Menopause – symptoms and treatment options

Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as nearly age 60s. The average age of menopause is usually about 49 to 51. It is normally diagnosed in females after 1 year of absent menstrual flow. Menopause does not occur suddenly. It is a slow transition and peri-menopause usually begins a few years before the last menstrual period. Menopause is only one event in the transition period involving changes in the female body between the mid or late 40’s, when the production of female hormones (estrogen and progesterone) begins to decline. Most of the signs and symptoms of menopause arise from this decrease in estrogen production even before periods stop altogether. Menopause occurring before age 40 is termed premature and may need medical evaluation for the cause. However, if menopause is delayed beyond the age of 55 (meaning a woman is still experiencing menstrual bleeding), there is an increased risk of breast, ovarian, and uterine cancer. This is due to the increased amount of time a woman’s body has been exposed to the estrogen. Therefore, regular mammograms and gynaecological review by specialist is important for women experiencing late-onset menopause.

Frequent symptoms and signs

  • Menstrual irregularity – the menstrual flow can be scanty, heavy and/or prolonged.
  • Hot flashes or flushes – sudden sensations of heat spreading from the waist or chest toward the neck, face and upper arms (symptoms are often referred to as vasomotor instability). Often associated with excessive sweating. It may occur frequently and last for few minutes. If they occur at night, they may disrupt your sleep. Hot flashes usually stop within one or two years but may persist for several years.
  • Headaches, dizziness, rapid or irregular heartbeat.
  • Sexual changes such vaginal itching and dryness, burning or discomfort during intercourse, (usually beginning a few years after menopause), reduced libido, or sex drive.
  • Urinary symptoms such as bladder irritability, discomfort, frequent urination and urinary tract infection may be more common.
  • Digestive issues such as constipation, diarrhea, bloating, heartburn.
  • Physical changes such as weight gain, thinning hair, dry skin, loss of breast fullness, reduced muscle mass, painful or stiff joints, increased hair growth on other areas of the body (such as the face, neck, chest), fatigue.
  • Psychological symptoms – such as mood changes, pronounced tension and anxiety, panic attack, sleeping difficulty, depression, difficulty concentrating, memory problems


  • This is a part of the normal aging process, when there is a decline in ovary function, resulting in decreased levels of the female hormones.
  • Surgical removal of both ovaries (surgical menopause).
  • Loss of ovarian function resulting from certain immunological diseases, infection, effects of radiotherapy or chemotherapy.
  • Genetic or chromosomal disorders

Risk factors

  • Smoking.
  • Hysterectomy.
  • Chemotherapy or radiotherapy.


Menopause cannot be avoided and currently there is no preventive strategy to avoid or delay it.

Possible complications

  • Increased irritability and susceptibility to infection in the urinary tract.
  • Decreased skin elasticity and vaginal moisture.
  • Increased risk of hardening of the arteries, heart disease, stroke.
  • Osteoporosis.
  • Changes in feelings of self-worth and mental health issues.


  • A blood test to confirm menopause is usually not necessary, unless when premature menopause is suspected.
  • Bone mineral density testing is recommended in older women or in those with a higher risk of osteoporosis.


  • Menopause is a normal process, not an illness. Most women can make an easy transition without difficulty.
  • Diagnosis is determined by patient’s age and symptoms. Laboratory tests (blood hormonal level assessment) are often not required for diagnosis.
  • Lifestyle changes may be necessary with the onset of menopause. Stay as healthy and happy as you can and live life to the fullest.
  • Psychotherapy or counseling may be required if emotional changes interfere with personal relationships or at work.
  • If you are sexually active, do continue to use birth-control measures until at least 12 months after your last menstrual period.
  • Reduce stress in your life as much as possible. Acupuncture, meditation, and relaxation techniques are all harmless ways to reduce the stress of menopause.
  • Herbal (or products termed as natural remedies) may be of help to some women, especially those with significant hot flushes. Discuss this with your health care provider.
  • Women who smoke may start menopause about two years earlier than nonsmokers. Also, smoking is linked to a decline in estrogen. If you smoke, talk to your health care provider about programs to help you quit.
  • See your doctor on a regular basis for health screening (Pap smear, mammogram, ultrasound scan and blood tests). Discuss the screening intervals with your doctor.
  • Activity – there is no restrictions. Active exercise is beneficial. Weight-bearing activities (such as walking) are helpful for bone strength. Swimming is also beneficial.
  • Diet – eat a well-balanced diet. Increase your calcium intake.
  • The menopausal transition is a trying time for the maintenance of weight. Many women gain weight during this period because their metabolism slows down. It is also related to aging, many lifestyle changes (e.g fewer activities), and other genetic factors. Therefore, you may need to reduce your calories (eat a healthy diet) and exercise more just to maintain your current weight.


