More women in Singapore seeking help to deal with menopause

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SINGAPORE - More women in Singapore are seeking help to manage menopausal symptoms at a time when public figures are speaking more openly about a once-taboo topic.

Local hospitals have seen a rise in such consultations, especially for perimenopause, the years that signal the transition to menopause.

Typically beginning several years before menopause, the hormonal changes that women experience lead to irregularities in the menstrual cycle, hot flushes (a sudden, uncomfortable sensation of heat), mood changes, fatigue, joint and muscle aches or other symptoms.

Perimenopause commonly takes place between the ages of 45 and 55. Menopause occurs when a woman has not had a menstrual period for 12 consecutive months.

The number of women with perimenopausal and menopausal symptoms seen at KK Women's and Children's Hospital has almost doubled from 2009 to 2019, estimates Dr Ang Seng Bin, who heads the hospital's Family Medicine Service and Menopause Unit.

"This is likely attributable to increasing awareness of the condition and its symptoms, which can be managed well," he says, though he was not able to provide a breakdown of the figures.

He says the majority of these women were seeking treatment during perimenopause, when most symptoms, such as hot flushes and body aches, start to appear.

National University Hospital (NUH) has also seen an increase in the number of women with such symptoms. There are more perimenopausal than menopausal patients, says a spokesman.

Assistant Professor Susan Logan, a senior consultant at the department of obstetrics and gynaecology at NUH, notes that women usually seek treatment if their symptoms are severe and start affecting their quality of life, relationships or work. This is especially if their own self-care remedies, which include maintaining a healthy weight and exercising, have not helped.

Many of the women in menopause seen by Dr Chua Yang, a consultant obstetrician and gynaecologist who is the founder of A Clinic For Women at Mount Alvernia Hospital, seek help for sleep disruption, mood swings and panic attacks. Dr Chua says: "I think a lot of people suffer in silence. I know patients who take crying breaks at their workplace."

 

The first signs

Menopause can be a puzzling, tumultuous time for some women, while others are less affected by its biological changes.

Former United States first lady Michelle Obama and, closer to home, veteran actress Xiang Yun have spoken previously about the challenges of menopause, which are seldom publicly discussed.

In a podcast in August last year, Mrs Obama, 57, described a hot flush "like somebody put a furnace in my core and turned it on high, and then everything started melting". She was not up to accompanying her husband, former US president Barack Obama, for an official event that day, but did it anyway.

She also talked about how she believes men have no clue about how women's hormones affect their bodies, and women should not be ashamed of the bodily changes that come with ageing.

Xiang Yun, 59, has also spoken in recent years about experiencing symptoms such as weight gain, excessive drooling and facial bloating. "I just don't understand this whole thing about menopause," she was quoted as saying in a 2019 magazine interview.

It is unclear when perimenopause officially begins. The first sign is usually a change in the normal pattern of one's periods, whether in menstrual flow or frequency.

But for many, such as Ms Wong Lee Fung, who is in perimenopause, the first missed period when she was 52 did not register.

"I didn't think too much about it. I thought the irregularity was because of work stress. I paid attention only after it happened a few times. Menopause is natural and something women have to go through," says Ms Wong, now 54, who works in a consumer electronics firm.

Dr Ang from KKH notes that sometimes women mistake their menopausal symptoms for medical problems, asking for scans or tests.

This was the case for freelance pilates instructor Jane Koh, 60.

Before she reached menopause at 55, she had been experiencing hot flushes, night sweats, disrupted sleep and frequent migraines. She went for an MRI (magnetic resonance imaging) scan about three years earlier to rule out neurological causes for the headaches she had been suffering for months.

The changes were emotional as well as physical. She become more agitated and short-tempered.

"It affects your whole being - that's why it's so frustrating. But the word menopause didn't even occur to me.

"You associate menopause with ageing. I just don't feel old. I don't even like the word 'ageing' - it puts you down straight away," says the former housewife, who became a pilates instructor at 52 after her backaches subsided when she took up the exercise in earnest.

 

A time of many challenges

Doctors and women's groups urge a holistic approach to supporting women in menopause, which usually comes at a time when mid-life challenges are thick on the ground.

Ms Bay Teck Cheng, president of Society for Wings (Women's Initiative for Ageing Successfully), says: "Middle-aged women who are, or will soon be, going through their menopause transition are likely to be caring for ageing parents, managing teenagers or experiencing empty nest syndrome while navigating career transitions all at the same time."

Besides helping them deal with the physical and sexual health aspects of menopause, she says it is important to shore up their mental and emotional well-being, and help them build more positive relationships at home and in the workplace.

Wings is the co-organiser of a free, ongoing webinar series, Women At 40, which recently dealt with the topic of menopause.

Managing menopause well has broader implications for an ageing society like Singapore, where women have a long life expectancy, says NUH's Dr Logan.

"Singaporean women can spend between one-third and half of their lives (in menopause and postmenopausal). Women are at the centre of families and, at age 50, many of them are looking after both parents and children. If their health is good, the wider family benefits (them)," she says.

For Ms Koh, surfing the Internet to learn more about menopause helped her understand what she was going through. She also distracted herself whenever she experienced discomfort by chatting with her sister and watching movies.

At 60, married with three children in their 20s and with no more interest in scaling the corporate ladder, she is relatively free from domestic and work concerns.

She describes going through menopause as "refreshing". "It's nice to know I've arrived at this stage when I can be free," she says.

 

Campaign to reduce risk of osteoporosis

A group of Nanyang Technological University (NTU) students are running a communication campaign targeted at middle-aged women and aimed at reducing the risk of osteoporosis, a disease that weakens bones.

Declining levels of oestrogen, a hormone that protects bones, during menopause puts women at greater risk of osteoporosis, which increases the possibility of fractures.

Ms Eldrida Yeong is one of four undergraduates who launched the campaign, The Bone Bank, in January as part of a final-year academic project. The 23-year-old from NTU's Wee Kim Wee School of Communication and Information says the campaign resonates with her because her mother is in its target demographic of women aged between 42 and 58 years old.

The Bone Bank, a collaboration with Sengkang General Hospital, advocates a "CDE" approach, which promotes the consumption of adequate calcium, vitamin D and exercise to reduce the risk of osteoporosis.

Campaign activities include yoga classes and social media groups fostering discussion among women about the disease.

Ms Faridah Mohd Akip, 58, is among The Bone Bank's 300 WhatsApp subscribers and Facebook followers. The assistant teacher at a childcare centre says she has benefited from being part of the WhatsApp discussions.

Before, she had suffered from joint pain at her wrists and knees. Her instinct was to lie down, take painkillers and "hope the pain goes away", but she was advised by the group to try some exercise instead. Her bodily aches have lessened as a result.

"I've come to know a lot of new things, for example, that exercise can be a form of release," she says.

 

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.

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