It began around the time she turned 47. All of a sudden, Layla Singam felt like her body was out of her control. She was exercising four times a week and eating sensibly – as she’d been doing for years – but she was gaining weight. Her waistline felt bloated and it felt like her skirts and pants were getting a bit more snug.
And then came the sudden bursts of heat from her body – usually it seemed like flashes of fire that started from her neck and crept upwards to her head or downwards to her chest – that would last a couple of minutes. This happened throughout the day and even at night. The hot flushes disturbed her sleep, leaving her tired all the time.
“I’d be sitting in the office with the air-conditioning at full blast and I’d feel like my insides were on fire. I’d have to stop whatever I was doing, halt conversations midway and fan myself. It felt like a furnace was lit inside me. Just for a couple of minutes and then it was gone, ” shares Layla.
“I used to wake up at 5am and be up and about all day until about 10pm. These days, I feel exhausted all the time and I’m ready for bed by 9pm... sometimes earlier, ” she added.
Knowledge is power
Hormones (or rather the lack of), Layla soon found out after a panicked visit to her doctor, was the problem.
Like many women her age, Layla is at the perimenopause stage. Her hormone levels are decreasing, causing her body to respond in unfamiliar ways.
“Usually, by about 40, a woman’s hormones start to fluctuate, ” explains obstetrician and gynecologist Dr Premitha Damodaran. “Lots of women around this age suddenly wake up and wonder what’s happening to them. For many, a hot flush at 40 means menopause will happen tomorrow. “But I call it the acclimatisation phase which is commonly known as perimenopause. And, for many women, this phase will go on for months or years and can last for up to 10 years or so before they actually experience menopause, ” she explains.
Layla wasn’t experiencing menopause which is defined as a full year without a menstrual cycle. But she was getting there as the production of two types of ovarian hormones – estrogen and progesterone – had begun to slow down.
The average age for menopause for Malaysian women, according to the Health Ministry portal myhealth.gov.my, is around 50.
Perimenopause (which can start after a woman turns 40 – sometimes, but rarely, earlier) is the term for the phase in a woman’s life where her body gets used to the lower levels of hormones.
“We are born with a certain number of eggs – we don’t get new eggs along the way. These follicles are what produces estrogen and progesterone. The (hormone levels) peak somewhere between the ages of 12 and 45. The good quality eggs – good levels of estrogen and progesterone – are used up first and so, as we get older, the quality gets lesser and lesser.
“By the time a woman is 40, the eggs are of not great quality, ” Dr Premitha explains.
Hormones, Layla learnt from her doctor, are powerful chemicals in the body that affect the way women feel, behave and how the body functions.
Knowing what was happening – and what she could do about it – was a huge relief for Layla. And, she was excited to tackle the latest challenge in her life.
“Knowing exactly what was going on inside me was comforting and finding out that there were changes I could make to feel better was even more reassuring.
“I wasn’t losing control of my body. In fact, I need to start taking control of my body and find ways to adjust to the changes that are taking place physiologically. I need to take charge.
“I wasn’t filled with dread anymore. I was curious to see how I could adjust to my ‘new normal’, ” says Layla.
Your body’s new normal
Perimenopause starts with a change in a (typically) 40-something woman’s period cycle and lasts until one year after her last period.
“It is a phase that your body goes through to get you used to lesser estrogen. Every woman is different and you can’t compare what you are going through with friends or even the women in your own family – not even your mother or sisters – because you all experience different anxieties, live in different environments and under different circumstances, ” says Dr Premitha.
The first thing that happens, she says, is that your periods change. First, your period cycles get shorter, and then the gap between periods gets significantly longer. A woman’s menstruation can get abnormally heavy and last for up to three weeks.
For some women – a small percentage, according to Dr Premitha – menopause comes without much fuss: periods gradually slow down and then, stops.
“But the general pool of women will experience these fluctuations, ” she says.
About 60-70% of Malaysian women experience the typical perimenopausal symptoms such as hot flushes, joint pains, mood fluctuations, night chills (see sidebar).
But, says Dr Premitha, only about 25% find these symptoms interfere with their quality of life.
“Most of the time, women learn to deal with it either by drinking cold water, staying in air-conditioned rooms or fanning themselves as much as possible. You need to find out what works for your body.
“And, if nothing else is working, then we must help them. Some of my patients come to me for advice. But there are many who come to me after trying a range of things to cope with the symptoms that hasn’t worked.
“That’s when I talk to them about hormone replacement therapy HRT. Not all women want to take hormone replacement, which is fine. Some fear that HRT can lead to breast cancer but the risk is very low. A lot of the breast cancer specialists I work with are very happy with us putting patients on hormones if they need it because they know that once a patient is on HRT, we would look after the breast simultaneously.
“Of course, the decision is ultimately up to each woman. I explain what the options are but it is entirely up to them, ” says Dr Premitha.
HRT, she says, can cost between RM100 and RM200 a month.
The transitions that come with the change in a woman’s body can be frightening and even depressing, says onstetrician and gynaechologist Dr Premitha.
“All of a sudden, what worked for you before doesn’t anymore. You’re exercising but you are putting on weight, especially around your middle. You’re at a meeting and all of a sudden, you lose your train of thought.
“You can’t remember things. You experience hot flushes or night chills which affect your sleep. It can be scary because you feel like you can’t control these changes, ” shares Dr Premitha.
Another common symptom that women experience during this time, she says, is vaginal dryness which can make intercourse unpleasant.
“While the fluctuating hormones can affect a woman’s libido, many women don’t want to be intimate because it becomes painful. And this can be yet another change that is distressing, ” says Dr Premitha.
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