Menopause is a natural event in a woman’s life. At around age 45, a woman’s body goes through certain changes, like the gradual cessation of ovary functions. This leads to a halt in menstrual periods, eventually ending fertility.
During the critical pre-menopausal period known as “peri-menopause”, the fluctuating levels of oestrogen and progesterone can cause symptoms like mood swings, headaches, fatigue, irregular periods and decreased libido.
However, every woman’s experience of menopause is different. “For some, menopause can come with the dreaded hot flushes, called night sweats when they happen at night. For the majority, it can be quite uneventful,” says Dr Yong Tze Tein, Senior Consultant, Department of Obstetrics & Gynaecology, Singapore General Hospital (SGH) .
Feeling hot & bothered?
Hot flushes, also known as hot flashes, are primarily caused by the hormonal changes that occur during menopause.
Dr Yong explains: “A hot flush is an unpleasant transient sensation of heat in the skin, mainly in the upper part of the body. The face becomes red while sweat may appear on the face, neck and trunk. It may even be accompanied by palpitations or sleep interruption.”
Typically, a hot flush lasts about four minutes, but it can vary from a few seconds to 30 minutes.
More than 75 per cent of women experience hot flushes during menopause. “In fact, this is the primary reason why women seek medical treatment,” observes Dr Yong. “For 25 per cent of these women, hot flushes can occur for more than five years.”
Hot flushes during menopause can also be caused by environmental factors, lifestyle habits or certain medications. Watch out for triggers like:
- Warm drinks, especially caffeinated beverages like coffee
- Spicy food, e.g. chilli
- High temperatures, such as in saunas
- Hot weather
- Warm clothing
Managing menopause with HRT
There are a few ways to manage bothersome menopausal symptoms like hot flushes. Hormone replacement therapy (HRT) alleviates the symptoms of menopause by increasing the low levels of oestrogen in the body.
Dr Yong explains: “HRT is the most effective at relieving hot flushes and night sweats. The patient receives a small daily oral dose of oestrogen. Side effects can include nausea, breast tenderness and fluid retention.” For patients with vaginal dryness, there is local oestrogen which has minimal side effects and risks.
According to a US-based study (Women’s Health Initiative, WHI), women on HRT have a slightly higher risk of breast cancer which increases with duration of use. “There were 8 per 10,000 more cases in the HRT group. The risk to the individual is almost negligible but because of this concern, there must be definite clinical reason for HRT and treatment should be only as long as necessary,” says Dr Yong. This is in contrast to the situation prior to the study where all menopausal women were encouraged to be on HRT for health benefits.
Alternatives to HRT include phyto-oestrogens, bio-identical hormones, anti-depressants, evening primrose oil and vitamins. However evidence for alleviation of symptoms is not as good and their safety profiles are not as well studied.
Alternative management options
- Phyto-oestrogens, which are plants with hormone-like effects, e.g. black cohosh
- Anti-depressants, e.g. Prozac
- Evening primrose oil Vitamins, e.g. vitamin E
- Bio-identical hormones, which are lab-manufactured hormones that are identical to natural hormones on a molecular level
Menopause is a natural part of life, and is a significant milestone for every woman. Although often times intervention is not necessary, it is a time that most women begin to take stock of their health. Go for your screening mammogram, Pap smear, blood test for diabetes and cholesterol. Start exercising if you have not done so as it is the most effective anti-ageing medicine. If you are finding it difficult to cope with menopause symptoms, don’t hesitate to consult your doctor.