Perimenopause Hits Hard, But 70% Of Women Aren’t Getting Help

Body aches. Poor sleep. Exhaustion.

These symptoms sound common enough, like the kind of complaints many women in their late 30s and 40s brush aside as stress, ageing or simply part of busy mum life.

But they are also hallmark symptoms of perimenopause, the transitional phase leading up to menopause that can last up to 10 years.

A 2025 study by KK Women’s and Children’s Hospital involving women aged 45 to 65 found that 70 per cent experienced moderate to severe menopausal symptoms. Yet 70 per cent of these women did not seek medical attention.

A second study involving healthcare professionals who see female patients in this age group revealed another concern: 90 per cent were not very confident in diagnosing and treating menopausal symptoms, citing lack of training, knowledge and time.

This disconnect in menopause care is precisely why Singapore has launched its first set of Guidelines on Management of the Menopause Transition — to standardise care and close the gap between what women are experiencing and the support they receive.

“Despite its significant impact on long-term health and quality of life, menopause transition remains one of the most overlooked phases in a woman’s life,” says associate professor Rukshini Puvanendran, co-director of KK Menopause Centre.

It is often under addressed — not only by women themselves, who may view their symptoms as inevitable, but also within healthcare settings where clinical approaches can be inconsistent.

Associate professor Rukshini Puvanendran

For women in their mid-30s to mid-40s who are entering perimenopause, this is validation.

Top five symptoms of perimenopause in Singapore

Menopause typically occurs around age 49 in Singapore, but symptoms often begin years earlier.

Locally, the top five symptoms during perimenopause are:

• New-onset joint and muscle pain
• Disturbed sleep
• Sexual health and urinary issues
• Physical and mental exhaustion
• Hot flushes and night sweats

This differs from Western populations, where hot flushes dominate the conversation.

In other words, if you are not drenched in night sweats but you are constantly exhausted, sore or struggling with intimacy, you could still be in perimenopause.

29 symptoms of perimenopause in Singapore, ranked

According to the KKH study involving 1,461 women, these are the top 29 moderate-to-severe menopausal symptoms, ranked from most to least commonly experienced:

1. Weight gain
2. Difficulty sleeping
3. Head and/or neckaches
4. Vaginal dryness
5. Joint and muscle aches
6. Avoiding intimacy
7. Feeling tired or worn out
8. Hot flushes
9. Decrease in sexual desire
10. Feeling a lack of energy
11. Low backache
12. Dry skin
13. Sweating
14. Frequent urination
15. Feeling bloated
16. Being dissatisfied with personal life
17. Decrease in physical strength
18. Involuntary urination when laughing or coughing
19. Decrease in stamina
20. Night sweats
21. Changes in appearance, texture, or tone of skin
22. Feeling anxious or nervous
23. Feeling depressed, down or blue
24. Feelings of wanting to be alone
25. Experiencing poor memory
26. Flatulence (wind) or gas pains
27. Accomplishing less than before
28. Being impatient with other people
29. Increased facial hair

What this shows: menopause cuts across multiple aspects of health: musculoskeletal, pelvic floor, sexual, mental, and even skin.

Because it unfolds over years, menopause requires longitudinal, individualised and holistic care — not episodic treatment, shared Dr Wong Tien Hua, president of the College of Family Physicians Singapore, at the launch of the guidelines.

Why the guidelines matter

The new guidelines provide clarity for both doctors and patients.

“These Guidelines are crucial in closing that gap,” says assoc prof Rukshini. “By establishing a clear, evidence-based framework, we are putting the necessary systems in place to ensure that menopause is recognised as a priority.”

She adds that the goal is two-fold: “to encourage women to be more aware and upfront in seeking help, and to better equip healthcare professionals… with the tools to provide effective, tailored care.”

Here’s what that framework looks like in practical terms.

1. Diagnosis doesn’t have to be complicated

Menopause is defined as 12 consecutive months without periods.

For women over 45 with typical symptoms, doctors can diagnose menopause based on clinical history and symptoms alone.

For women under 45 who have stopped having periods, have irregular cycles or present with atypical symptoms, further tests may be required.

If something feels persistently different, it warrants proper assessment.

2. A healthy lifestyle is the foundation

The fundamentals remain the same: 

• A balanced diet
• Regular exercise
• Weight management
• Not smoking
• Limiting alcohol
• Stress management
• Adequate sleep

Optimising your lifestyle can help to reduce the severity of menopausal symptoms, as well as the long-term risks of heart disease and bone loss.

3. Hormone therapy has been clarified

The guidelines reaffirm menopause hormone therapy (MHT) as safe and effective when prescribed appropriately.

For most women under 60 or within 10 years of menopause who are experiencing bothersome symptoms, the benefits of starting MHT usually outweigh the risks.

Examples of MHT include estrogen (pills or patches) and/or progesterone (pills or intrauterine device).

This clarification is significant after years of confusion and fear around hormone treatment.

4. Intimate health is part of overall health

Vaginal dryness, painful sex and decreased libido are common but often unspoken.

The guidelines encourage doctors to actively screen for these concerns and provide appropriate treatment pathways, including vaginal oestrogen therapy where suitable.

These are medical concerns. You do not have to wait until something becomes unbearable before raising it to your GP.

What to say to your GP

If you suspect you may be in perimenopause or menopause, clarity helps. Instead of saying “I don’t feel great”, try being specific.

You could say:

• “I’ve been experiencing persistent sleep disruption for the past few months.”
• “My joints have been aching even though I haven’t changed my activity levels.”
• “I’ve noticed vaginal dryness and discomfort during intimacy.”
• “My mood has shifted. I feel more anxious or irritable than usual.”
• “I’ve gained weight despite maintaining the same diet and exercise routine.”
• “Could these symptoms be related to the menopause transition?”
• “Based on the new menopause management guidelines, what are my treatment options?”
• “Am I suitable for menopause hormone therapy?”
• “What lifestyle changes would make the biggest difference in my case?”

If you’re over 45 and experiencing typical symptoms of perimenopause, diagnosis can often be made based on your history and symptoms alone.

Bringing a brief symptom log — even notes on your phone — can make the conversation more productive. The more precise the discussion, the more tailored the care.

With an average life expectancy of 85.6 years for women in Singapore (based on 2024 data), many of us will spend more than three decades — over a third of our lives — post-menopause.

Certainly, that stage of life deserves clarity, structure and support.