Sat, Nov 01, 2008
Mind Your Body, The Straits Times
Hormonal havoc
She was often moody, started feeling listless and was constantly lethargic. It happened last year and during this time, her periods also stopped for about three months.
Madam Jade Ng, a 45-year-old housewife, consulted her gynaecologist who told her not to worry and gave her medication to regulate her menstruation.
However, her mood swings continued.
GOING THROUGH THE PHASES
Most women have heard about menopause and know that it is something that they need to deal with when they get to a certain age. But other terms related to menopause and the changes a woman's body can go through might be less familiar:
Perimenopause
This encompasses the two to eight years before a woman's final menstrual period, plus a year after it.
Premenopause
It refers to the time after puberty and before menopause. Thus, any woman who is menstruating is premenopausal.
Premature ovarian failure (POF)
This is when a woman's ovaries stop working before she is 40. POF used to be called premature menopause. However, POF is not the same as menopause. Some women with POF still have occasional periods.
Premature menopause
This is when periods stop before the age of 40. This can be natural or caused by surgery, chemotherapy or radiation.
Menopause
It is defined as the permanent cessation of menstruation and fertility. It is a retrospective diagnosis, that is, when a woman has not had her menstrual periods for 12 consecutive months, having excluded other reasons. The average age of menopause for women worldwide is 50 years.
Madam Ng said: 'I lost interest in things I used to enjoy, like meeting friends or shopping. My husband and daughter would complain that I was always very grumpy.'
She never thought that the symptoms she experienced were due to perimenopause. She had not even heard of the term. Menopause was far from her mind.
'I thought that at 44, it was impossible for me to be on my way to menopause. I felt I was too young,' she recalled.
The United States Department of Health and Human Services defines perimenopause as the time when a woman's body begins the transition to menopause.
This includes the years leading up to menopause - anywhere from two to eight years - plus the first year after the final menstrual period. There is no way to tell in advance how long it will last or how long it will take for a woman to go through it.
Perimenopause is a natural part of ageing that signals the ending of a woman's reproductive years.
Dr Choo Wan Ling, a consultant obstetrician and gynaecologist at the Pacific Healthcare Specialist Centre, said many women are shocked when told that they are perimenopausal.
She said: 'They tend to link perimenopause with the actual menopause state.'
Many women do not realise that they can begin to experience menopausal symptoms years before it actually begins.
Dr Chua Yang, the director and consultant obstetrician and gynaecologist at A Clinic For Women, said that in the West, it is typically reported that up to 80 per cent of women experience significant symptoms during perimenopause.
However, Dr Chua, who is also the president of the Menopause Research Society (Singapore), said that a study here has shown that only 20 per cent of local women experience moderate to severe symptoms.
A 2004 local survey of 300 women aged between 40 and 55 found that the majority of women knew about the general concept of menopause and were able to cite common symptoms. However, only 22 per cent of these women consulted their doctors to find out more about menopause and 64 per cent claimed they did not prepare for menopause or the health issues that may follow.
Dr Chua said: 'Perhaps Asian women are more conservative and less willing to talk about symptoms such as emotional instability or sexual discomfort due to vaginal dryness.'
She added that women need to realise that managing many of the menopause-related symptoms involves turning to herbal or alternative remedies, or making simple lifestyle changes.
'Medication is often not needed. But if a woman is assessed to be in need of medication, there are plenty of safe choices to make,' she said.
Dr Christopher Ng, a consultant obstetrician and gynaecologist at GynaeMD Women's and Rejuvenation Clinic at Camden Medical Centre, emphasises the importance of good nutrition and regular exercise to his patients who have perimenopausal symptoms.
Due to the increased risk of osteoporosis and heart disease at this stage of their lives, perimenopausal women should adopt a low-fat, high-fibre diet rich in calcium. Dr Ng also advises his patients to avoid alcohol and caffeine, which can trigger hot flushes.
The US Department of Health and Human Services states that oral contraceptives can ease perimenopausal symptoms. The hormone treatments of combined oestrogen and progestin can help regulate menstrual cycles and other perimenopausal symptoms.
Four months ago, Madam Ng started on hormone replacement therapy (HRT) to relieve her perimenopausal symptoms. She said she has been feeling much better and no longer suffers from mood swings. Her sleep has also improved greatly.
Madam Ng also began participating in the Woman-to-Woman Menopause Support Group meetings at KK Women's and Children's Hospital. Although most of the women in the group are older than her, she does not feel out of place during the meetings.
'Just being able to talk about my perimenopausal experiences has made me feel much better,' she said.
