It’s generally clear which doctor you should see for your ailment. Have a niggling foot pain? Go to a podiatrist. Consult a cardiologist if having heart issues and a dermatologist for eczema. Where it gets a bit blurry though, is deciding what sort of medical advice we need when we’re experiencing menopause symptoms.
Associate Professor Rukshini Puvanendran, co-director at KK Menopause Centre at KK Women’s and Children’s Hospital (KKH) said that menopause is a clinical diagnosis.
Doctors assess a woman based on her symptoms, medical history, and through a physical examination,. They will assess if the symptoms – such as poor sleep, exhaustion, weight gain or heart palpitations – are due to menopause or other medical conditions.
“Your GP or family doctor will be a good first point of contact,” she said. “Most gynaecologists will be able to advise on management of menopausal symptoms.
“If an alternative opinion is deemed necessary, general practitioners, family physicians or gynaecologists
She said that growing evidence shows that the drop of oestrogen levels caused by menopause affects a woman’s body from head to toe, including her bones, heart, brain, skin, musculoskeletal system and even emotions.
Places such as the KK Menopause Centre offer a comprehensive approach to menopause care, with specialists in gynaecology, family medicine, dermatology and mental health working together work together to provide thorough evaluations and appropriate treatments.
“We are starting to understand that all over the world, medical professionals lack adequate education and training in menopause,” said a family physician in Singapore. (Photo: iStock/Marcos Calvo)
Dr June Tan Sheren, a family physician, acknowledged it can be challenging for a woman to find the right doctor for her menopause
However, this process isn’t always as easy as it sounds. Dr Sheren
“We are starting to understand that all over the world, medical professionals lack adequate education and training in menopause,” she told CNA Women.
Dr Sheren recalled that during her early years of practice over 20 years ago, it was routine to prescribe hormone replacement therapy (HRT) – but all that changed in 2002 when the Women’s Health Initiative study in the United States was released.
The study reported that HRT carried more risks than benefits, and as a result, HRT prescribing fell by 80 per cent globally.
“There is now a generation of doctors who have never prescribed HRT or trained in menopause management and may lack the confidence to have conversations on well-being in midlife with their patients,” said Dr Sheren, who is also medical advisor to local menopause platform Surety.
Dr Chua Yang, director and specialist obstetrician and gynaecologist at A Clinic For Women noted that “many GPs or even gynaecologists may choose not to manage menopause in a big way as it is potentially very time-consuming to discuss the wide spectrum of menopause issues or concerns with patients”.
“My consultation with each patient who seeks answers about their menopause is typically at least half an hour to an hour long,” she said. “There is a lot of health education and lifestyle counselling involved, never just to prescribe a pill.”
“We are starting to understand that all over the world, medical professionals lack adequate education and training in menopause,” said a family physician in Singapore. (Photo: iStock/Chinnapong)
Dr Chua suggested that the most important thing with choice of healthcare professional is that patients feel they can be completely open and discuss all their intimate concerns, and that they trust their physicians to care for them.
“What is important in the initial conversation is to find out if your doctor is a good listener and will address your concerns,” said Dr Chua, who has served as president of both the Menopause Research Society of Singapore and the Asia Pacific Menopause Federation.
Added Assoc Prof Rukshini: “A doctor who cares for you will take your concerns seriously and try to help. If they don’t feel comfortable with menopause management, they should be able to refer you to other qualified healthcare professionals, which… could be a dietitian, physiotherapist or counsellor, for the necessary care.”
It’s hard to judge if what you’re going through is a normal part of menopause or something that needs special medical attention. Dr Charu Narayanan, family physician at International Medical Clinic, said that ‘severe’ symptoms are not for the doctor to decide but for the woman herself.
“For some, these symptoms may severely impact their quality of life and daily functioning and can continue for a few years after the last menstrual period, whereas others may sail through these years without experiencing these to a large degree,” she said.
Dr Charu remarked that this does not mean we can trivialise the impact menopause can have on many women.
