Women’s health
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What are the Stages of Menopause?

Menopause is a natural biological process that every woman goes through as she gets older. It marks the cessation of ovarian functions and the end of the reproductive years. It brings about various changes in the body.

To better understand menopause symptoms, it’s important to know the different stages of menopause [1] and how age factors into this transition.

1. Perimenopause

This is the stage leading up to menopause, when hormone levels fluctuate irregularly. It typically starts in a woman’s 40s but can begin earlier for some individuals. During perimenopause, menstrual cycles may become irregular, and women may experience symptoms such as hot flashes, mood swings, and sleep disturbances.

2. Menopause

Menopause is when ovaries stop producing eggs and menstruation ceases permanently. It is defined as having gone 12 consecutive months without a period. The average age for menopausal onset is around 45 to 55 years old, but it can happen earlier or later depending on various factors like genetics, lifestyle choices, and certain medical conditions.

3. Postmenopause

Once menopause has been reached, the postmenopausal stage begins. At this point, most menopausal symptoms start to subside or lessen in intensity. However, women will continue to experience long-term effects related to hormonal deficiencies such as heart attack, stroke, and loss of bone density.

What are the Factors Affecting the Age of Onset of Menopause?

The age of menopause onset among Malaysian women is usually between 45 and 55 years old. It’s also important to note that the timing of menopause can vary individually. The ovaries lose their function gradually therefore, it’s difficult to determine the exact age at which menopause will start.

Several factors can influence the age of menopause onset.

Genetic Factors

Family history plays a role in determining the age at which a woman may experience menopause. Women whose mothers experienced earlier menopause are likely to have a similar pattern.

Lifestyle Factors

Certain lifestyle choices and habits can affect the timing of menopause. Smoking, heavy physical activity, malnourishment, and underweighting have been associated with earlier menopause onset.

While moderate alcohol consumption, light physical activity, and overweight have been associated with late menopause onset. High consumption of fruits, vegetables, and protein are associated with late onset of menopause.

Medical Factors

Underlying medical conditions and surgical interventions can influence menopause onset. For instance, women who are exposed to heavy metals exposure enter menopause earlier than those who do not. Surgical removal of one of the ovaries, chemotherapy, or radiation therapy can accelerate menopause.

Reproductive & Menstrual Factors

Generally, women who start menstruating at a younger age tend to experience menopause earlier. Women who have more children enter menopause later than those who have fewer or no children. The use of oral contraceptives has been related to late menopause onset.

These factors can influence the timing of menopause, nevertheless, they do not determine it with absolute certainty. Each woman’s experience with menopause is unique, and individually vary to each other.

If you have concerns about menopause or are experiencing related symptoms, it’s best to consult a healthcare professional who can provide personalized advice and guidance.

What are the Common Signs, Symptoms and
Side Effects of Menopause?

If you start noticing any or all of the symptoms listed below, it could indicate that you are entering the perimenopausal phase [2]. Check for these common signs and symptoms to understand this natural phase of life better.

Hot Flashes

One of the most common symptoms experienced by women going through menopause is hot flashes [3]. These sudden feelings of intense heat can cause sweating, flushed skin, and a rapid heartbeat.

They can occur at any time, leaving women feeling uncomfortable and self-conscious. Hot flashes vary in frequency and intensity from person to person, but they are a hallmark sign of menopausal transition.

Night Sweats

Alongside hot flashes, many women also experience night sweats during menopause. These episodes involve excessive sweating during sleep, often leading to damp sheets and disrupted rest. Waking up drenched in sweat can be distressing and contribute to overall fatigue during the day.

Vaginal Dryness and Discomfort

Hormonal changes during menopause can lead to vaginal dryness and discomfort. The decrease in estrogen levels affects the moisture-producing glands in the vaginal walls, resulting in dryness, itching, and irritation. This can make intercourse painful or uncomfortable for some women, impacting their sexual well-being.

Mood Swings

Menopause is known for causing mood swings that range from irritability to sudden bouts of sadness or anger. Fluctuating hormone levels can disrupt neurotransmitters responsible for regulating emotions, leading to unpredictable mood shifts.

Women experiencing these mood swings may feel overwhelmed or struggle with anxiety.


Fatigue is another prevalent symptom associated with the menopausal transition. Hormonal fluctuations disrupt sleep patterns, making it challenging for women to get a good night’s rest. Constantly waking up due to hot flashes or night sweats contributes to daytime tiredness and lack of energy.

Memory Problems

Many women going through menopause report experiencing memory problems or “brain fog.” Difficulty concentrating, forgetfulness, and trouble recalling information are common complaints during this stage of life.

