Menopause Management

Menopause is a natural, biological transition in a woman’s life marking the end of her reproductive years. It usually occurs between the ages of 45, and 55 years old, with the average age in Singapore being around 49 years old. 

While menopause is a natural part of ageing, various factors such as lifestyle, genetics, diet, and overall health can influence when it begins. For some, it arrives earlier due to medical treatments or health conditions, while for others, it may come later. 

Menopause is a sign of transition, not decline. At Holistic Gynaecology & Fertility, we believe that the right support and personalised care can help women navigate menopause smoothly and age gracefully with strength and radiance. 

What is Menopause?

Menopause occurs when the ovaries cease producing the hormones oestrogen, and progesterone, leading to the end of menstrual periods. This transition does not happen overnight. It is a gradual process that includes several stages.

The condition is officially diagnosed when a woman has not had a menstrual period for 12 consecutive months, without any other biological or medical cause.

Hormonal changes can significantly affect physical, emotional, and mental wellbeing. While some women experience minimal discomfort, others may face symptoms that impact daily life and relationships.

Stages of Menopause

The stages are as follows:

STAGE	CHARACTERISTICS	DURATION
Perimenopause	Begins as hormone levels fluctuate, leading to irregular periods, hot flushes, and mood changes.	4 to 10 years.
Menopause	12 months without a period, with major hormonal shifts accompanied by more noticeable symptoms.	Onset of 1 year.
Postmenopause	Symptoms may persist or stabilise, with long-term health shifts.	Remainder of life.

How does Menopause happen?

Menopause is triggered by the natural ageing process of the ovaries. As women age, the ovaries gradually produce less oestrogen, and progesterone. These hormonal shifts lead to less frequent ovulation, which in turn causes irregular menstrual cycles and eventually, the cessation of periods.

However, menopause may also occur prematurely due to medical interventions such as surgery (hysterectomy), chemotherapy, radiation as well as underlying medical conditions.

Are there any complications associated with Menopause?

Although menopause is natural, it does have the potential to increase the risk of certain health complications due to the decline in hormone levels.

Some of these complications include:

• Heart disease – the declining levels of oestrogen may impact cholesterol, and blood pressure.
• Mental health – due to the fluctuating hormone levels, anxiety, depression, and mood swings may intensify.
• Osteoporosis – the lower oestrogen levels can cause bone thinning, thereby increasing fracture risk.
• Urinary incontinence – the weakened pelvic floor muscles may lead to leaks or urgency.
• Vaginal dryness – vaginal dryness occur due to reduced lubrication, thus causing discomfort, and affect intimacy.
• Weight gain – the slowed metabolism combined with hormonal changes lead to weight shifts.

Symptoms of Menopause

The symptoms vary in type, and intensity, but common signs include:

• Anxiety, and depression
• Brain fog or memory issues
• Fatigue
• Hot flushes
• Irregular or missed periods
• Low libido
• Mood swings
• Night sweats
• Sleep disturbances
• Thinning hair or dry skin
• Vaginal dryness
• Weight gain

How can symptoms worsen?

Menopause symptoms can worsen due to several lifestyle, and health factors. Some of the factors that can intensify menopausal symptoms are:

• Alcohol – alcohol consumption has been known to exacerbate sleep issues, and mood fluctuations.
• Chronic stress – stress is associated with increased anxiety, and mood swings.
• Lack of physical activity – the lack of exercise or physical activity may worsen weight gain, and mood problems.
• Poor diet – nutritional deficiencies due to poor diet can increase fatigue, and bone loss.
• Smoking – smoking increases hot flushes, and may trigger earlier menopause.
• Underlying health conditions – health conditions such as thyroid issues, diabetes, and others may mask or magnify the symptoms.

Hormonal changes during Menopause: What to expect

It goes without saying that menopause brings about a series of hormonal changes that can significantly influence a woman’s physical, emotional, and mental wellbeing. These changes do not happen all at once, but rather progress gradually, beginning in the perimenopausal phase, and continuing into postmenopause. As such, understanding these shifts can help women make informed choices about managing their health during this time.

Hormonal shifts

The primary hormonal changes involve a decline in oestrogen, and progesterone, the key hormones produced by the ovaries. As ovarian function slows, these hormones drop to consistently low levels. In response, the body increases production of follicle-stimulating hormone (FSH) in an attempt to stimulate the ovaries, which no longer respond as they once did.

These hormonal imbalances cause the symptoms commonly associated with menopause, such as hot flushes, mood swings, and changes in menstrual patterns. The reduction in oestrogen in particular has far-reaching effects on many body systems.

Impact on fertility 

Oestrogen, and progesterone are essential for the menstrual cycle, and ovulation. As their levels fall:

• Ovulation becomes irregular – making it more difficult to predict fertile windows.
• Periods become less frequent – and may vary in flow, and duration.
• Eventually, ovulation stops altogether – leading to the end of natural fertility.

Impact on overall women’s health

Hormones like oestrogen do more than regulate reproduction as they also play a vital role in maintaining long-term health. When these hormone levels decline:

• Bone health may deteriorate – oestrogen helps maintain bone density. As such, its loss can lead to osteopenia, and osteoporosis, increasing the risk of fractures.
• Heart and blood vessel health may suffer – oestrogen supports healthy cholesterol levels, and flexible blood vessels. Its decline can result in increased LDL (bad) cholesterol, reduced HDL (good) cholesterol, and a higher risk of cardiovascular disease.
• Insulin resistance can increase – raising the risk of type 2 diabetes in some women.
• Metabolism slows down – many women notice weight gain, particularly around the abdomen, even if their diet, and activity levels remain the same.

