopausal Symptoms - Dr Pamela Tan

Now you’re thinking, “Hey, this sounds like menopause!” 

This is usually where the misconception is. 

Most people think that these unpleasant symptoms are that of menopause, when in fact, these are hallmarks of perimenopause. However, these can also be referred to as symptoms of menopause because they indicate what is coming imminently. 

Perimenopause is the period where the “real action” happens. Unfortunately, there’s no way to predict in advance for how long the perimenopausal stage would last. This experience can vary for each woman, with some not even displaying any symptoms of being perimenopausal at all. However, one can get an idea as to when they might get into menopause based on their family history.

When exactly is Menopause?

Officially reaching menopause means that it has been a full year that you have not menstruated. To put it simply, it’s just that one day to mark the anniversary of your last period. 

In Western societies, the average age of menopause is 51, but in Singapore, it’s 49. However, menopause has a wide starting range, but it is usually expected within the ages of 42-58 – sometimes earlier.

If there’s no test to determine for how long perimenopause will run its course, for menopause, you can get a ballpark figure on when it may happen based on how old your mother and grandmother reached theirs. 

Reproductively, this is a major milestone because it marks the end of your fertility. Although for most women, the journey leading to it is riddled with discomfort, menopause is not a health problem, rather a natural phase in your life

Premature Menopause

When your menses have officially ceased for 12 consecutive months, but this happens before you reach 40, this is known as premature menopause or premature ovarian insufficiency

This can run in families, but there are external influences that affect your ovaries such as, medical treatments (e.g. chemotherapy, radiotherapy, ovarian surgery, hysterectomy) and lifestyle choices (e.g. smoking).

It can be hard for women to come to terms with a diagnosis of premature menopause, especially if they still desire to have a baby in the future. Besides infertility, this condition also increases a woman’s risk for osteoporosis, cardiovascular disease, and diabetes

So, if your period becomes infrequent, or has stopped before you reach 40, you must schedule a visit to your OB-GYN. You may be offered blood tests to measure hormone levels that will help diagnose premature menopause. 

Managing Menopause Symptoms

Fortunately, it’s not like you don’t have a choice over those uncomfortable symptoms. There are various treatments such as lifestyle changes, non-prescribed therapies, and prescribed interventions to help allay some effects.

1. Lifestyle changes

Lifestyle Changes - Dr Pamela Tan

You can minimise the blow of these symptoms with some lifestyle tweaks. For instance, eating a healthy diet should be established or improved to accommodate your metabolism which is now running at a snail’s pace. Together with regular exercise, this can help you maintain a healthy weight and improve sleep. You may also have to cut back on caffeine and alcohol to reduce night sweats and hot flashes. 

2. Non-Prescribed Therapies

Non Prescribe Therapy - Dr Pamela Tan

Herbal Medicines

Mother nature’s treatments can also help you manage your symptoms. Black cohosh and evening primrose oil have received quite a bit of scientific attention when research revealed that it can reduce the severity and frequency of hot flashes. You might have even heard of other popular names thrown out there such as Dong Quai, Red Clover, Ginseng, or Kava – and some women swear by them. However, you must take this with a grain of salt because herbal remedies have no established safety standards. It may also run the risk of interacting with any prescribed medications. Therefore, consult your doctor first before you consider this type of treatment. 

Alternative Therapy

Acupressure, acupuncture, and aromatherapy massage are some non-traditional treatments that can also be effective for some women. These have been tagged to improve symptoms like hot flashes, night sweats, and even anxiety. Again, this should be considered with advice from your doctor. 

Complementary Therapy 

Hypnosis, biofeedback and relaxation training are therapies that can be done alongside prescribed interventions to boost their results. 

Bioidentical Hormones

These are man-made hormones that are designed to be molecular copies of our natural hormones. However, concerns have been raised especially among custom-blended hormones for menopause because they tend to have unpredictable ingredient mixtures. This can pose reproductive risks which outweigh the relief of early menopause symptoms. 

3. Prescribed Interventions

Prescribed Interventions - Dr Pamela Tan

Hormonal Replacement Therapy (HRT)

HRT is a commonly prescribed treatment to relieve menopausal symptoms. It means being treated with the female hormones, estrogen and progestin since numbers decline as you approach menopause. 

HRTs offer the following benefits:

    • It can relieve hot flashes

    • Improve mood associated with menopause

    • It can improve sexual desire

    • Reduces vaginal dryness

    • Helps keep the bones strong, preventing osteoporosis

To know the different HRTs available for you, please check out the video below. 

However, this treatment is not for everyone, especially if you are pregnant, diagnosed with certain cancers, experiencing vaginal bleeding, have blood clots, have had a heart attack or stroke, or suffering from liver disease. 

Non-Hormonal Medications 

Medications can be prescribed to treat symptoms such as hot flashes. Some drugs can also be given to manage anxiety or depressive symptoms. 