While not all women experience significant cognitive changes during menopause, memory issues can be frustrating and impact daily functioning.

While the symptoms mentioned above are common, it’s important to remember that each individual’s experience may vary. If you’re experiencing severe or persistent symptoms, it’s always advisable to consult with a healthcare professional for personalized advice and support.

Remember, menopause is a unique journey for every woman. Understanding the signs and side effects can help women navigate this stage of life with more knowledge and confidence.

Sleep Disturbance

Fluctuating hormone levels, particularly estrogen, progesterone, and melatonin, can contribute to this symptom. The hormonal changes affect the regulation of sleep patterns, leading to difficulties falling asleep, staying asleep, or experiencing restful sleep.

Common menopausal symptoms such as night sweats and hot flashes can jolt you awake in the middle of the night, leaving you feeling all hot and bothered. Nervousness and mood changes due to menopause can also negatively impact sleep.

Irregular Menstruation

Irregular menstruation is indeed one of the classic signs of menopause. During the menopausal transition, known as perimenopause, hormonal fluctuations can cause changes in the menstrual cycle.

In the years leading up to menopause, you may notice that your periods become irregular. This means your menstrual cycle may be shorter or longer than usual, and the time between periods may vary. Some months, you might experience heavier or lighter flow, while others may be skipped altogether.

These changes occur as your ovaries produce less estrogen and progesterone, leading to irregular ovulation. This hormonal rollercoaster can result in the irregular menstrual pattern many women experience during perimenopause.

It’s important to note that irregular menstruation can be a sign of other health issues as well, so if you’re unsure whether it’s due to menopause or something else, it’s a good idea to consult with your healthcare provider. They can help assess your symptoms and provide appropriate guidance and support during this transition.

Dianogsis Menopause: Understanding the Process

The diagnosis of menopause is usually based on symptoms. Women usually experience a series of symptoms before menopause.

Some women may experience inconsistent symptoms, so doctors may conduct a few tests to diagnose menopause. Doctors may perform a few other tests to assess health issues related to menopause.

1. Diagnosis Based on Symptoms

Diagnosis of menopause is usually made after menstruation has ceased for 12 consecutive months in a woman in age between 45 and 55 years old without other obvious causes.

Menopause is usually preceded by a series of menopausal symptoms, including hot flashes, mood swings, fatigue, and night sweats.

2. Diagnosis Based on Laboratory Testing

Some women might experience inconsistent symptoms during perimenopause. The periods can be irregular and the symptoms can be non-classical, raising women’s concerns.

In these cases, a doctor may conduct a few laboratory testing to check the levels of:

  • Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). These two hormones are raised in menopause.
  • Estradiol. Estradiol is decreased as menopause occurs.
  • Thyroid-stimulating hormone (TSH) and Prolactin. Thyroid hormone and prolactin can affect menstrual regularity.
  • Anti-mullerian hormone (AMH). AMH can be used to assess ovarian reserve and predict the time to menopause.

3. Expert Consultation

It’s important to remember that each woman’s experience is unique. Seeking professional advice can provide personalized guidance and support throughout this natural transition. During a consultation, the expert could:

  • Explain to woman the symptoms and stage of menopause.
  • Recommend a few tests to check on hormone levels.
  • Assess other long-term health issues related to menopause
  • Provide individualized treatment for women to regain their quality of life.
  • Provide guidance and support throughout the menopausal journey.

Can Menopause Be Treated?

Menopausal symptoms can often be devastating to a woman’s life. The hormonal fluctuations that occur during menopause can have various physical, emotional, and psychological effects, which can negatively impact a woman’s self-confidence and self-image.

These detrimental symptoms can be alleviated with professional medical treatment and self-care.

After menopause, women are also at increased risk of certain medical conditions, including heart attack, stroke, low-impact fractures, and dementia. Proper medical advice and periodic health screening can prevent these severe diseases.

When Should I Seek Medical Attention?

Menopause involves significant physiological changes in women. Seeking professional help allows women to receive accurate information about these changes and their potential impact on their health. Doctors can address individual concerns and questions, provide personalized advice, and discuss treatment options.

Several strategies and options are available to help you navigate menopause turbulence. The aim of medical treatment is to alleviate symptoms, improve overall quality of life, and prevent menopause-related diseases.

Here are some useful guides for determining whether you should seek medical help if you encounter menopausal symptoms.

1. Severe or Persistent Symptoms

Menopause can bring about a range of symptoms that vary in intensity and duration. While some women may experience mild discomfort, others may find their symptoms significantly impacting their daily lives.

