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Pause For A Cause: Changing Attitudes and Treatments For Menopause

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  • 10 months ago
  • Balvinder Sandhu

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Pause For A Cause: Changing Attitudes and Treatments for Menopause
Gone are the days when women were thought to have gone insane when menopause changed their bodies.
In Victorian times, some women were locked up in asylums, and even just a few decades ago, it was not uncommon to hear women talk about “going through the change” in hushed tones, and men rolling their eyes when they realised women had hit “that age” and were feeling perhaps more erratic and hormonal than usual.
With more emphasis on women’s health in recent years, menopause is now viewed as a phase that women don’t have to suffer through.
Whether it’s having a better understanding of the common symptoms, the advancements in hormonal treatments or even what happens after “Aunt Flo” no longer visits you, we now seem more open to discussing this natural transition that all women go through.
Associate Professor Rukshini Puvanendran, Head and Senior Consultant, Family Medicine Service, KK Women’s and Children’s Hospital (KKH), says that, compared to a decade ago, more women are coming forth to discuss their menopausal symptoms.
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Also, with the recent launch of HealthierSG, menopause awareness among members of the public and healthcare professionals has been raised even further.
"But what we can do to further improve is to continue to normalise menopause,"
she adds.

"Continue to raise awareness that it is a perfectly natural thing to go through menopause and never be shy to seek help. Being informed about what may happen during the perimenopausal (the period shortly before menopause) and menopausal transitions is a very good starting point when coping with menopause."

Do you need hormone therapy?
Pause For A Cause: Changing Attitudes and Treatments for Menopause - Associate Professor Rukshini Puvanendran
Associate Professor Rukshini Puvanendran, Head and Senior Consultant, Family Medicine Service, KK Women’s and Children’s Hospital (KKH)
A/Prof Rukshini says that women in Singapore have access to healthcare services for menopause.
KKH has been receiving referrals from the community and from its obstetrics and gynaecology team and managing patients with moderate to severe menopausal symptoms since the 1990s.
"We do engage with our patients through regular menopause-related public forums and our menopause interest group,"
she explains.

"From our observation of their sharing, they are gradually more willing to seek help, but there will always be some women who are still shy or will not seek help due to personal factors."

Pause For A Cause: Changing Attitudes and Treatments for Menopause - Associate Professor Yong Tze Tein
Associate Professor Yong Tze Tein, Head and Senior Consultant, Obstetrics & Gynaecology, Singapore General Hospital
A/Prof Yong Tze Tein, Head and Senior Consultant, Obstetrics & Gynaecology, Singapore General Hospital, shares that many local women do not like the idea of hormone therapy.
"We help them weigh the risks and benefits, and tailor treatments according to their respective symptoms, ages and medical backgrounds,"
she explains.
"In my experience, it was very popular in the 1990s when HRT was thought of as a potential fountain of youth and many women were keen to go on it. However, a Women’s Health Initiative (WHI) study in 2002 was published and the use of HRT plummeted when risks seemed to outweigh benefits."
She has also seen a change in the way women look at menopause hormone therapy (MHT), which was previously known as hormone replacement therapy (HRT):
She reveals that the study looked at the use of HRT to prevent chronic disease in healthy postmenopausal women and the results were complex – it found that there was an increase in risks of breast cancer, stroke and pulmonary embolism in women on oestrogen and progestogen.
Other risks were increased dementia in women over 65, gallbladder disease and urinary incontinence. Benefits included decreased hip fractures, diabetes and vasomotor symptoms like hot flushes.
But with oestrogen alone (oestrogen replacement therapy, or ERT), there was a decrease in hip fracture, diabetes and breast cancer, but increased stroke and venous thrombosis.
The increase in adverse events is not high, at 12 excess cases per 10,000 women for ages 50-59 and 38 for ages 70-79.
"In the following years, a re-analysis of the WHI study showed that women in early postmenopausal years had beneficial effects in reducing coronary disease and all-cause mortality (death due to any cause),"
she says.

"Hence the use now of MHT is more balanced – used only when indicated for recently menopausal women, for the shortest time necessary."

"I think the biggest breakthrough in terms of menopause treatments in recent years is our understanding that MHT is safe for most women whose onset of menopause is recent (within 10 years),"
she adds.

