I am 42 years old? Am I in the perimenopause?

In a way, yes. Perimenopause is the time before menopause and can occur even up to 10 yrs before menopause. The perimenopause is a gradual transition time between the reproductive years and menopause. One can already start experiencing irregular cycles, night sweats and other symptoms.

I am on the oral contraceptive pill and have my periods every month. How would I now if I have reached menopause?

When on the pill, you have periods every month which is brought on by the pill. You don’t experience symptoms because of the pill. Stop the pill only under guidance from your doctor as you can still get pregnant.

You are only menopaused if you are above 50 years and don’t have a period for more than one year when off the pill. If you are under 50 years, you would have to wait for 2 years of no periods before declaring yourself menopaused.

What is premature menopause?

When menopause occurs before the age of 40, it is called premature menopause. This can happen either naturally or induced. It occurs in about 1% of women. At times, premature menopause can be genetic, metabolic or autoimmune.

Surgical Menopause occurs when both ovaries are removed during surgery in a premenopausal woman. Similar menopause symptoms occur, however the symptoms can be more intense. This is also called induced menopause.

I still have my periods monthly but am having sleep disturbances and am tired all the time. Is this menopause?

As women get older, they handle more roles. As a wife, daughter, mother as well as a valuable member at work in many instances. This can cause a lot of stress. At the same time she also deals with changing hormones and body changes. All this can cause sleep disturbances, and when sleep is not optimal, tiredness comes along.

These changes can occur in the last 2 weeks before a period and once the period comes she feels slightly better. Many women experience restless leg syndrome, anxiety, depression and mood swings at the same time.

Try avoiding coffee before sleep, in fact stop coffee by 6 pm. Relax yourself by reading a book, doing breathing exercises and focusing your mind on positive and happy moments.

I am perimenopausal. Should I still worry about contraception?

Contraception is still very important till 1 year after the last period. In fact if your periods have stopped before the age of 50 years, then you should continue contraception till 2 years after the last period. Contraception may be in the form of implants, the intrauterine device or system, or even the progestin only pill.

The combined oral contraceptive pill can be taken in selected women up till the age of 50 years. The estrogen content in the pill will help the perimenopausal symptoms and help in cycle control. It can also help with bone loss in the menopause. The combined pill cannot be taken by women with history of cardiovascular disease, clots and breast cancer.

I am having problems with my memory. Is this menopausal related or due to impending Alzheimer’s disease.

Our memory can change with time. We tend to get tired, tiredness causes us to forget. Stress does the same thing to memory. We need to keep the brain “alive” with constant stimulation. Meet friends, laugh and play games. Socialize and be happy. Learn new things, anything simple from dancing, cooking to writing our thoughts in a diary. Never give up on stimulating that brain.

I have a major problem with vaginal dryness. Sex is painful and I don’t have the desire.

Vaginal dryness can start in the 40’s way before menopause. The changes that occur in the vulva, vaginal area is now called genitourinary symptoms of the menopause (GSM) which involves dryness around the vagina, itchiness, painful sex, problems passing urine such as frequency, irritability or incontinence and more infections in the vagina and bladder.

We should avoid hot water, harsh soaps, douches, ph. sensitive washes etc., when cleaning the vagina. Pads and panty liners should be changed every 3 hours even if they remain relatively clean. Change of washing powder and types of underwear to the tight g string variety can also cause problems of dryness, infection and painful sex.

A decrease in estrogen level with the menopause can also cause vaginal dryness. The vaginal lining of the vagina becomes thin and brittle. The muscles supporting the vagina and bladder become weaker and cause a sagging which increases risk for bladder problems and infections.

Lubricants and vaginal moisturizers may help take away this problem. Low dose estrogen can be used but it is not available in Malaysia. The estrogen vaginal cream is available and can be advised by your gynaecologist. Regular sexual activity helps preserve vaginal function by increasing blood flow to that area and maintains size of vagina.

I am worried about menopause because my skin would wrinkle and I would look old.

Many factors can affect the skin such as genetics, damage from the sun, weight changes, smoking, and loss of estrogen at menopause. The collagen loss along with the loss of elasticity of the skin causes uneven skin tone. Dryness is caused by decreased water and fat content of the skin. Maintain good skin from young, having adequate fluids, staying away from caustic agents to the skin and topical retinoids help keep the skin integrity. Plenty of moisturizers helps prevent dryness.

Can hot flushes happen to everyone? Will it last a long time?

Not all women experience hot flushes. It is described as a flash of heat over the upper chest and face lasting about 30 seconds and more. It can happen at night as a night sweat and lead to disruption of sleep pattern. In most women it lasts 6 months to 2 years, but can in some women go beyond 10 years.

Will my menopausal symptoms last a long time?

This depends on the symptoms you are experiencing. Hot flushes, mood swings, palpitations and night sweats eventually fade away. However hot flushes are sometimes reported to go on past 60 years of age. Genitourinary symptoms like incontinence and vaginal dryness unfortunately go on with the menopause. Problems such as cardiovascular disease and osteoporosis is a long term complication of menopause.

How can I be sure if the symptoms I am experiencing is due to menopause and not other problems?

If you are the menopause age and experiencing the typical symptoms there is no reason to check the ovarian hormone levels in your body. However it becomes important if you are less than 45 years and having these symptoms to rule out premature menopause. The other hormone which is always worth checking is the thyroid hormone Many women going through menopause may have a low thyroid level which aggravates their symptoms. They would then need thyroid medication. Always check with your doctor and they can advise accordingly.

How do I prepare myself for menopause?