If you’re dealing with severe or persistent menopausal symptoms that are affecting your quality of life, it’s important to reach out to a healthcare professional or consider consulting with a hormone therapist, such as Functional Healing.

Taking proactive steps to address these symptoms can significantly affect your well-being. Seeking medical attention will allow you to explore various treatment options, including hormone therapy if appropriate, and find relief from the discomfort caused by menopause.

Remember, you don’t have to suffer in silence–help is available to support you on your journey toward better health and well-being.

2. Unusual Changes in Menstrual Bleeding

During perimenopause, the transitional phase leading up to menopause, changes in menstrual bleeding patterns are expected.

However, sudden or unexplained alterations should not be ignored. If you notice any irregularities like heavy bleeding, prolonged periods, spotting between cycles, or periods occurring closer together or further apart than usual, it’s crucial to seek medical attention.

These changes could be signs of underlying health issues that need evaluation and treatment. Your healthcare provider can assess your situation and determine the appropriate course of action to address these abnormal bleeding patterns effectively.

3. Sleep Troubles or Mental Well-being Affected

Sleep disturbances are common during menopause due to hormonal fluctuations and other factors. If you find yourself tossing and turning at night or waking up feeling exhausted despite adequate rest, it’s time to discuss this with your healthcare provider.

If your mental well-being is being negatively impacted by menopausal symptoms such as mood swings, anxiety, irritability, or feelings of sadness or depression–don’t hesitate! Open communication with your healthcare provider can lead to strategies for managing these emotional challenges effectively.

Furthermore, sexual function may also be affected by menopause. If you’re experiencing decreased libido, vaginal dryness, pain during intercourse, or other sexual difficulties, seeking medical advice is essential. Your healthcare provider can offer guidance and potential treatments to help you maintain a satisfying and enjoyable sex life.

4. Regular Check-ups for Monitoring and Management

Menopause is a significant phase in a woman’s life that requires appropriate monitoring and management. Regular check-ups with your healthcare provider are crucial during this time to ensure any emerging concerns are addressed promptly.

By maintaining open communication with your healthcare provider, you can discuss any new or ongoing symptoms, receive necessary screenings or tests, and explore treatment options tailored to your specific needs.

These regular check-ups will help you navigate the menopausal journey more smoothly and make informed decisions about your health.

What Are the Treatment Options for Menopause?

Since menopause can be treated, we’ll now discuss the treatment options.

1. Hormone Replacement Therapy

Hormone replacement therapy (HRT) [4] is a treatment option that can effectively manage the symptoms associated with menopause and improve the overall quality of life and self-confidence.

During menopause, many women experience a decline in hormone levels, particularly estrogen and progesterone. Hormone replacement therapy works by replacing the hormone the body is no longer producing in sufficient amounts. It effectively reduces vasomotor, urinary, and mood symptoms, and prevents menopause-related diseases.

Studies have shown that HRT effectively reduces hot flashes, night sweating, flushing, and urinary symptoms. It has been shown to improve mood, sleep, skin texture, and sexual function. It can also prevent osteoporosis, fracture, and colorectal cancer.

Alleviates Hot Flashes

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Reduces Night Sweating

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Reduces Painful Urination

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Improves Mood

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Improves Sleep

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Enhances Skin Texture

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Improves Sexuality

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Strengthen Bones & Muscles

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Prevents Fractures

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Prevents Colorectal Cancers

Hormone therapy may contribute to a reduced risk of colorectal cancers during menopause, providing additional health benefits with proper medical supervision.

Hormone replacement therapy is generally recommended at the lowest effective dose to achieve the treatment goal. It can be administered in different forms, such as pills, patches, creams, and vaginal preparations. The choice of administration depends on individual needs and choices.

Side Effects

Hormone replacement therapy has been associated with certain conditions. Studies have shown that the use of conjugated estrogen and progestin pill has been associated with:

  • Heart Attack
  • Stroke
  • Blood Cot Formation
  • Breast Cancer

The risks vary according to the types of hormones used, individual age, health condition, and the duration of use. It’s crucial to discuss with doctors with expertise in this area to understand the potential benefits and risks before starting hormone therapy.

2. Transdermal Hormone Replacement Therapy

Estrogen and progesterone can be administered through the skin via patches, creams, or gel.

Studies have shown that transdermal hormone replacement therapy DOES NOT appear to increase the risk of blood clot formation and breast cancers [5,6]. Transdermal preparations offer certain benefits:

By-Passing Liver Metabolism

When hormones are swallowed, they are absorbed by the digestive system and metabolized by the liver.