Also, it’s important to know that there are cultural differences in expression and some cultures may even place less emphasis on certain complaints, hence sweep things under the carpet.
Dr Charu pointed out that Southeast Asian women may not have severe hot flushes but may have more joint and muscle pains. Plus, sexual symptoms such as low libido, urinary complaints and genital dryness are frequently ignored even though they affect the woman’s quality of life in a significant fashion.
Assoc Prof Rukshini lists some common menopausal symptoms.
Irregular menses: Changes can include duration, timing and flow. Consult your doctor if you are having an increase in menstrual flow – especially with clots – spotting between periods or bleeding after sexual intercourse.
Hot flushes and night sweats: Sudden sensations of heat that typically come from within and affect the face, neck and chest. Hot flushes at night are called night sweats. They can cause disturbances to sleep and affect a woman’s quality of life.
Mood swings: Changes in mood, including increased irritability and anxiety.
Sleep issues: Difficulty falling asleep and/or staying asleep can lead to fatigue and daytime sleepiness. Prolonged sleep issues can lead to functional memory issues.
Vaginal changes: Thinning and dryness of the vaginal tissues can lead to discomfort or pain during intercourse.
Sexual desire: A decrease in sexual desire or changes in sexual function, sometimes due to vaginal changes.
Physical changes: Weight gain, drier skin, reduced thickness in hair texture.
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Dr Charu suggested several questionnaires which can be done online (The Greene Climacteric Scale, Australian Menopause Society Symptom Score Sheet, MenoScale), with one specific to mood changes around menopause (called the Meno-D scale), to assess the severity of symptoms.
“KKH and the British Menopause Society have good information on their websites around menopause management,” she added.
Hormone replacement therapy, also called menopausal hormone therapy, is safer than previously thought to be. (Photo: iStock/JazzLove)
Dr Charu urged women to seek help and be aware of menopause to improve their quality of life.
She added that they should also be able to make choices around treatment once they are aware of the pros and cons, especially of HRT, which is safer than previously thought to be – the results of the Women’s Health Initiative study were re-analysed and subsequently found to be flawed.
“The conclusions from evidence available from this study and others since suggest a lower risk of cardiovascular disease, no increased stroke risk and reduced overall mortality in women using HRT in the first 10 years after menopause or between 50 and 59 years of age,” said Dr Charu. “Even if HRT is started after the age of 60 years, there is no increase in the risk of cardiovascular events or overall mortality.”
“It’s also about improving ‘health span’ and not just ‘life span’ – so staying healthy for longer and preventing certain chronic diseases that are now linked to lack of hormones at menopause,” she added.
Dr Sheren said that hormone tests are useful in some situations such as in the evaluation of premature menopause. Other tests can be helpful depending on your symptoms, such as thyroid function testing and checking for iron deficiency and anaemia.
Some tests your doctor can do during menopause include thyroid function testing, checking for iron deficiency, vitamin D, heart tests and anaemia. (Photo: iStock/Anchiy)
“Women at risk of osteoporosis can have their vitamin D level tested and a bone density scan to screen for osteopenia and osteoporosis,” she said. “Menopause is associated with cardio-metabolic changes and it is important to screen for cardiovascular risk factors like high cholesterol and diabetes/pre-diabetes.”
Dr Sheren also suggested staying up-to-date with regular screening tests for cervical cancer, breast cancer and, from age 50, bowel cancer.
She strongly encouraged every woman in menopause transition to talk to their doctors about these tests as part of essential screening and preventive healthcare.
Dr Chua noted that one of the difficulties at menopause results from many women not having their mother’s advice when they approach menopause, unlike at puberty. She stressed the importance of understanding the changes and health consequences, as well as being well prepared and knowing what options there are for continuing good health and wellness.