It is important to prepare for the menopause.  A simple visit to your gynaecologist or general practitioner for a general medical review including blood pressure and weight. General blood tests should be taken for lipids, kidney, liver and other organs. Pap smears, mammograms and bone mineral densities should be done at regular intervals.

You can discuss further tests that need to be done depending upon family history. You could also go through types of exercises that suit you and a healthy diet plan.

Will supplements be sufficient to help me through menopause?

Always consult your doctor prior to taking any supplements or menopausal herbal treatment for the menopause. It is always better to get supplements that would be directed specifically against your health problems rather than taking the common everyday supplements. Some of these supplements can interact with other health problems you have and medication that you are on. Your doctor can guide you through this. Also over the counter drugs do not usually comply with the rigorous quality controlled measures thus many times we do not know the purity of its ingredients.

I cannot control my bladder. Is this part of menopause?

There are many reasons for incontinence such as diabetes, obesity, weight gain, history of long labour and big babies, medication for heart failure and problems such as fibroids and large ovarian cysts that can put pressure on the bladder.

Aging causes weakness of the muscles holding the bladder and uterus in position. When the muscles start sagging, it drags the bladder neck down and causes incontinence. Many women manage it by themselves without asking for help as they feel embarrassed. Please speak to your doctor who can then direct you to carry out certain investigations or to specialists who deal with this problem.

I am 50 years old, exercising and looking after my diet. Why am I still putting on weight around my tummy and hips?

Unfortunately with menopause, there is a change in body composition from the pear shaped woman to the apple shaped woman. The fat distribution changes and fat generally gets stored in the mid riff area. This puts the woman at a higher risk for metabolic problems and heat disease. The diet with menopause should concentrate on lesser fat and carbohydrates, along with smaller portions of meals. There should be weight bearing and muscle strengthening exercises.

Weight loss is always slower with the menopause as the metabolic rate slows down. Finding different types of exercises from which your body is used to helps trick the body to respond better.

I have joint pains and my knees hurt so badly. Why is that?

Joint pains are common in the menopause. It is not a sign of osteoporosis but a sign of degeneration of the joints. It is called osteoarthritis (OA). Maintaining an ideal weight helps cut down the risk of OA. Other risk factors are previous joint injuries and overuse of that particular joint. The usual joints that cause pain are the knees and shoulder joints. When the joint is not in use, the pains are more. You need to exercise and strengthen those muscles to help with pain relief.

I seem to be losing hair on my head but growing facial hair?

Hair loss can occur with aging. The unbalanced estrogen / androgen levels can cause “female pattern hair loss” which usually starts at the center top and upper back of the head. It usually resolves within 6 months. Other reasons for hair loss is bad nutrition and thyroid issues. A diet rich in minerals, such as zinc, iron, vitamin d and biotin helps with hair loss.

Facial hair growth may be a problem. It usually happens during the “change’ and is usually not a long term problem. Some women resort to waxing and electrolysis. Please check with your doctor first.

What can I do to improve my sleep?

Sleep can become a problem with the menopause. Getting to sleep, having disturbed sleep and waking up many times in the nights to go to the toilet lead to tiredness and irritability.

Do not exercise before sleep or take any stimulants such as coffee after 6 pm. Try not to sleep during the day time. Try to find some relaxation therapies prior to going to bed.

My eyes are always tearing and I have to use a lot of eye drops. Is this part of the change?

Any surface of the body can get dry with the menopause, more commonly the eyes and mouth. The eyes especially is very sensitive and it can cause tearing, itchiness, swelling, blurring of vision, light sensitivity and even sensitivity to certain eye makeup. The eyes do not tear which leads to lead less lubrication. It can even cause pain which then leads on to irritability. This may be sometimes due to Sjogren ’s syndrome, or certain allergy medications or even with the use of antidepressants.

Drink more water, using artificial eye drops or gels and taking more omega fish oil may be beneficial. Always check with your eye doctor to rule out any other problems

How do I take care of my teeth in the menopause?

Menopause and bone loss can cause problems in the mouth. The tooth sockets can become loose leading to problems of receding gums and roots being exposed which then brings about pain and sensitivity to cold. Always look after your mouth, teeth and gums. Gum care becomes really important in the menopause because with certain medical problems like diabetes, gum disease is very common. Gum disease can also be genetic. Regular dental checkups helps keep your mouth healthy.

Does being in the menopause increase my risk of cancer?

As we get older, our risk of cancers increase. We know that the risk of breast increase after the age of 40 years in Malaysia. Other cancers such as uterus, colon and other gastro related issues are also age related.

Lifestyle, medication and genetics start playing a more important role in the menopause with regards our chance of getting any cancers. Look after yourself by going for regular checkups and speaking to your doctors about your concerns. They can then guide you correctly in your health, diet and screening tests required.

Do I need to keep having Pap smears after menopause?

Every girl / woman who is sexually active needs a pap smear every year. This is because it can pick up pre cancer changes that can be quickly treated. Pap smears are continued regularly up to the age of 65 years and after which it should be done every 3 years. If there has been pre cancer changes before, pap smears should be done every 6 months or under the advice of your doctor.

Is it normal to have vaginal bleeding after menopause?

Post-menopausal bleeding is bleeding after having no periods for 1 year and confirmed menopause. Always see your doctor if you have post-menopausal bleeding.

It may be due to simple issues like dry vaginal walls (atrophic vaginitis), a benign polyp, urinary tract infections or due to stimulation with external factors such as high collagen in the diet, taking sheep placental hormones, irregular use of hormone therapy or even bioidentical hormones.