  • Menopausal hormone therapy (MHT) is an option. Hormone treatment has benefits as well as risks. It must be considered on a patient-by-patient basis.
  • Medications to prevent and/or treat loss of bone density may be prescribed, depending on the bone mineral density assessment (BMI) and the risk factors for osteoporotic fractures.
  • Take calcium and vitamin D supplements every day. Discuss with your doctor regarding the types and the dosage required.
  • Antidepressants may be effective for treating hot flashes.
  • For vaginal dryness, moisturizers such as Replens may be effective. It comes in a pre-filled applicator and makes it easier to introduce the moisturizer into the vagina.

You should see your doctor immediately if you have:

Any unexplained vaginal bleeding, new or unexpected symptoms develop during the menopausal period. Drugs used in treatment may produce side effects and you should discuss these with your doctor.


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Loop Electrosurgical Excision Procedure (LEEP/LLETZ) for CIN

Loop electrosurgical excision procedure (LEEP), also known as large loop excision of the transformation zone (LLETZ), is a procedure for further diagnosis and treatment of cervical intraepithelial neoplasia (CIN). CIN lesion is an abnormal growth in the cervix. The CIN lesion is usually diagnosed during a routine Pap smear (or called Thin Prep) test. LEEP is a very safe way to remove abnormal tissue from the cervix that might otherwise progress to cancer. It minimizes the amount of tissue removed in order to preserve childbearing ability.

Reason for the procedure

• Presence of CIN lesions from the colposcopy evaluation and confirmed via cervical biopsy. Some types of CIN can progress to cervical cancer if not treated. This can be used as a treatment for CIN lesions.
• Unsatisfactory colposcopic evaluation whereby the whole transformation zone cannot be visualized or the cervix appeared abnormal and requires a bigger tissue specimen for a more accurate diagnosis to exclude cancer changes.

Read moreLoop Electrosurgical Excision Procedure (LEEP/LLETZ) for CIN

Endometrial biopsy (Endometrial sampling or curettage)

Endometrial biopsy is a procedure that involves the removal of tissues from the endometrium, which is the inner lining of the uterus.

Reason for the procedure

It is done to diagnose endometrial cancer or hyperplasia (with or without atypia). Endometrial hyperplasia is a potentially precancerous condition. This procedure is indicated in a woman with abnormal uterine bleeding. This includes bleeding between menstrual periods, excessive bleeding during a menstrual period, or bleeding after menopause. It is also done to exclude endometrial cancer in post-menopausal  women with abnormal endometrial finding on ultrasound scan of the uterus.

Read moreEndometrial biopsy (Endometrial sampling or curettage)

Pre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

Article contributed by Ms Yong Lai Mee

The prevalence of Type 2 Diabetes Mellitus (T2DM) among women in childbearing age is increasing. Pre-existing T2DM in pregnancy increased the risk of maternal and neonatal complications such as macrosomia big baby), miscarriage, stillbirth, eclampsia (high blood pressure and its complications), and preterm labour. The American College of Obstetricians and Gynaecologists and the American Diabetes Association emphasized the importance of achieving optimum diabetes control for promoting the well-being of maternal and reduced prenatal fetus and baby adverse outcomes. Below are some tips to achieve optimum pre pregnancy diabetes care.