“I encourage all women to discuss their future health with their doctors – what can you do when you are pregnant or in your thirties, that will make your midlife and perimenopause healthier and happier,” she added.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
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Associate Professor Rukshini Puvanendran, co-director at KK Menopause Centre at KK Women’s and Children’s Hospital (KKH) said that menopause is a clinical diagnosis.
Doctors assess a woman based on her symptoms, medical history, and through a physical examination,. They will assess if the symptoms – such as poor sleep, exhaustion, weight gain or heart palpitations – are due to menopause or other medical conditions.
“Your GP or family doctor will be a good first point of contact,” she said. “Most gynaecologists will be able to advise on management of menopausal symptoms.
“If an alternative opinion is deemed necessary, general practitioners, family physicians or gynaecologists
She said that growing evidence shows that the drop of oestrogen levels caused by menopause affects a woman’s body from head to toe, including her bones, heart, brain, skin, musculoskeletal system and even emotions.
Places such as the KK Menopause Centre offer a comprehensive approach to menopause care, with specialists in gynaecology, family medicine, dermatology and mental health working together work together to provide thorough evaluations and appropriate treatments.
“We are starting to understand that all over the world, medical professionals lack adequate education and training in menopause,” said a family physician in Singapore. (Photo: iStock/Marcos Calvo)
Dr June Tan Sheren, a family physician, acknowledged it can be challenging for a woman to find the right doctor for her menopause
However, this process isn’t always as easy as it sounds. Dr Sheren
“We are starting to understand that all over the world, medical professionals lack adequate education and training in menopause,” she told CNA Women.
Dr Sheren recalled that during her early years of practice over 20 years ago, it was routine to prescribe hormone replacement therapy (HRT) – but all that changed in 2002 when the Women’s Health Initiative study in the United States was released.
The study reported that HRT carried more risks than benefits, and as a result, HRT prescribing fell by 80 per cent globally.
“There is now a generation of doctors who have never prescribed HRT or trained in menopause management and may lack the confidence to have conversations on well-being in midlife with their patients,” said Dr Sheren, who is also medical advisor to local menopause platform Surety.
FINDING A DOCTOR WHO LISTENS TO YOU
Dr Chua Yang, director and specialist obstetrician and gynaecologist at A Clinic For Women noted that “many GPs or even gynaecologists may choose not to manage menopause in a big way as it is potentially very time-consuming to discuss the wide spectrum of menopause issues or concerns with patients”.
“My consultation with each patient who seeks answers about their menopause is typically at least half an hour to an hour long,” she said. “There is a lot of health education and lifestyle counselling involved, never just to prescribe a pill.”
“We are starting to understand that all over the world, medical professionals lack adequate education and training in menopause,” said a family physician in Singapore. (Photo: iStock/Chinnapong)
Dr Chua suggested that the most important thing with choice of healthcare professional is that patients feel they can be completely open and discuss all their intimate concerns, and that they trust their physicians to care for them.
“What is important in the initial conversation is to find out if your doctor is a good listener and will address your concerns,” said Dr Chua, who has served as president of both the Menopause Research Society of Singapore and the Asia Pacific Menopause Federation.
Added Assoc Prof Rukshini: “A doctor who cares for you will take your concerns seriously and try to help. If they don’t feel comfortable with menopause management, they should be able to refer you to other qualified healthcare professionals, which… could be a dietitian, physiotherapist or counsellor, for the necessary care.”
HOW WOMEN IN MENOPAUSE CAN STAY HEALTHY LONGER
It’s hard to judge if what you’re going through is a normal part of menopause or something that needs special medical attention. Dr Charu Narayanan, family physician at International Medical Clinic, said that ‘severe’ symptoms are not for the doctor to decide but for the woman herself.
“For some, these symptoms may severely impact their quality of life and daily functioning and can continue for a few years after the last menstrual period, whereas others may sail through these years without experiencing these to a large degree,” she said.
Dr Charu remarked that this does not mean we can trivialise the impact menopause can have on many women.
Also, it’s important to know that there are cultural differences in expression and some cultures may even place less emphasis on certain complaints, hence sweep things under the carpet.
