Forced to Shut
Most women expect menopause to come at around 50 years old, but for one per cent of us, it can arrive as early as 40.
AZKUBDA SAID tells you more.
OUR EXPERTS
Dr Chua Yang, director, specialist obstetrician and gynaecologist at A Clinic For Women
Dr Kelly Loi, obstetrician and gynaecologist at Mount Elizabeth Hospital
Dr Kim Hayes, director and managing physician at Complete Healthcare International
How many of us have joked that we can't wait for the day our periods stop? For the cramping, moodiness, staining and inconvenience to end? On average, Singaporean women hit menopause between 50 and 51 years; the normal age range is between 45 and 55 years, says Dr Chua Yang, director, specialist obstetrician and gynaecologist at A Clinic For Women.
When a woman hits menopause, her ovaries stop producing eggs and her body make less oestrogen and progesterone, the female hormones. This leads to less frequent periods and eventually, no periods at all – she then cannot get pregnant anymore. If your period doesn't come for 12 months in a row, chances are, you are menopausing.
However, one in 100 women here has early menopause – where she stops menstruating between 40 and 45, says Dr Chua. In rare cases, a woman may have premature ovarian failure – her periods stop and she loses her fertility before turning 40.
When you suffer from early menopause, you'll get mood swings, hot flashes and insomnia (just to name a few symptoms), similar to those of regular menopause. The difference is, you go through them at an earlier age, say our expert.
You Can't Delay It
"When menopause happens is largely predetermined by the number of eggs a woman is born with, which decreases as she gets older," says Dr Kelly Loi, obstetrician and gynaecologist at Mount Elizabeth Hospital. "If she has surgery for ovarian cysts (where some ovarian tissue and eggs may be removed), or chemotherapy and radiotherapy for cancer, these can affect her eggs, and menopause may occur earlier. Smoking can also lead to early menopause."
Dr Chua explains that there's no known cause for early menopause in most women, except menopause in most women, except for a genetic link. "If you have a family history of early menopause, there is little that can be done to prevent it," she points out. There is also no way to delay it, with or without a family history.
It May Affect Your Sex Life
One effect of early menopause is a lower libido, partly due to the fact that your vagina becomes dry, making intercourse painful. In this situation, Dr Kim Hayes, director and managing physician at Complete Healthcare International, says you should spend more lubricated for sex.
"Occasionally, women are prescribed testosterone as part of hormone replacement to increase their libido," she says.
Dr Chua adds:" Consider also the psychological effect of menopausing early and losing the ability to have children (or more children), for example. That may affect libido, too."
And a menopausal woman may go through emotional changes like irritability and mild depression. If these get worse, seek medical help or see a therapist.
"Someone
going
through early
menopause
should be
on HRT until
she turns 50
– the age at
which natural
menopause
would occur."
What Your Doctor Can Do
She can recommend hormone replacement therapy (HRT), which tops up waning levels of oestrogen and progesterone. Someone going through early menopause should be on HRT until she turns 50 – the age at which natural menopause would occur – as it helps to stave off cholesterol issues which can cause heart disease, explains Dr Chua.
Besides HRT, your doctor can put you on an ultra-low dose of birth control-type pills, or topical hormonal treatment, to give you the hormones you need. "What you get depends on your medical history and whether your uterus is intact," adds Dr Loi.
She further points out that HRT not only eases early-menopause symptoms like mood swings, it protects against the early onset of osteoporosis (brittle bone disease) too. Dr Loi also recommends calcium supplements to strengthen the bones.
Dr Chua agrees," Women start to lose bone mass from the time they reach early menopause. So they may get osteoporosis earlier."
But HRT also has side effects, says Dr Hayes," Too much oestrogen can cause fluid retention, bloating breast tenderness or swelling, nausea and headaches. Too much progesterone can bring about mood swings, depression and acne."
However, most times, as HRT is given in the lowest dose possible, the chances of suffering side effects – if at all – are minimal, notes Dr Chua. " What's important for anyone taking any kind of hormonal preparation is to not to obese, extremely sedentary or smoke," she says.
The Breast Cancer Risk
A common concern about HRT is the increased risk of breast cancer. But Dr Hayes points out that studies show you're at risk only if you've been taking HRT for over five years. "Also, if only oestrogen is replaced, the risk of breast cancer is much less, compared with if you have to replace both oestrogen and progesterone."
Dr Chua adds that a woman's risk of breast cancer also depends on how long her breasts have been exposed to hormonal stimulation. "A woman who starts menstruating exceptionally early (the average age is about 11 years) or gets menopause exceptionally late (after the normal age cap of 55 years) already has an increased risk of breast cancer, compared to her peers who menopause at age 50."
Know the Signs
The symptoms for early menopause are similar to those of normal menopause:
  • Reduced menstrual flow, then your periods stop
  • Lethargy
  • Body aches and pains
  • Night sweats
  • Reduced libido
  • Memory loss
  • Hot flashes
  • Emotional changes like irritability, mild depression or mood swings
  • Insomnia
  • Vaginal and skin dryness
Freezing Your Eggs
Is this an option at the onset of early menopause?
Doctors say it's not, because..
  1. PREDICTING THE LIKELIHOOD OF EARLY MENOPAUSE IS ALMOST IMPOSSIBLE
    "It is very unlikely that you can predict the onset of early menopause, short of suspecting it due to a strong family history. Once you hit early menopause, you no longer have eggs or follicles that are viable for ovulation. Therefore, hormone production discontinues, ending your fertility."says Dr Chua.
  2. SINGAPORE LAW DOESN'T ALLOW A WOMAN TO FREEZE HER EGGS FOR SOCIAL REASONS
    "You can do this only for medical reasons. For instance, you’re about to undergo chemotherapy and would like to preserve your eggs to protect them from the harm of chemotherapy. Currently, the only way a woman can freeze her eggs is to stimulate the eggs through medication, monitor their growth and retrieve as well as store them in an egg bank overseas," notes Dr Chua.
    Dr Hayes adds:"Freezing your eggs requires using hormones and invasive procedures. Apart from possible health risks, it’s also expensive."
  3. YOU NEED TO FIND A SURROGATE
    Even if you can afford to freeze your eggs overseas, there’s another complication. "The risk of miscarriage is extremely high, due to a lack of ovarian hormonal support, which is necessary in the first trimester of pregnancy," says Dr Chua. "It would mean hormonal medication from the start – as soon as the embryo is transferred into you for implantation. So a surrogate pregnancy is your best bet as it will enable you to have a child that is genetically yours."
  4. IT'S BEST TO FREEZE YOUR EGGS BEFORE 40
    Early menopause may set in when a woman turns 40, but “it’s best to freeze your eggs before that, despite the fact that eggs can be kept in an egg bank indefinitely," says Dr Loi. “This is because the quality of your eggs declines as you get older, and the chance of genetic abnormalities gets higher."