Psychological Treatments

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that helps patients to modify dysfunctional thoughts, emotions, and behaviours. It can help with mood changes caused by hormonal fluctuations, and it may also help relieve associated symptoms like anxiety, depression, and even insomnia.


Stages of Menopause- Dr Pamela Tan

The post-menopause period starts the day after menopause – or pretty much the rest of your life. The transformation your reproductive system went through over the years can also have an effect during the post-menopausal period. For this, you must learn to adapt health-seeking behaviours that can help reduce the effects of menopause as you go into the next phase.

For the next couple of years, your body is exposed to the following changes and health risks: 

1. Bone changes

After the age of 35, it’s normal for men and women to experience a small amount of bone loss. But after menopause, you lose it at a rapid rate due to decreased estrogen levels. With excess bone loss, you increase your risk of osteoporosis which makes you vulnerable to fractures, particularly around the hips, spine, or wrist.

To keep bones strong in midlife, make sure that your fitness routine includes weight-bearing exercises. Do it regularly to slow down bone loss. Additionally, your diet must include foods high in calcium (dark leafy greens, dairy, and canned fish) and vitamin D (milk, orange juice, supplements, or 15 minutes of Singapore sunshine). You must also cut off any habit that compromises bone health, such as smoking. 

You may not notice your bones weakening just yet since it takes years before it shows any symptoms. A fracture is the first sign of the disease, which is why women above 65 are advised to get a bone mineral density test. 

2. Urinary incontinence

Almost half of post-menopausal women complain of urinary incontinence. Your low estrogen levels weaken the urethra, making you unable to control urine flow. You may have noticed this when you laugh, sneeze, cough, which is a common type called stress incontinence. To prevent this, you may empty your bladder as often as possible, control your weight, stay fit, or you can start doing regular Kegel’s exercise to strengthen your pelvic floor muscles. 

3. Sexual side effects

It is normal for changes to your sex life after menopause. Some say that they enjoy it more since they no longer have to worry about getting pregnant. However, others may no longer enjoy it as much. 

Decreased hormone levels can put a damper on your sex drive. It can even make sex less pleasurable as vaginal tissues become thinner and drier. A lot of women suffer in silence when they don’t need to because there are available treatments. If this is troubling you, don’t hesitate to seek professional advice from your gynaecologist. 

4. Heart attacks

The menopausal transition also breeds cardiovascular risk factors. This is even considered the biggest danger during the post-menopausal stage as rates of heart attacks spike roughly a decade in. 

Estrogen helps keep blood vessels flexible so they can easily contract and expand to accommodate blood flow. But, once it diminishes, this ability is lost giving way to problems like high blood pressure. This can thicken the walls of your artery which compromises blood flow making you vulnerable to heart attacks.

To protect yourself, you need to commit to a healthy lifestyle. There must be discipline in following diet modifications and regular exercise. If you have prescribed maintenance medications for high blood pressure, or any lifestyle disease, do take them regularly. 

5. Stroke

Premenopausal women are protected by the risk of cerebrovascular diseases such as stroke. As mentioned earlier, estrogen provides beneficial effects to blood vessels as it gives them more flexibility to expand to promote blood flow. However, for every decade after 55, the risk of stroke roughly doubles in women. The risk is further heightened in women with premature menopause. The low estrogen levels at this point triggers cholesterol build-up on artery walls including those that are in your brain. It results in this “brain attack” which is either caused by a blockage (ischaemic stroke) or rupture (Haemorrhagic stroke).

To prevent stroke, Singapore’s Health Promotion Board suggests the following: 

    • Eat healthily and in moderation

    • Keep blood pressure, cholesterol, and glucose under control

    • Exercise and maintain a healthy weight

    • Go for regular health screening and follow up

    • Avoid smoking

6. Gynaecological cancers

Cancers affecting your reproductive health are present even before menopause. However, you must still check for any warning signs such as bleeding after menopause. The risk increases as you age and in women who are undergoing hormone therapy to treat menopausal symptoms.

To maintain good gynaecological health during this reproductive milestone, you must seek regular cancer screening. You can read more about cancer screening in Singapore in our blog, here. If you have any bleeding after your menopause, you must seek attention immediately to rule out cancers of the womb and cervix. 


Some may look at menopause with a tinge of dread due to some horror stories shared by women who have gone through it or as played out in movies. While there’s truth to it, your journey doesn’t have to be that way. Now that you’re aware of what you could be going through in the coming years, you can prepare for it. With the right help, you can float your way through perimenopause with the least amount of issues, and even forge towards the post-menopausal period in good health.

We’re we able to tackle your concerns about menopause? For your questions and other concerns, you may book a consultation with Dr Pamela Tan today. 


Dr Pamela Tan
About Dr Pamela Tan

Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.