Dr Charu pointed out that Southeast Asian women may not have severe hot flushes but may have more joint and muscle pains. Plus, sexual symptoms such as low libido, urinary complaints and genital dryness are frequently ignored even though they affect the woman’s quality of life in a significant fashion.
COMMON MENOPAUSE SYMPTOMS
Assoc Prof Rukshini lists some common menopausal symptoms.
Irregular menses: Changes can include duration, timing and flow. Consult your doctor if you are having an increase in menstrual flow – especially with clots – spotting between periods or bleeding after sexual intercourse.
Hot flushes and night sweats: Sudden sensations of heat that typically come from within and affect the face, neck and chest. Hot flushes at night are called night sweats. They can cause disturbances to sleep and affect a woman’s quality of life.
Mood swings: Changes in mood, including increased irritability and anxiety.
Sleep issues: Difficulty falling asleep and/or staying asleep can lead to fatigue and daytime sleepiness. Prolonged sleep issues can lead to functional memory issues.
Vaginal changes: Thinning and dryness of the vaginal tissues can lead to discomfort or pain during intercourse.
Sexual desire: A decrease in sexual desire or changes in sexual function, sometimes due to vaginal changes.
Physical changes: Weight gain, drier skin, reduced thickness in hair texture.
Collapse Expand
Dr Charu suggested several questionnaires which can be done online (The Greene Climacteric Scale, Australian Menopause Society Symptom Score Sheet, MenoScale), with one specific to mood changes around menopause (called the Meno-D scale), to assess the severity of symptoms.
“KKH and the British Menopause Society have good information on their websites around menopause management,” she added.
Hormone replacement therapy, also called menopausal hormone therapy, is safer than previously thought to be. (Photo: iStock/JazzLove)
Dr Charu urged women to seek help and be aware of menopause to improve their quality of life.
She added that they should also be able to make choices around treatment once they are aware of the pros and cons, especially of HRT, which is safer than previously thought to be – the results of the Women’s Health Initiative study were re-analysed and subsequently found to be flawed.
“The conclusions from evidence available from this study and others since suggest a lower risk of cardiovascular disease, no increased stroke risk and reduced overall mortality in women using HRT in the first 10 years after menopause or between 50 and 59 years of age,” said Dr Charu. “Even if HRT is started after the age of 60 years, there is no increase in the risk of cardiovascular events or overall mortality.”
“It’s also about improving ‘health span’ and not just ‘life span’ – so staying healthy for longer and preventing certain chronic diseases that are now linked to lack of hormones at menopause,” she added.
TESTING FOR MENOPAUSE
Dr Sheren said that hormone tests are useful in some situations such as in the evaluation of premature menopause. Other tests can be helpful depending on your symptoms, such as thyroid function testing and checking for iron deficiency and anaemia.
Some tests your doctor can do during menopause include thyroid function testing, checking for iron deficiency, vitamin D, heart tests and anaemia. (Photo: iStock/Anchiy)
“Women at risk of osteoporosis can have their vitamin D level tested and a bone density scan to screen for osteopenia and osteoporosis,” she said. “Menopause is associated with cardio-metabolic changes and it is important to screen for cardiovascular risk factors like high cholesterol and diabetes/pre-diabetes.”
Dr Sheren also suggested staying up-to-date with regular screening tests for cervical cancer, breast cancer and, from age 50, bowel cancer.
She strongly encouraged every woman in menopause transition to talk to their doctors about these tests as part of essential screening and preventive healthcare.
Dr Chua noted that one of the difficulties at menopause results from many women not having their mother’s advice when they approach menopause, unlike at puberty. She stressed the importance of understanding the changes and health consequences, as well as being well prepared and knowing what options there are for continuing good health and wellness.
“I encourage all women to discuss their future health with their doctors – what can you do when you are pregnant or in your thirties, that will make your midlife and perimenopause healthier and happier,” she added.
CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.
Continue reading...