Do You Have These Early Signs Of Menopause?

Mention the word 'menopause' and what comes to mind is women in their 50s having hot flushes, interrupted sleep and weight gain. However, the true impact of menopause is felt much earlier and could hit you before it's even on your radar. 

We officially hit menopause when we haven't had a period for 12 consecutive months. But the years before that is when we feel the brunt of this hormonal change. This period is known as perimenopause and can last a number of years. 

“The age range for perimenopause is generally about late 30s to early 50s, although most women become aware of the transition in their mid to late 40s,” reveals Associate Professor Rukshini Puvanendran, Head and Senior Consultant, Family Medicine Service, KK Women's and Children's Hospital. “The duration of perimenopause is variable, ranging from a few years to as long as up to 10 years.”

There is no way to predict what age a woman will hit perimenopause or how long this transition will last. But in Singapore, the average age of menopause is 49, so most women should expect symptoms to appear a few years before that.

Associate Professor Rukshini, who is also co-lead at KK Menopause Centre, explains that perimenopausal symptoms differ among women. However, there are some early signs we could look out for.

Early signs to look for

1. Irregular menses

The changes here could be in terms of duration, timing or flow. Your periods could be shortened or lengthened – so, if you used to have a regular 28-day cycle, you may then experience shortened cycles like 21 days or lengthened cycles like 60 days. 

Associate Professor Rukshini cautions that not all irregular menstrual patterns in the perimenopausal phase are benign: “Do consult your doctor if you are having an increase in menstrual flow, especially with clots, spotting between periods or bleeding after sexual intercourse. These are red flags and will require evaluation.”

2. Hot flushes

Associate Professor Rukshini describes this common symptom as “sudden sensations of heat that typically come from within and affect the face, neck and chest which may cause sweating”. And, when these hot flushes occur at night, they are known as night sweats, which can cause disturbances in sleep and affect a woman's quality of life.

3. Mood swings

You know how PMS makes you moody and irritable? Going through perimenopause causes changes in moods too, which can include increased irritability, anxiety or moodiness, says Associate Professor Rukshini.

4. Sleep issues

Perimenopause could make it difficult for you to fall asleep and/or stay asleep throughout the night, which can then lead to fatigue and daytime sleepiness. Associate Professor Rukshini warns that prolonged sleep issues can also lead to functional memory issues. 

5. Vaginal changes 

Thinning and dryness of the vaginal tissues can lead to discomfort or pain during intercourse.

6. Sexual desire

You might not even feel like having sex as you'll experience a decrease in sexual desire or changes in sexual function. This can sometimes be due to the fact that you feel discomfort or pain during sex, as mentioned above. 

7. Physical changes

Some perimenopausal changes could be more obvious, such as weight changes, drier skin or reduced thickness in hair texture, says Associate Professor Rukshini.

Dealing with perimenopause 

One way to combat the symptoms of perimenopause is to adopt healthy lifestyle habits. Associate Professor Rukshini encourages women to pay attention to their health, including quitting smoking, eating well, exercising regularly, having good-quality sleep and incorporating some relaxation techniques.

She stresses the importance of good-quality sleep as it helps to regulate hormones, improve mood and reduce hot flushes and night sweats. It also reduces stress levels, which contributes to better mood, as well as maintains good cognitive function. Overall, you will feel more energetic and well-rested. 

Exercise is good for everyone's health. Physical activities release endorphins which improves mood, and benefits the entire body including bone health, weight management and heart health. 

But what if you can't combat the common perimenopausal symptoms? Associate Professor Rukshini suggests self-management strategies such as carrying a fan to manage hot flushes, always having a cool sugar-free drink with you and using a facial water spray. Avoiding spicy foods, red meats, caffeine and alcohol will also reduce flushing. 

“Some women may find relief from menopausal symptoms with herbal or alternative remedies, however, most have not been studied or shown to be of benefit scientifically,” she adds. “The safety of these supplements is also not thoroughly studied and they can interact with other supplements or prescribed medications. It is not recommended that these treatments are taken for longer than six months, and a doctor should be consulted if there is an intent to take it beyond that period.”

Do you need hormone therapy?  

You might have heard of women who deal with this tricky period with the help of hormones. Menopause Hormone Therapy (MHT), in patches or tablets, has been demonstrated scientifically to reduce menopausal symptoms. But how can you tell if this is the right path for you?  

“MHT is generally thought to be safe for most women under the age of 60 and within 10 years of menopause,” Associate Professor Rukshini elaborates. “A woman interested in taking MHT should discuss the benefits and risks with her doctor before starting the treatment to see if she is a suitable candidate. 

“Doctors may prescribe other drugs to relieve symptoms, such as anti-depressants (which have been shown to reduce hot flushes), gabapentin and clonidine. If the woman has symptoms that are very bothersome, it is important that she seeks further assessment with a doctor. Management of these symptoms will help her optimise her health and quality of life,” she adds. 

Associate Professor Rukshini also reveals that, in general, KKH encourages all women who experience moderate to severe menopausal symptoms that affect their function to seek a detailed consultation to assess their suitability for MHT. 

Other parts of your body could be affected by menopause too, it might not just be a gynaecological issue. Associate Professor Rukshini shares that early menopause (menopause before the age of 45) is associated with health problems including osteoporosis. A woman who has had early menopause should also consult her doctor for an evaluation regarding the need for MHT. 

“Traditionally, women see a gynaecologist for perimenopausal or menopausal symptoms. However, emerging evidence shows that the drop of oestrogen levels caused by menopause affects many aspects of a woman’s body, including her bones, heart, brain, skin, musculoskeletal system and even emotions,” she explains.

“Therefore, at KKH, our patients are managed at the KK Menopause Centre – a multi-specialty practice comprising gynaecology, family medicine, dermatology and mental health specialists so that women can receive comprehensive and holistic assessment, detection and intervention.”

For more information on navigating menopause, visit KKH’s health guide, Women In all Stages Empowered (WISE), at www.kkh.com.sg/WISE