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What is menopause?

  • Menopause means the cessation of menstruation (period)
  • You can’t have children anymore
  • Menstruation may suddenly cease, gradually decrease or irregular

When does menopause occur?

The usual age of menopause is between the ages of 45 and 55.The average age is around 50.

Can menopause occur before the age of 40?

Yes. Menopause can occur before the age of 40. It is called Premature (early) menopause. It means the ovaries have stopped working. This accounts for about one percent of menopausal women and can be due to :

  • Surgery e.g. Removal of cancerous ovaries
  • Autoimune conditions e.g. Systemic lupus Erythromatosus , rheumatoid arthritis, Hypothyroidism or Crohn’s disease
  • Genetic conditions e.g.: Familial ovarian failure and galactosaemia
  • Viral infection
  • In the majority of cases, the cause cannot be found

What are the symptoms of menopause?

Symptoms of menopause can be divided into :

  1. Vasomotor symptoms
    • Hot flushes
    • Sweating
    • Fast heart beat
    • Panic attack
    • Sleeping difficulty
  2. Psychological symptoms
    • Emotional lability
    • Mood changes
    • Tiredness
    • Poor memory
    • Irritability
    • Reduced sex drive
  3. Urogenital tract symptoms
    • Vaginal dryness
    • Urinary frequency
    • Urinary incontinence
  4. Skeletal disease
    • Thinning of bone (osteoporosis)
    • Loss of height
    • Fractures
  5. Other symptoms
    • Skin atrophy (Thinning)
    • Loss of skin elasticity
    • Dryness of skin
    • Increase hair loss
    • Prone to have rashes

What are hot flushes?

85% of menopausal women experience hot flushes. Hot flushes are :

  • warm sensation, usually begins in the head and face, spreads down to the neck and to other parts of the body
  • lasts about three to six minutes
  • associated with sudden increase in heart rate, rise in skin temperature, sweating
  • can occur once a month, once a week or several times an hour

What are the complications of menopause?

  • Heart disease
  • Osteoporosis (decreased bone density that causes bone to become porous and fragile)
  • Stroke

Is there any treatment available for menopausal symptoms?

Improved lifestyle habit will greatly reduce the unpleasant symptoms of menopause. These include :

  • Healthy diet
  • Avoid smoking
  • Regular exercise
  • Positive thinking
  • Regular pap smear
  • Regular breast checks

Hormone replacement therapy (HRT) can effectively reduce menopausal symptoms especially hot flushes, vaginal dryness and urinary problems. This involves taking oestrogen alone or estrogen combined with progestin. The hormones are available in the form of :

  • Vaginal cream
  • Implant
  • Pills
  • Injection
  • Patches
  • Vaginal ring inserts

What should I do before starting the HRT?

Evaluation done before starting on HRT may include :

  • A complete examination including breast and pelvic examination
  • Papanicolaou smear
  • Mammogram
  • Fasting lipid profile
  • Fasting glucose level
  • Liver function test

Can HRT cause breast cancer?

The risk of breast cancer increases if the duration of use is more than 5 years

What are the side effects of HRT?

Side effects of HRT include :

  • Mild side effects :
    • Breast tenderness
    • Cramping
    • Bloating
    • Depression
    • Nausea and vomiting
    • Headache
    • Per vaginal bleeding
  • Very small risk of serious side effects :
    • Breast cancer
    • Heart attack
    • Stroke
    • Endometrial (uterus) cancer (those patients who are on high dose of Oestrogen)

Therefore patients on HRT should be monitored closely by the health professional so that they can get maximum benefit from the treatment.

When is HRT unsuitable?

HRT is unsuitable in :

  • Pregnancy
  • Active liver disease
  • Suspected breast or uterine cancer
  • Thrombophlebitis (inflammation of vein)

Where to get help?

Where to get help?


  • Better Health Channel Feb 2004 Menopause
  • Better Health Channel Nov 2004 Premature menopause
  • Women’s Health Community Dec 2004 Menopause
  • Family doctor org. Sept 2004 Menopause; What to expect when your body is changing
Last Reviewed : 26 April 2012
Writer : Dr. Fuziah Paimin
Reviewer : Dr. Haris Njoo Suharjono