Blood Glucose Control

  • Keep pre pregnancy HbA1C < 6.5% to avoid complications during pregnancy.
  • Fetal mortality rate increased 4 folds in those with HbA1C >6.6%.
  • Poorly controlled pre pregnancy diabetes increases congenital heart diseases by 3 folds, neural tube defects increase by 4 folds and spontaneous miscarriages in 30-60% of all pregnancies.
  • Plan 4-6 months before pregnancy to ensure diabetes control is within target range.

Read morePre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

Uterine Prolapse (pelvic organ prolapse)

This refers to the descend of the uterus into the lower half of the vagina and beyond. In its most severe form, the whole uterus may be outside the vagina. Besides the uterus, other pelvic organ may descend as well such as bladder (cystocoele), rectum (rectocoele) and the small intestines (enterocoele).

Symptoms and signs

  • A lump is seen or felt at the opening of the vagina. It may be seen protruding outside of the vagina.
  • Vague discomfort or pressure in the pelvic region.
  • Backache that worsens with lifting.
  • Urination problems such as frequent and painful urination, difficulty in urination. occasional stress incontinence (urine leakage when laughing, sneezing or coughing), inability to control urination (uncontrollable urine leakage).
  • Difficulty in defecation.
  • Pain during or difficulty with sexual intercourse.
  • Abnormal per vaginal bleeding, usually arising from the exposed vagina wall and cervix.

Read moreUterine Prolapse (pelvic organ prolapse)

Lower Urinary Tract Infection (Lower UTI, cystitis)

Infection of the lower urinary tract occurs when the inner lining of the bladder becomes infected and the urine is full of bacteria. In pregnancy, 5 – 10% of women have bacteria in their bladder and some will have no symptoms at all.

How common?

Up to 40 – 50% of women will have at least one attack in their lifetime and 25% will have recurrences.


  • Bacteria can reach the bladder from the genital and anal area, or through the bloodstream.
  • Injury to the urethra or the bladder.
  • Prolonged use of a urinary catheter to empty the bladder, such as during childbirth or surgery.

Risk factors

  • Sexual activity.
  • Infection in other parts of the genitourinary system.
  • Pregnancy.
  • Poor hygiene.
  • Menopause.
  • Diabetes mellitus.
  • Underlying abnormalities of the urinary tract, such as tumours, calculi (stones), and strictures.
  • Incomplete bladder emptying.
  • During or after major surgery

Read moreLower Urinary Tract Infection (Lower UTI, cystitis)

How Pregnancy Affects the Feet

Article contributed by Ms Emily Mah

For every pregnancy journey, a mother or mother-to-be naturally experiences feelings of excitement and apprehension. In this 40-week period, a woman’s body goes through so many phases of change. Visible changes of increasing waistline and digits on the weighing scale are often coupled with swelling in the ankles and the presence of stretch marks. Internal observations will show pregnancy’s effects on metabolism, respiration, bone density, and the digestive system, to name a few.

As the body accommodates a nurturing and developing fetus, stark changes in the anatomy and physiology of a woman will occur. Throughout the course of these 9 months, such changes actually have an impact on every organ system in the body.

In this article, we will cover how pregnancy affects the feet. Swelling is a common occurrence during this phase. Also known as oedema, swelling can occur in different parts of the body though it largely occurs in the ankle region. Puffiness in the face or the hands is occasionally present. Dark spider veins, also known as varicose veins, often cause aesthetic concerns in women. Pregnancy is presumed to be a major contributing factor in its increased prevalence. Aside from its undesirable sight, this can also lead to cramps, heaviness, aching or numbness in the feet and calves.

Read moreHow Pregnancy Affects the Feet


This is a microscopic examination of the cervix, vagina, or vulva. It is used to diagnose potential abnormalities of these areas, which sometimes cannot be seen with the naked eyes. The colposcope can magnify the tissue by up to 30 times, thus making it clearer and much more accurate in terms of surface evaluation. Therefore, the biopsy of the abnormal areas performed with a colposcopic examination is more accurate than those done without the use of a colposcope.

Why do I need a colposcopy evaluation?

  • It is usually recommended if you have an abnormal Pap smear (Thin Prep) test or when pre-cancerous lesion is suspected in the vagina or labia area.

Read moreColposcopy