"We also know which types of MHT are safer and they are tailored individually to the women. For example, systemic oestrogen given by gel or a patch, bypasses the liver metabolism and is associated with lower risk of gallbladder disease and blood clots."

Advances in menopause treatments
A/Prof Rukshini agrees that having more conclusive evidence showing the effectiveness of MHT is a big breakthrough.
She says it’s been shown to be safe and effective in most women under the age of 60.
"However, women remain fearful and many are suffering through the symptoms of menopause,"
she adds.

"We encourage all women who have experienced moderate to severe menopausal symptoms to seek a detailed consultation to assess their suitability for MHT."

But there are some women who may not benefit from MHT – women with a history of breast cancer, blood clotting disorders, stroke or heart diseases, unexplained vaginal bleeding, liver disease, uterine conditions or those who smoke.
This is why it’s important to seek an assessment with a doctor to weigh the benefits and potential risks based on your medical history and health condition.
A/Prof Rukshini shares how the advances in MHT continue to evolve. There are newer oestrogen and progesterone preparations that are like natural (body-identical) hormones.
Oestrogen comes in oral or transdermal (skin applications) forms. Transdermal preparations have lower risk of thrombosis (blood clotting) and doctors can tailor the treatments according to the woman’s needs.
"Non-hormonal alternatives such as selective serotonin (targeting the levels of mood-regulating hormones) and norepinephrine reuptake inhibitors (medications used to treat various mental health conditions by increasing the levels of specific mood-regulating hormones) that target menopausal symptoms without hormonal effects are also available for women who may not be suitable for MHT,"
she adds.
Take charge of this transition
A/Prof Rukshini is also co-lead at KK Menopause Centre, which takes a holistic approach to menopause treatment. Women’s symptoms are assessed, as well as the potential risks she may have holistically, even beyond menopause. menopause.
"We also care for women with complex menopause issues such as early menopause, surgically or medically induced menopause, cancer survivors with menopausal symptoms, menopause-related sexual health issues, osteoporosis, osteopenia (reduced bone mass) and management of menopause in women with complex medical issues such as auto-immune conditions, blood clotting disorders, breast cancer or those carrying a breast cancer genetic mutation,"
she explains.
Patients with perimenopause and menopause are managed by gynaecology, family medicine, dermatology and mental health specialists so that they can receive comprehensive and holistic assessment, detection and intervention.
"We also have an interest group led by Singapore’s first Advanced Practice Nurse, specialising in the care of women with menopause and osteoporosis, to support our patients and their loved ones through this challenging transitional period,"
A/Prof Rukshini adds.
A/Prof Yong notes that menopause is a natural physiological process and most women sail through it.
However if you have troublesome symptoms, seek help. Not all that happens (e.g., depression etc) is due to menopause.
At the menopausal age, many women also experience life changes like empty nest syndrome, ailing parents or potential loss of work, hence do visit your doctor to see what can be done to help.
"With menopause, periods can become irregular. But prolonged heavy bleeding lasting 10 days or more, erratic bleeding or bleeding after one year of stopping menstruation is not normal and you should see your doctor,"
she points out.
She also advises women to think about going for mammograms, cancer screenings for the breast, cervix and colon, which can be done at polyclinics or by GPs.
"We encourage all women to not ‘bear with it and hope for the best’. Instead, take charge!"
says A/Prof Rukshini.

"An optimal management of menopause and transition will greatly contribute to healthier ageing and better quality of life."

Menopause is not a disease and is a natural biological phase in a woman’s life and while it marks the end of your reproductive phase, it’s also a new beginning for you to take charge of your life – emotionally, mentally and physically.

KK Menopause Centre is a multi-specialty practice comprising gynaecology, family medicine, dermatology and mental health specialists. It aims to offer women easy access to effective and holistic treatment, the most up-to-date information as well as emotional and psycho-social support in the community. The hospital's health guide, Women In all Stages Empowered (WISE), also offers more information on menopause.

Also read:

Balvinder Sandhu

Balvinder Sandhu

A published author who lives in Melbourne but stays in touch with her Singapore roots and way of life.

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