Empower women to experience menopause confidently

Menopause is defined as the end of a woman’s menstrual cycles, which is confirmed with the absence of menstruation for 12 consecutive months. Menopause is a significant milestone because this natural biological process indicates the end of a woman’s reproductive years, but it is often misunderstood and obscured by misconceptions.

Women going through menopause deserve understanding and support besides being empowered to recognize the transformative nature of this unique phase in their lives, said Dr Syeda Nureena Zaidi, a consultant obstetrician and gynecologist. “However, many Malaysian women may not be aware of the full extent of their symptoms and that they can be managed effectively. This includes arming themselves with knowledge and talking about it with their family and friends to help maintain their overall wellbeing and manage symptoms,” she explained.

During the transition when estrogen production ends, women may have symptoms such as hot flashes, fatigue, vaginal dryness, and insomnia as well as increased risk of cardiovascular disease, osteoporosis, type 2 diabetes, and dementia. [Br J Gen Pract 2019;69(688):540–541] Also, menopause significantly increases the prevalence of subclinical atherosclerosis in middle-aged women with polycystic ovary syndrome (PCOS). [Maturitas 2020;139:12–19] Thus, their hormone levels should be closely monitored and regulated to prevent further risks such as endometrial cancer, Syeda said.

Women may hesitate to discuss their experiences openly due to the social stigma surrounding menopause possibly resulting in mental distress or depression. Encouraging them to discuss their symptoms with their support network including their doctor can help relieve their distress, she said.

The role of hormone therapy
Menopausal hormone therapy (MHT), either with a combination of estrogen and progestogen or estrogen alone, is a viable option for relief of vasomotor and genitourinary symptoms, and prevention of bone loss. MHT can also reduce the risk of cardiovascular disease, stroke and venous thromboembolism in women aged below 60. “However, the key to [MHT] treatment is to start early [within 10 years of menopause],” Syeda said. [https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf]

Syeda stressed the importance of informed decision-making and patient selection regarding MHT. “While there’s a slight increase in breast cancer risk with long-term [MHT], it’s essential to consider individual factors like family history and overall health. Regular monitoring and open communication with healthcare providers mitigate potential risks, ensuring women can make choices aligned with their wellbeing,” she said.