Can you explain what menopause is and at what age women typically experience it?
The menopause is defined as no period/menstrual cycle for 12 consecutive months and as per the WHO is “caused by the loss of ovarian follicular function and a decline in circulating blood oestrogen levels.”
Research shows that the average age of the menopause for Caucasian women is 51 years, Singaporean/East Asian Women is 49 years, and South Asian including Sri Lankan women is 46-47 years.
What are the most common symptoms women face during menopause, and how can they manage them effectively?
Perimenopause is the time before the menopause (lasting 5-15 years), when female sex hormones, mainly estradiol and progesterone along with testosterone fluctuate causing symptoms. The most common symptoms in South Asian/Southeast Asian women including sleep problems, joint pains and tiredness, vaginal dryness (genitourinary syndrome of the menopause), mental health conditions, and vasomotor symptoms (hot flashes/night sweats).
There are likely over 70 symptoms of menopause, and these can be wide and varied, and broadly speaking categorised in to:
- Physical symptoms – hot flashes, night sweats, palpitations, joint pains, headaches, breast tenderness, change to hair and skin, period changes, sleep issues, weight gain
- Cognitive symptoms – brain fog, forgetfulness, poor focus/concentration, poor short-term memory/recall
- Mood changes – anxiety, impatience, irritability, poor motivation, mood swings, tearfulness
- Urinary/Sexual/Vaginal symptoms (Genitourinary Syndrome of the Menopause) – recurrent UTIs, incontinence, low sex drive, painful sex, vaginal dryness
How does menopause affect a woman’s physical and mental health long-term?
Yes, menopause is a ‘natural process’ that all women will go through with a quarter of these women having none or barely any symptoms. This could be due to genetic, environmental, and lifestyle factors. However, most women will have their quality of life affected in some way or form, which will inevitably spill into their personal and professional lives.
A survey completed in 2022 shows that 7 in 10 women blamed the menopause for the breakdown of their marriage. Suicide rates in women aged 45 to 54 years in the United Kingdom going through the menopause have risen. Many women in the workforce are having to reduce their working hours, take time off work, or change/leave their employment due to the effect of their symptoms.
Are there natural or non-medical ways to manage menopause symptoms? What lifestyle changes can help?
Absolutely. Optimising the 6 pillars of lifestyle medicine is key:
- Sleep: adults should aim for 7-9 hours of sleep routinely.
- Nutrition: aim to get enough protein in your nutrition (1.6g to 2.2g per kg of body weight as a rough guide depending on your own personal goals) via wholefoods along with 30g of fibre each day.
- Exercise: strength and conditioning is vitally important to build muscle, along with Zone 2 cardio work as “fat burn” and other individualised combinations of exercise.
- Mental health self-care and support: consider cognitive behavioural therapy and mindfulness based-stress reduction as proven measures depending on your needs.
- Social connectedness: having the right support network/ “tribe” around you makes a huge difference.
- Avoidance of risky substances: you know I need to say, “don’t smoke or do drugs” and along with this, cut back on alcohol.
How important is diet and exercise in managing the effects of menopause? Can certain foods help alleviate symptoms?
80% of chronic conditions are lifestyle related. As such, yes, diet and exercise are hugely important. A woman’s baseline wellness can be affected by obesity, smoking, alcohol and drug intake, as well as being sedentary. It is never too late to be active and this can be built up gradually to reduce the risk of injury as well.
There is no “perfect diet” but focusing on a whole-food, predominantly plant based, sustainable nutrition plan, optimising protein, complex carbohydrates, and “good” fats are key.
What are the common myths about menopause that women should be aware of?
The list is endless unfortunately! Here are some examples:
‘Menopause starts later in life’ – most women will go through the menopause between 45-55 years but 1:100 women will be <40 years and 1:1000 < 30 years.
‘Menopause can’t be managed… you just get through it’ – a quarter of women may experience none to mild symptoms, which can be self-managed. However, for those who have symptoms affecting their quality of life and daily activities, medical and psychological management is likely to be required. A priority overall should be to optimise the 6 pillars of lifestyle medicine noted above to have a solid functioning foundation of health and wellbeing. But don’t forget, positive outcomes having been through the menopause includes having no more period, premenstrual symptoms, and no more pregnancy risk!
‘HRT is dangerous’ – this unfortunately stems from worrying medical reports from a large study done in the early 2000’s, which has seen been reviewed and updated with new research along with body-identical, much-safer to use, hormone therapy options in place. For most women under the age of 60 years and within 10 years of the menopause, the benefits of hormone therapy do outweigh the risks. Hormone therapy is the most effective way to treat menopause symptoms and is also beneficial in bone protection and reducing the risk of some chronic conditions, especially in women who go through early menopause (<40 years of age). Evidence shows that the risk of serious side effects from hormone therapy are low. Managing menopause symptoms at a personal and individualised level is key.
How does menopause affect cardiovascular health, bone density, and overall aging?
The number one cause of death in women is in fact, heart disease. This increases significant post-menopause due to the lack of estradiol. 1 in 2 women over the age of 60 will have a fracture secondary to osteoporosis, which is also due to a lack of estradiol post-menopause. Falls and fractures over the age of 65 years increases the risk of frailty considerably, which in turn accelerates ageing but reducing both health span and lifespan in longevity.
How can women stay proactive in their health before, during, and after menopause to ensure long-term well-being?
Easy! Optimise the 6 pillars of lifestyle medicine in a way that is sustainable in the long-term. It is never too late to start sleeping better, eating better, exercising correctly, managing mental health and wellbeing, ensuring good social connections, not smoking or doing drugs, and reducing alcohol intake.
What advancements or new treatments are available today for women going through menopause?
Hormone therapy is the most effective treatment for symptoms of menopause in most women, for primary prevention of health risks associated with early menopause, and for osteoporosis preventing in women under 60 years of age. It is also being researched as a “longevity treatment” in the future – so, watch this space.
How can women best prepare for menopause mentally and emotionally, and what role can healthcare professionals play in providing support during this transition?
Find your trusted family physician to guide you. I am a vocal advocate for women health, and this needs to start in primary care – we are the gatekeepers for all our patients, ensuring they receive the personalised best care available to them.
Optimise the 6 Pillars of Lifestyle Medicine in a way that is sustainable for you:
- Aim to sleep 7-9 hours each night
- Improve your protein and fibre intake
- Lift some heavy weights please
- Keep a check on your mental health and wellbeing
- Quit smoking and reduce alcohol consumption
- Don’t hide away from family & friends – have an open conversation with your partner – and get the support you need early so you can thrive!
(Dr. Tashiya Mirando, a British-trained Family Physician, graduated from the University of Sheffield and completed her training in Coventry and Warwickshire. She later worked in the U.S. Embassy in India before returning to London to gain her MRCGP and membership in the Royal College of General Practitioners. Focusing in Women’s Health, Dr. Tash holds diplomas in Women’s Health, Diabetes, Sexual Health, and Minor Surgery. She is also accredited by the International Board of Lifestyle Medicine. Now based in Singapore, she cares for patients of all ages, with a strong focus on family and women’s health, and is a member of the British Menopause Society.)
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