Illuminating the path to menopause: A doctor’s journey in advocacy and awareness

MIMS Doctor speaks to Dr Premitha Damodaran, a renowned Obstetrics and Gynaecology consultant, about her passion for medicine and the topic closest to her heart—menopause.

Premitha’s advocacy and interest in the field of menopause stem from her own experiences. Reflecting on her mother’s menopausal struggles following a hysterectomy at age 50, she recalls the profound changes she observed. Once vibrant, her mother became withdrawn and moody due to hormonal imbalances, but eventually recovered with proper treatment. This personal experience coincided with her specialization in obstetrics and gynaecology, fueling her interest in menopausal health.

Motivated by this, Premitha established the Menopause Clinic at University Hospital. Through interactions with her patients, she gained deep insights into the extensive physical, cognitive, and emotional challenges women face during menopause, further shaping her approach and understanding.

Premitha highlights the uniqueness of women and the complexities of menopause, emphasizing its physical and emotional impact. Given that Malaysian women have an average lifespan exceeding 75 years and typically enter menopause around age 50, they spend a significant portion of their lives in this phase. This exposes them to increased risks of various health issues, including heart disease and osteoporosis, along with common menopausal symptoms like hot flashes and mood swings.

Among those issues that concern her are the stigma and silence surrounding menopause discussions, the lack of resources, and insufficient local data. She advocates for breaking this silence, fostering awareness, and approaching menopausal women with empathy and understanding.

Menopause should be viewed as a new life phase, noted Premitha, not as a period of decline or suffering. She urges women to focus on fine-tuning their health and enjoying life.

Victories along the way
As a menopause advocate, Premitha has achieved some notable milestones. In 2022, she chaired a team that crafted the Clinical Practice Guidelines: Management of Menopause in Malaysia. The comprehensive guidelines, incorporating local menopause data and covering various aspects like lifestyle changes and hormone replacement therapy, is reshaping healthcare professionals’ approach to menopause. It is recognized as one of the top menopause guidelines globally.

Another significant achievement was receiving the FIGO Women’s Award 2023 in Paris, a prestigious recognition from the International Federation of Obstetrics and Gynaecology for her contributions to menopausal health in Malaysia. This honor, being one of only 15 awardees worldwide, was a memorable and gratifying experience for her.

Viewing menopause through proper lenses
Premitha calls for women to embrace menopause as a natural shift in life, not something to fear. Women experience it differently, and the goal is to maintain health during and after this phase. While some navigate it with ease, others struggle in silence due to fear, misinformation, or uncertainty about seeking help. It’s important to avoid comparing oneself to others as each woman’s menopause journey is distinct. Support extends beyond hormone therapy, offering emotional support, lifestyle guidance, and medical attention tailored to individual needs. Remember, seeking help benefits not just the menopausal woman, but also those around her. 

The frequent trivialization of menopause through jokes and stereotypes has contributed to its stigmatization, overshadowing the real physical and emotional challenges women face. This stigma hinders open discussions, exacerbates mental health issues, and can strain relationships and careers. A cultural shift is needed, with a focus on disseminating accurate information and encouraging sensitive portrayals in media and social media. Open dialogues, support groups, and the involvement of public figures who share their menopause experiences could play a crucial role in demystifying and normalizing menopause.

Another common issue linked to menopause is that of supplement-taking. Premitha said supplements are often seen as the first treatment option for various illnesses, not just menopause. However, their effectiveness and safety are not as well-researched as pharmaceutical drugs. Herbal products might only be as effective as placebos for menopausal symptoms. It is, therefore, crucial to consult a doctor when using them, and they should not be used beyond 3 months if ineffective. Thus far, only calcium (1000 mg daily) and vitamin D are generally recommended, with calcium being better sourced from food and vitamin D important for various health aspects. Other supplements should be used judiciously and under medical advice.

Hormone therapy safe, effective
On the topic of hormone therapy, Premitha noted that some years ago there was a bout of bad publicity surrounding the use of hormones in menopause, known as hormone replacement therapy (HRT). However, in recent times, with newer options, there is a new hormone-based treatment for perimenopausal symptoms. Now called menopausal hormone therapy (MHT), it is safe for younger, healthier women in the perimenopause and within 10 years of their last period.

Menopause is caused by cessation of estrogen and progesterone production by the ovaries. The loss of estrogen brings about the symptoms of menopause along with the long-term effects to the vagina, heart, bone and brain. MHT replaces these hormones at just a small dose to alleviate the symptoms and help the woman cope better through this phase.

A woman who still has her uterus intact (no hysterectomy) needs to go on both estrogen and progestogen therapy. The latter is to ensure the lining of the uterus remains healthy. Conversely, a woman who has had hysterectomy only needs estrogen therapy.

Estrogen therapy can come in the form of tablets, gels, creams or sprays. Progestogens may be in the form of an intrauterine system, vaginal tablets or oral tablets. The variety of delivery systems allows a woman to select the safest MHT option for her.

Premitha cautioned every woman should be evaluated prior to starting on MHT and thereafter annually. MHT used these days is safe with minimal risks. However, the emphasis on lifestyle changes including diet and exercise is paramount. While there is no time limit for MHT use, it is encouraged to reduce doses along the way with prolonged therapy.

Treatment with MHT is the gold standard treatment for menopausal symptoms and surpasses complementary and alternative therapy. MHT is the only therapy that treats the menopausal woman, reducing menopausal symptoms, and improving heart, bone, vaginal and brain health.