Obstetrics & Gynaecology

The Final Period

  • November 1, 2019
  • 2 minutes read

Menopause marks the “official” end of a women’s fertile years and brings with it some challenging changes. Here’s what to expect.

Menopause refers to the complete cessation of menstrual cycles, and it is said to occur 12 months after the last menstruation, typically between the ages of 45 and 55. In the years preceding menopause (the peri-menopausal period), oestrogen levels start to decline, bringing with it a range of symptoms that vary greatly between women. Menopausal symptoms occur over four categories:

  • Menstrual irregularities
  • Genital and bladder changes
  • Vasomotor problems
  • Mental and emotional problems

Menstrual irregularities include delayed menstruation, prolonged periods and heavy or scant menstrual flow. Genital and bladder changes result in vaginal dryness, painful intercourse, frequent urination and urinary incontinence, while vasomotor problems include hot flashes, sweating, insomnia, dizziness and palpitations. Lastly, mood changes, depression, fatigue, lack of concentration and poor memory are also commonly experienced. Women who have had a hysterectomy to remove their uterus but not their ovaries will cease to have menstruation but will not experience menopausal symptoms until their ovaries stop functioning.

Interestingly, the incidence of symptoms varies among ethnic groups. Hot flashes and mood changes occur in about 75% of American Caucasians, but only in 10% of Chinese. This has sometimes been attributed to the regular intake of soy products by Chinese. Soy products contain phytoestrogens which are similar in structure to female oestrogen which helps prevent or alleviate some of the symptoms.

Eastern vs Western management

There are several ways women in Singapore can manage the changes in the peri-menopausal period and alleviate the symptoms. Traditional Chinese Medicine (TCM) therapy is one. This approach uses syndrome differentiation to diagnose the underlying problem and treat the problem accordingly. According to TCM, common vasomotor problems such as hot flashes, sweating, insomnia, dizziness and palpitations are due to deficiency of kidney yin. Some other symptoms may be due to ageing resulting from liver dysfunction, and the decline in essence and blood storage. TCM physicians typically prescribe appropriate herbal concoctions or acupuncture treatment to treat the identified deficiency and to restore the yin and yang balance. In Western medicine, a doctor takes a detailed history and does a medical examination to evaluate the condition and to exclude gynaecological problems. Appropriate treatment is then based on the predominant complaint. Medications using herbal extracts have been proven by research to help alleviate menopausal symptoms and can be used to treat hot flashes, mood changes, sweating and insomnia. To treat genital and bladder problems, topical oestrogen application is usually recommended.

Other important changes that occur during this period include decrease in bone density and increase in bad cholesterol (LDL) due to decline in oestrogen levels. Bone mineral densitometry (BMD) and fasting blood test to screen for high cholesterolemia should be done and treatment instituted if necessary.

In addition, women should be counselled regarding measures to improve general health like a balanced diet, moderate exercise, decrease in smoking and excessive caffeine intake, and appropriate supplements. These will help improve well-being, maintain good bone density and cholesterol levels, and enhance sleep quality.

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