How does Menopause affect quality of life?

The hormonal shifts during menopause can deeply affect day-to-day wellbeing, such as:

• Energy levels – many women feel persistently fatigued during menopause, even after adequate rest.
• Mood changes – hormonal fluctuations can contribute to feelings of sadness, anxiety or mood swings, especially in those with a history of mental health challenges.
• Sexual wellbeing – vaginal dryness, reduced libido, and discomfort during intercourse are common and can impact intimacy and relationships.
• Sleep disturbances – hot flushes and night sweats can disrupt sleep, leaving you tired and irritable.

How is Menopause diagnosed?

Menopause is typically diagnosed based on a combination of your symptoms, age, and medical history. It is not usually a single test that confirms menopause, but rather a clinical evaluation that considers several factors.

For most women over the age of 45, doctors rely primarily on the nature and pattern of symptoms. However, additional tests may be used to rule out other conditions or confirm hormonal changes, particularly in women who experience early or premature menopause.

Diagnostic methods include:

METHOD	DESCRIPTION
Detailed medical history and symptom review	Our doctor will ask about changes in your menstrual cycle, sleep patterns, mood, and any physical symptoms such as hot flushes or vaginal dryness. This helps form a clinical picture of where you are in the menopausal transition.
Blood tests to assess hormone levels	Levels of FSH (follicle-stimulating hormone) are often elevated during menopause, while oestrogen levels drop. These tests can support a diagnosis, especially if symptoms appear before age 45 or periods have stopped suddenly.
Bone density scans (DEXA scan)	A significant drop in oestrogen can lead to bone loss. If you are at risk for osteoporosis, especially if menopause occurred early, our doctor may recommend a scan to assess bone strength.
Thyroid function tests	Because underactive thyroid (hypothyroidism) can mimic menopausal symptoms like fatigue, weight gain, and mood changes, doctors may test your thyroid hormones to rule out this possibility.

Why diagnosis takes time

Diagnosing menopause is not always straightforward. Hormone levels naturally fluctuate during perimenopause, and symptoms can overlap with other conditions such as thyroid dysfunction, depression or chronic fatigue syndrome. This is why some women wait months, or even years, for a clear diagnosis.

As such, a holistic, and patient-centred approach ensures that symptoms are not dismissed, and that appropriate care begins as early as possible.

How is Menopause treated?

While menopause is a natural transition, and not a disease, its symptoms can be disruptive, and may require medical attention. Oftentimes, treatment aims to relieve symptoms, protect long-term health, and enhance quality of life. 

It should be noted that every woman’s experience of menopause is unique, and treatment plans should reflect her individual needs, preferences, and medical history. During the initial phase, treatment plans may include:

TREATMENT PLAN	DESCRIPTION
Personalised care plans	We create tailored care strategies that take into account the severity of symptoms, your age, overall health, and personal preferences. We combine medical guidance with lifestyle, and emotional support to ensure a comprehensive approach.
Lifestyle guidance	Simple changes in diet, physical activity, stress management, and sleep hygiene can significantly ease symptoms, and improve wellbeing. In fact, lifestyle-based interventions are usually the first line of care for many women.
Medical interventions	If symptoms are severe or affect your daily life, medical options, both hormonal and non-hormonal, may be recommended.

Medical interventions

Speaking of medical interventions, our doctors may recommend one of the following treatments:

Hormonal Therapy

Hormone Replacement Therapy (HRT) is one of the most effective treatments for managing moderate to severe menopausal symptoms. It works by replacing the oestrogen your body is no longer producing, helping to regulate temperature, mood, sleep, and vaginal health.

• Oestrogen Therapy (ET) – ideal for women who have had a hysterectomy. It involves only oestrogen, and offers effective relief from hot flushes, night sweats, and vaginal dryness.
• Oestrogen-Progesterone Therapy (EPT) – for women with an intact uterus, this combination therapy adds progesterone to reduce the risk of endometrial cancer. EPT helps regulate hormones, and manage a broad range of menopausal symptoms.

Non-Hormonal Therapy

As not all women wish to undergo HRT, there are effective non-hormonal treatments available. These treatments when combined with lifestyle strategies can ease symptoms, and maintain long-term health.

Depending on the severity of your symptoms, treatments may include:

• Avoiding triggers – alcohol, caffeine, spicy foods, and stress can intensify hot flushes, and night sweats. That is why it is crucial to identify potential triggers as avoiding them can offer significant relief.
• Changing diet – it is encouraged to focus on foods rich in calcium, vitamin D, and phytoestrogens. These support bone health, and may help balance hormones naturally.
• Exercising regularly – physical activity helps preserve bone density, improves mood, reduces anxiety, and supports weight management. However, when deciding on an exercise regime, it is best to aim for a mix of cardio, strength training, and flexibility exercises.
• Prescription medications – some women may benefit from non-hormonal medications, including:
  • Antidepressants (SSRIs/SNRIs) – helpful for mood swings and hot flushes.
  • Clonidine – may reduce the frequency and severity of hot flushes.
  • Gabapentin – often used for hot flushes and sleep disturbances.

Summary

Menopause is more than just a phase. It is a powerful transition that marks a new chapter in your life. With the right support, this journey can become one of self-awareness, resilience, and renewed wellbeing.

Gynaecologist, Dr Anupriya Agarwal, believes in empathetic, evidence-based care that puts you at the centre. Early diagnosis, and personalised management not only ease symptoms as we strive to empower you to take control of your health, energy, and quality of life.

Book a consultation with Holistic Gynaecology & Fertility today for a thorough assessment and personalised treatment plan.