Absolutely menopausal

MENOPAUSE can be described as the time in a woman’s life when monthly cycles of menstruation cease and the level of hormones produced by the ovaries decreases. “Natural” menopause usually occurs in the late 40s or early 50s, but it can also be caused by surgical removal of both ovaries (bilateral oophorectomy), or by some chemotherapies that destroy ovarian function. In this case, it can be classified as induced menopause.  

Natural menopause 

This occurs when the ovaries naturally decrease their production of the sex hormones oestrogen and progesterone; there are no menstrual periods for 12 consecutive months; and no other biological or physiological cause can account for this. (The basis for the “12 consecutive months” criterion for menopause is that, until 12 months have passed without a period, a woman may still become pregnant).  

Induced menopause 

Induced menopause, as opposed to natural menopause, occurs when the ovaries are surgically removed or are damaged by radiation or drugs. Due to the abrupt cut-off of ovarian hormones, induced menopause causes the sudden onset of hot flashes and other menopause-related symptoms such as a dry vagina and a decline in sex drive.  

Early menopause (before age 40), whether natural or induced, carries a greater risk for heart disease and osteoporosis since there are more years spent beyond the protective cover of oestrogen.  

Symptoms of menopause 

A woman can usually tell if she is approaching menopause because her menstrual periods starts changing. The medical terms used to describe this time are the “menopause transition” and “perimenopause”.  

The changes of the menopause transition (perimenopause) begin about six years before the natural menopause when the levels of hormones produced by the ageing ovaries fluctuate, leading to irregular menstrual patterns (irregularity in the length of the period, the time between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing).  

Other changes associated with the menopause (natural or induced) include night sweats, mood swings, vaginal dryness, fluctuations in sexual desire (libido), forgetfulness, insomnia (trouble sleeping) and fatigue, probably from loss of sleep. Conditions that have not been shown to be due to the menopause (natural or induced) include headache, dizziness, palpitations of the heart and depression.  

The timing of natural menopause is variable. In the Western world, the average age is now 51. Natural menopause can, however, occur in a woman’s 30s or 60s. Factors influencing the timing of menopause include heredity (genetics) and cigarette smoking. Smokers (and ex-smokers) reach menopause an average of two years before women who have never smoked.  

There is no relation between the time of a woman’s first period and her age at menopause. The age at menopause is not influenced by a woman’s race, height, number of children or use of oral contraceptives.  

How to stay healthy during menopause 

  • Regular gynaecological and medical checkups. 

  • Annual blood work (to screen for diseases such as diabetes, cardiovascular disease, cancer and thyroid problems.) 

  • Annual mammogram, Pap smear, screening for vaginal infections and STDs 

  • Bone density test to assess bone density every one to three years.  

    Hormone replacement therapy (HRT 

    HRT is used to treat symptoms of menopause, such as hot flushes, insomnia, headaches and irritability. 

    The barrage of recent news pointing to the mounting risks of hormone replacement therapy (HRT) has sent millions of worried women running to their doctors. The key here is to weigh out the advantages over the disadvantages with your gynaecologist before deciding if you would like to start, stop or continue therapy. 

    New guidance suggests that if a woman has taken HRT for around five years, she should consider if it is in her best interest to continue. The guidance, in a Royal College of Obstetricians and Gynaecologists book, follows a review of HRT research.  

    Short-term benefit 

    The latest guidelines are published in a new RCOG book, Menopause and Hormone Replacement. They reflect recent recommendations made by the Committee on the Safety of Medicines.  

    The key recommendations are:  

  • HRT will continue to be prescribed for women with severe menopausal symptoms.  

  • For women who are not suffering from menopausal symptoms, the risks of taking HRT outweigh the benefits.  

  • That ultimately women should have the choice to take the drugs, provided they understand the risks. 

    Prof Valerie Beral, director of Cancer Research UK’s Epidemiology Unit at the University of Oxford, said: “This new report clearly lays out the risks and benefits associated with taking HRT. We know that the drug can offer short-term benefit for relieving menopausal symptoms but we also know that the longer women take HRT, the greater the risks of breast cancer and strokes.”  

    Prof Shaughn O’Brien, the RCOG’s junior vice president, said: “75% of women complain of significant menopausal symptoms. The short-term use of HRT for these women can be prescribed with relatively little risk. “For longer-term therapy the risks really must be weighed up by the patient and her doctor together.”  

    If you are a woman currently taking HRT or considering taking HRT: 

  • Be aware of and reassess the reasons why you chose to take HRT or why your doctor suggested you take HRT.  

  • Seek information on the benefits and risks of taking HRT for both short and long time frames.  

  • Seek information on lifestyle changes or complementary therapies that could improve your health and well-being.  

  • Be aware that science and medicine still does not have all the answers and with future research we will continue to discover both positive and negative effects of certain treatments.  

  • Make your decision using balanced information and how this fits in with your experiences and the context of your life. Any treatment should be tailored to you as an individual.  

  • Any decision you make now is always open for reappraisal and possible change.  


  • Diong Swee Hoon is a pharmacist. For more information, e-mail starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. 

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