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ARTICLE | 24th December 2019

Health Article: Menopause "What You Need to Know in a Nutshell?"

MENOPAUSE - What you need to know in a nutshell !

Menopause essentially means “ stopping of periods “ in a woman. It signifies that the ovaries have stopped functioning, and there is no further production of the hormone, estrogen.

So, there is a lack of estrogen in the body. It also signifies the end of reproductive life.


Menopause is not a disease. Every woman will have to go through this phase in life.

Menopause usually occurs around the age of 50 – 55 years, with an average of 51 years.

If it occurs before the age of 40 years, it is referred to as “ Premature menopause “.

If it occurs after the age of 55 years, this is referred to as “ Delayed menopause “.

If menopause occurs at the usual age, this is “ Natural menopause “.

Menopause induced by surgery ( removal of both ovaries ) is called “ Surgical menopause “.


Women with premature menopause and surgical menopause have higher risks, and therefore require special attention.

Women with delayed menopause have a higher risk of uterine ( womb ) cancer, and needs careful monitoring.


In Malaysia, based on the population statistics for 2017 -2018, if we follow the definition of natural menopause, about 2 million women, or about 12% of the female population will fall into this group.


Women can help themselves prepare for the menopause, and during menopause in the following ways :

  1. Learn about menopause, so as to understand what the process is all about, and what to expect during this phase of life.

This will reduce the anxiety and fear of the menopause.

Their partners should also be made aware of menopause, so that they can understand and appreciate what their partner is going through, and they can even help and support them through this phase.

  1. Manage weight properly during this period. Do not put on too much weight, neither lose too much weight.
  2. Eat a well-balanced diet, with less red meat, less fat, sufficient fluids, and sufficient vegetables and fruits.
  3. Drink more milk or milk products to get sufficient calcium to protect the bones.

Otherwise, take supplements of calcium with vitamin D.

Natural sunlight alone is not sufficient.

  1. Avoid excessive smoking and excessive alcohol intake.
  2. Exercise regularly
  3. Reduce stress levels, by de-stressing oneself through various channels, like meditation, prayer, yoga, listening to music, etc. Find your own way !
  4. Avoid boredom, by having hobbies, like gardening, painting, etc. Participate in group activities, like senior citizen’s groups.


Menopause is not a disease, but it can lead to various ailments.

These are classified into short-term, medium-term, and long-term problems.


Short-term problems, from 6 months to 2 years, involve the suffering from menopausal symptoms, namely hot flushes, profuse sweating, sleeplessness, general body aches and pain, headaches, irritability, memory lapses, failure of concentration, etc.

These can be quite distressing.


Medium-term problems, from 2 – 5 years, include psychological problems like anxiety, depression, mood swings. It also includes bladder problems like feeling of passing urine frequently; vaginal problems like dryness, infections, painful intercourse; skin dryness and irritability, wrinkles; sexuality problems like decreased sex desire, poor sex performance, and decreased frequency of sex.

Menopause women are disturbed and distressed with these issues, but only about 30-50 % will come forward to seek help. The others are what we refer to, as “ silent sufferers “.


As doctors, we are more concerned with the long term problems which may kill the woman or incapacitate her for life.

These include,

  • increased risks of heart disease, and more importantly, increased risks of heart attack. In fact, heart attack is the number one killer in postmenopausal women, not cancers.
  • increased risks of bone issues, especially osteoporosis, bone pain, and fractures of the hip and the spine
  • significant loss of memory, and failure to be able to concentrate
  • increased risks of colon cancer.


Menopause treatment has advanced significantly.

Menopause can be managed and treated very effectively, so that such women can continue to live a good quality of life.

Treatment modalities include,

  • use of supplements
  • use of herbal products
  • use of hormones ( HRT )
  • use of tibolone, an effective alternative option ( a STEAR )
  • counselling


The correct advice is, do not self-medicate, but seek the professional advice of doctors, especially those who are menopause experts.Treatment options will be discussed with you by your doctor.

Ask all your questions and be happy and satisfied to take whatever treatment has been advised by your doctor.

Experienced and knowledgeable menopause doctors will advise you the appropriate medications, which will offer you benefits during your menopause, without any significant side effects.


Hormone replacement therapy ( HRT )

This involves the use of estrogen only therapy (ERT ), or combined estrogen and progestin therapy HRT ( EPT ).

ERT is used for those with surgical menopause.

HRT is used for those with premature menopause and natural menopause.

To avoid any significant risks, ERT or HRT should not be started in women over the age of 60 years, because of the increased risks of breast cancer, heart diseases, and ovarian cancer, and perhaps, also. in women over 10 years from the onset of menopause, except in those with premature menopause or surgical menopause.

ERT and HRT are safe to be used in postmenopausal women below the age of 60 years, and in those less than 10 years from menopause.

In women who have started the therapy before 60 years of age, or less than 10 years after menopause, and who have been monitored carefully by doctors, and found to have no significant side effects, they can continue with the benefits of their therapy for as long as they want, safely.



Tibolone is not classified as an HRT. It is a STEAR, meaning, Selective Tissue Estrogen Activiity Regulator. Tibolone does not contain any estrogen or progestin. Therefore, it does not have the side effects seen with estrogen or progestin.

Tibolone use does not increase the risk of breast cancer or ovarian cancer or uterine cancer, and it reduces the risk of colon cancer.

When tibolone enters into the body, it works like an HRT, with all its benefits for the postmenopausal woman.

Tibolone can be used long term with safety.


Herbal preparations

Of these preparations, red clover preparations appear to offer many benefits, and being a herbal product, there are no risks.

Herbal products can even be taken together with ERT, HRT, and tibolone for additional beneficial effects.

They are especially useful for peri-menopausal women with symptoms, and who cannot be given the medications for menopausal women yet.


Note. For information about how these preparations can help you through your menopause, please consult with your doctors and clarify any doubts.

In essence, these treatments can help with menopausal complaints, heart health, bone health, vaginal and bladder health, sexuality health, and prevent various cancers in the body.

Careful monitoring is nevertheless advised, so women should have regular follow-ups with their doctor.

In essence, women do not have to suffer through their menopause. Help is always available by consulting with menopause experts. This can only materialise if women seek the help of such doctors.

The overall aim, is to help the menopausal woman go through her menopause smoothly, and to offer her options to prevent any significant problems following menopause, and in the long run, to help women lead a better quality of life into her later years !




MBBS ( Malaya ), FRCOG ( UK ), FICS ( USA ), M. Med. O&G ( Singapore ),

FAMM ( Malaysia ), FRCI ( Ireland ), FSAAARMM ( Malaysia ),

Certificate in Estrogen Deficiency & Menopause ( USA )

Consultant Obstetrician & Gynaecologist, & Menopause Consultant

Taman Desa Medical Centre








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Taman Desa Medical Centre
45, Jalan Desa, Taman Desa, Off Jalan Klang Lama, 58100 Kuala Lumpur Malaysia.


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