This can produce certain byproducts that can have adverse effects on blood clotting. With transdermal HRT, the hormones enter the body via the skin, bypassing the liver. This can result in a lower risk of blood clot formation.

Steady Hormone Level

Transdermal hormones replacement therapy provides a consistent release of hormones into the bloodstream. This helps maintain stable hormone levels compared to tablets, which can result in fluctuating hormone levels throughout the day.

Steady hormone levels can improve symptom control and a more balanced overall hormonal environment.

Bio-identical Formulation

Bio-identical hormones are hormones that are prepared in a way that the chemical structure is the same as human hormones. They are usually derived from plants.

The bio-identical formulation can be compounded according to individual dosage requirements. Certain synthetic hormones, such as progestin, are associated with breast cancer. A bioidentical form of progesterone can be compounded for safer use.

It’s important to take note that the choice of hormone therapy should be individualized based on individual needs, personal choice, and medical conditions.

It’s essential to discuss with doctors for a better understanding of the benefits and risks and determine the appropriate treatment approach.

3. Lifestyle Changes [7]

Regular Exercise

Aerobic exercise boosts heart health and reduces disease risk. Resistance exercises strengthen bones, and muscles, preventing osteoporosis, and fractures.

Balanced Diet and Nutrition

Eat beans, legumes, and veggies for protein, calcium, and antioxidants. Limit sugar, processed, and fried food to lower heart disease and diabetes risk.

Relaxation Practice

Practising a 10-20 minutes relaxation practice, deep breathing, meditation, and massage could balance hormones naturally and prevent depression and anxiety.

Adequate Quality Sleep

Avoid caffeine and exercise after the evening. Preventing staring too long at the television, smartphones, and other electronic devices.

Pelvic Floor Exercises

A 10 – 15 minute Kegel exercise can improve urinary incontinence and prevent uterovaginal prolapse.

Sleep Disturbance in Menopause

Women going through menopause often have sleep disturbance. Some might have difficulty in falling asleep, while others may have difficulty staying asleep, resulting in interrupted sleep or poor-quality sleep. Menopause affects women’s sleep in different ways:

Menopausal Symptoms

Hot flashes are sudden feelings of warmth and intense heat that can cause sweating and discomfort. They often occur during the night and can disrupt sleep.

Hormone Changes (E2/P4)

Estrogen plays a role in falling asleep and regulating sleep patterns. Progesterone helps women to relax and maintain sleep. As estrogen and progesterone decline during menopause, it disrupts the normal sleep cycle, leading to sleep disturbance.

Mood Changes

Hormonal fluctuations during menopause can lead to mood swings, depression, and anxiety. They can directly contribute to sleep disturbance.

Melatonin Deficiency

Melatonin is a sleeping hormone produced in the brain. It plays an important role in circadian rhythm, especially in helping both men and women in falling asleep and maintaining sleep. Melatonin levels decrease with age, resulting in sleep disturbance.

How to Improve Sleep During Menopause Transition?

Improving sleep quality is crucial for overall health. Here are some tips to promote better sleep while going through menopause:

Establish a Regular Bedtime and Walking Time Routine

Going to bed and waking up at the same time daily helps regulate the body’s circadian rhythm.

Maintain a Conducive Sleep Environment

Ensure the bedroom is cool, dark, quiet, and comfortable.

Avoid Stimulants

Limit caffeine intake in the late afternoon. Avoid heavy physical activities after the evening.

Practice Relaxation Techniques

Stretching, meditation, and deep breathing exercise help to reduce stress and anxiety, resulting in better sleep.

Take Foods that Help in Sleep

Foods such as whole grains, nuts, and chickpeas are riched in tryptophan. A serving at dinner could help the brain produce melatonin for better sleep.

Hormone Therapy

Numerous studies [8,9] have shown that hormone replacement therapy helps fall asleep and improves sleep quality.

It’s important to note that menopause affects each woman differently. Finding the right strategies that are suitable for you is important. Consulting a healthcare professional can provide personalized options based on individual needs.

Sexual Changes in Menopause

During the menopausal transition, women often experience decreased sexual function. The changes include vaginal changes and psychological factors. It can also be a result of other factors including medication, medical condition, and social factors.

As age increases, sexual interest continues for many women. While some women may experience sexual changes, others may find that sexual function remains unaffected.

Mechanism of Sexual Changes in Menopause Transition

Most of the sexual changes are attributed to the decline in estrogen levels. Here are three common signs of menopause that lead to sexual changes.

