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The stages and associated symptoms of menopause. —

We don’t talk enough about menopause

Menopause is a dreaded word because of its implications on a woman’s physical appearance and wellness.

It’s a new phase that starts when our menstrual cycles stop occurring every month, and with it, comes a whole list of other changes, including sagging skin, hormonal changes and stiffness of joints, just to name a few.

It’s no wonder that no one wants to discuss a condition that causes so much discomfort, particularly as it is a reminder of ageing. But it’s exactly because of the uncertain nature of menopause that we should be talking about it.

From the basics like symptoms and what to expect, to things you can do to mitigate symptoms and how to let your partner know that you need support, discussing menopause-related topics will make it less scary when you experience it.

A drawn-out affair

Let’s start with the very basics: what exactly is menopause?

Menopause is when a woman’s period has stopped for 12 months and she is unable to get pregnant naturally. Most women will notice their period becoming less consistent in timing prior to this. Their flow will also tend to become heavier and longer.

In Malaysia, menopause typically happens between 45-55 years of age. As the life expectancy of women in Malaysia is 76 years, this means that a third of her life is now spent in menopause.

For some however, menopause can occur even earlier due to certain medical conditions or treatments, such as being on chemotherapy or surgical removal of the ovaries. But around 1% to 5% of women experience menopause naturally before 40 years of age.

Depending on the severity of symptoms, many will feel that adjusting to menopause is a tremendous burden. Hot flashes, anxiety, mood swings, night sweats, vaginal dryness, frozen shoulder and a reduced sex drive are common and expected. These symptoms often start before our menstrual cycle stops and they can last for several years.

The three stages of menopause are:


This is a transitional time that starts around your mid to late forties and may last for months or years before the menopause. On average, most women experience this phase for about five to 10 years before their periods stop completely.


This is the last day your menstruation stops, whether naturally or for a clinical reason, such as following surgery that involves the removal of the ovaries.


These are the years after menopause, although it can be unclear when menopause finishes and when postmenopause starts. From a male’s perspective, it might seem like a woman would be downright delighted to get rid of a monthly occurrence that forces her to bleed from her vagina.

But looks can be deceiving. It is not necessary always better not to have any more menses. The impact on a woman’s quality of life can range from mild to severe.

The lucky ones among us will show minimal symptoms, enabling them to have normal and full lives throughout the transition and beyond, with the added benefit of not needing to go through their period every month or remembering to take birth control.

For those who are not so fortunate when it comes to menopausal symptoms, don’t worry, there are ways of managing them. First, let’s have a closer look at the most common symptoms.

Lower hormone levels

Disturbances to your sleeping pattern due to an increased need to pee at night, night sweats and anxiety, are a common symptom of menopause. — TNS

It is a natural process for us to experience menopause. As our ovaries get older, they produce fewer eggs and less reproductive hormones.

Our body responds to the lowered levels of hormones like oestrogen, progesterone, luteinising hormone (LH), follicle-stimulating hormone (FSH) and testosterone. One of the most notable changes is the loss of active ovarian follicles.

Ovarian follicles are the structures that produce and release eggs from the ovary wall, allowing menstruation and fertility. Menopause usually begins with increasingly irregular periods in the perimenopause stage, but each woman’s experience with menopause symptoms is usually different.

Lifestyle choices, the medications you take and other health conditions can influence your menopause experience. Here are five of the most common symptoms of menopause:

Hot flashes

About 75% of women get hot flashes during menopause. They cause a person to feel a sudden sensation of heat in the upper body. The sensation may start in the face, neck or chest, and progress upward or downward.

Hot flashes can cause a person to break out in sweat and flush in the face or other parts of the body. Night sweats are common, and even “cold flash” is linked to this menopausal symptom. Hot flashes usually occur in the first year after menstruation ends, but they can keep happening for up to 14 years after menopause.

Irregular periods

The earliest sign that menopause is coming is usually when your periods occur less regularly. They may come more or less frequently than usual, and they may be heavier or lighter. Anyone who has concerns about menstrual changes should see a doctor, as these changes can also indicate pregnancy or some other health issue.

Mood changes

During menopause, it is not unusual to experience periods of irritability and wanting to cry. Anxiety, depression and low mood are not uncommon during menopause due to the drastic hormonal changes.

However, while feelings of sadness, irritability and fatigue are common, they do not always indicate clinical depression. Anyone who experiences a low mood for more than two weeks should see a doctor to be advised on the best course of action.

Sleep changes

Problems with sleep can occur during menopause due to the increased need to pee at night, breaking out in night sweats and anxiety. To help manage these issues, avoid heavy meals and add exercise to your daily routine.

Vaginal dryness

You may encounter vaginal itching and discomfort as early as the perimenopause period. If your skin breaks due to chafing during sex, infection may occur, so do remember to lubricate.

Atrophic vaginitis, which is the thinning, drying and inflammation of the vaginal wall, can sometimes occur during menopause. This may, of course, affect your sex life, which may cause a strain in your relationship with your husband if not managed properly.

Other symptoms of menopause are:

  • Weight gain
  • Difficulty concentrating
  • Dry skin and mouth
  • Sore or tender breasts
  • Headaches
  • Urinary tract infections
  • Stiff joints
  • Reduced bone mass
  • Hair loss

Confirming menopause

Menopause is not a disease, but it doesn’t hurt to have a talk with your doctor about your symptoms, especially if they are particularly troubling or are occurring sooner than expected. To help determine if you’re entering the menopause stage or close to it, you can get a blood test to measure the level of specific hormones in your blood like oestradiol and FSH.

Elevated FSH blood levels of 30 mIU/mL or higher, plus a lack of menstruation for 12 consecutive months, is confirmation of menopause.Many studies have also found that going through menopause may increase a woman’s risk of developing certain medical issues, such as:

  • Heart disease, including heart attack and stroke
  • Osteoporosis, resulting in bone fractures
  • Depression
  • Dementia, and
  • Cancer.

Other clinical tests that can be used to assess a woman’s wellbeing during menopause are:

  • Blood tests for testosterone, progesterone, prolactin, oestradiol, insulin, DHEA (dehydroepiandosterone), cortisol and lipid (fat) levels; thyroid function tests; renal and liver function tests; inflammation; and cancer markers.
  • Mammogram
  • Pap test
  • Ultrasound of the abdomen and pelvis

In my next column, I will discuss tips for how men can help their partner transition through menopause, while maintaining a healthy relationship with her.

By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 23 Aug 2021

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