SINGAPORE – Menopause, which marks the end of natural fertility for a woman, affects not just her reproductive organs but her whole body, said Associate Professor Rukshini Puvanendran, the co-lead of ​the KK Menopause Centre, which was launched in mid-October.

Just understanding how this can happen can make a difference to how women cope with the menopausal transition, the time leading up to menopause, which typically takes place between the ages of 45 and 55, she said.

Some women experience few or no symptoms, while others may need help with their symptoms. However, most women do not seek help, convinced that this is a phase​ they have to bear with, Professor Tan Hak Koon, ​chairman​ of the Division of Obstetrics and Gynaecology​ at KK Women’s and Children’s Hospital (KKH), said​ in a press release for the centre’s launch. 

Among the women who do reach out for help, they usually turn to a gynaecologist​, which may not be sufficient, he said. “Taking a multi-speciality approach – combining specialities in gynaecology, family medicine, dermatology and mental health, alongside group support, and coupled with early assessment, detection, and intervention, will enable all women to age gracefully and healthily,” he added.

In the latest Health Check podcast episode, this reporter spoke to Prof Rukshini, who is also the head and senior consultant of KKH’s Family Medicine Service, to find out why and how menopause can affect a woman, whether hormone replacement therapy is a good option, and what she can do about this phase of life.

Here are edited excerpts from the conversation:

Q: How can menopause affect the entire body? 

A: Ovaries, which produce eggs for fertilisation, also produce very important hormones for women, predominantly being estrogen, progesterone, and also testosterone. Oestrogen is not just a hormone required for reproduction, it is a hormone that affects almost the entire body.

The menopausal transition, also known as perimenopause, starts when symptoms of the change first appear and can last for several years. Vasomotor symptoms are the most commonly known – these include hot flushes and night sweats. They indicate an abnormality of a woman’s thermoregulation system, which is in the brain. This shows that estrogen has effects on the brain.

Vasomotor symptoms can be accompanied by poor sleep. Some women may experience rashes, while others develop acne or melasma (brownish patches on the skin) on the face, among other symptoms.

Q: Menopause is also when a woman’s risk of cardiovascular disease can go up. What are the other issues?

A: Women may see their blood pressure and cholesterol levels creep up during the menopausal transition. They also tend to put on weight, which can tip them into insulin resistance, a pre-diabetic state. So this increase in cardiovascular risk is actually because we start having these risk factors.

It’s very important for women to understand this so that they get themselves screened. They can maintain a healthy lifestyle to protect themselves against cardiovascular disease.

Q: Do the symptoms go away?

A: (The age of) 49 or 50 could be the time of the final menstrual period, but a woman’s hormone levels start going down in the years before. A lot of woman in their early 40s may find their periods getting a bit lighter and they may get feelings of heat.

The symptoms are usually more pronounced in the perimenopausal period because that’s when the hormone levels are fluctuating. By the time the hormone levels are quite low, the symptoms are much better.

Most women may just have mild hot flushes but some can have moderate to severe hot flushes. It’s important for them to understand what’s happening to their bodies during this transition. Women should consult their doctors if their symptoms are bothersome or affect their quality of life.

Q: For years, many women have stayed away from hormone replacement therapy (HRT), mostly for fear of a higher risk of breast cancer. How safe is HRT?

A: In the 1980s and 1990s, a lot of women were getting hormone therapy and we could see a lot of benefit. That changed after 2002. One arm of a large randomised controlled trial, the Women’s Health Initiative study, was halted because the researchers found that women taking oestrogen and a synthetic form of progesterone known as progestin had an increased risk of breast cancer, heart attacks, stroke, and blood clots.

However, there are a few caveats. First, the women in the trial were between the ages of 50 and 79 – we do not start women in their late 60s and 70s on hormone therapy, but those in their 40s and 50s.

Second, a lot of the women were smokers, obese, or had hypertension and so on.

Since then, newer hormone therapies have emerged. Nowadays, we also have transdermal patches or gel, which have been shown to be much safer and much more similar to the human body.

HRT is the most effective treatment for vasomotor symptoms, and generally, the benefits of HRT outweigh the risks in healthy women under the age of 60.

To hear more of their conversation, click on the Health Check podcast.