Reduced Sexual Desire

A decrease in estrogen levels can lead to reduced sexual desire. Testosterone levels in relation to women’s sexual desire are debatable.

Decreased Sexual Responsiveness

A decrease in blood flow to the uterus, pelvic floor, and vagina can reduce sexual sensitivity and arousal.

Vaginal Dryness

Low estrogen levels can cause vaginal dryness and decreased lubrication. These changes can make sexual intercourse uncomfortable or painful.

How Can I Improve My Sexual Relationship During Menopause?

Improving sleep quality is crucial for overall health. Here are some tips to promote better sleep while going through menopause:

1. Hormone Replacement Therapy

Hormone replacement therapy [10] has improved menopausal women’s sexuality. Both estrogen-only or combined estrogen/progesterone hormone therapy improves women’s sexual desire and overall sexual satisfaction.

Hormone therapy with estrogen can improve sexual satisfaction by improving vaginal secretion and reducing dryness. Estrogen cream or gel for vaginal application can be used to reduce vaginal dryness, however, they are less effective in alleviating hot flashes and night sweating.

Testosterone therapy in addition to women on estrogen hormone therapy may further improve sexual function. Single-use of testosterone therapy might improve sexuality in women who underwent the removal of ovaries.

Conventional estrogen therapy can cause side effects such as heart attack, stroke, blood clot formation and breast cancer. Transdermal estrogen can be considered for safer use.

Hormone replacement therapy should be based on personal needs, preferences, medical conditions, and risk of side effects. It’s best to discuss with a professional while considering hormone replacement therapy.

2.Vaginal Lubrication

Water-based or gel-based lubricants can be used to relieve vaginal dryness and reduce discomfort during sexual intercourse.

3.Psychological Counseling

Psychological therapy can be helpful for menopausal women suffering from decreased sexual function. Couples therapy enables couples to improve communication and identify relationship issues.

4.Open Communication

Talking openly with your partner about the changes you are experiencing is crucial for maintaining intimacy during this phase of life.

Many women find it helpful to discuss their changing sexual needs and desires with their partners. With that, both partners can better understand each other’s expectations and work together to find solutions that promote intimacy and pleasure.

Maintaining Bone Health in Menopause

Our bone undergoes a continuous formation and resorption to maintain a healthy bone. Osteoporosis is a bone condition where bone resorption outpaces bone formation, reducing bone density and strength.

Estrogen plays a crucial role in maintaining bone formation and resorption balance. After menopause, when estrogen level drops, bone resorption outpaces bone formation, decreasing bone density and strength.

Osteoporosis affects 24% of postmenopausal women in Malaysia. They are at increased risk of fractures. Common sites of fractures include spines, hips, and wrists.

It requires a holistic approach to prevent osteoporosis during menopause, focusing on nutrition, exercise, hormone therapy, and medical treatment.

What Else Do I Needto Know About Menopause?

Preventing Cervical Cancer

Cervical cancer is predominantly caused by the human papillomavirus (HPV). HPV is transmitted sexually, infecting the cervix, leading to cervical cancer over a long time.

PAP smears are used to detect abnormal changes in the cervix cells, which could indicate the presence of cervical cancer or precancerous conditions. Women should continue to have regular PAP smears done to ensure cervical health.

Discuss with your doctor regarding your need for a PAP smear and how frequently you should have it done.

Screening for Breast Cancer

Breast cancer is the commonest cancer among Malaysian women. One in nineteen women in Malaysia is at risk of breast cancer. The risk of breast cancer increases with age and is not necessarily related to menopause.

As with most cancers, the earlier breast cancer is detected, the higher the chances of successful treatment. Breast self-examination should start as early as the age of 18.

Mammograms can detect breast cancer at an earlier stage, often before symptoms are noticeable.

The mammogram recommendation can be different individually based on age, risk factors, medical condition and family history. Generally, women are encouraged to go for a mammogram every 2 years after age 40.

Discuss with your doctor regarding the timing and frequency of mammograms.


In conclusion, menopause symptoms vary among women, affecting them differently in terms of duration, intensity, and overall well-being.

While some experience minimal disruption, others face more significant challenges. The good news is that various management options alleviate symptoms and enhance the quality of life. Lifestyle changes and medical interventions like hormone therapy can make a difference.

Seek support from healthcare professionals who can provide personalized advice for your unique circumstances and guide you through this phase.

Remember, menopause is a natural part of life. Embrace self-care practices, stay informed about available options, and take control of your health.

With the right approach and support, you can confidently navigate this stage and empower yourself throughout the menopausal journey.