Menopause is the natural cessation of a woman’s menstrual cycle and marks the end of her reproductive years. It is commonly associated with symptoms such as hot flashes, sleep disturbances and mood changes and typically starts between the ages of 49 to 51.
A study conducted by National Population and Talent Division found that the number of Singaporean women aged 80 and above has risen from 57,000 in 2015 to 89,000 in 2025. This means an increasing number of women will spend approximately 36% of their lives in postmenopause. Hence, it is important to better understand the broader impact menopause has on women, including its symptoms, impact on quality of life, and ways to manage it.
Whether you have just reached this stage of life or are curious about what to expect in the years ahead, we speak with Obstetrician & Gynecologist Dr. Alex Ooi, Cardiolist Dr. Pinakin V Parekh, and Dietitian Ms. Wong Chai Ling about menopause and how its symptoms can be managed.
An average woman is born with approximately two million eggs. This number decreases to about half a million by the time puberty begins, drops further to around 27,000 by the mid-30s, and by the time menopause occurs, most women have only about 1,000 eggs remaining. It is this gradual depletion of eggs that ultimately leads to menopause, as there are no longer enough eggs to sustain the body’s hormonal cycle.
“Menopause is not a sudden event, but the result of a gradual and natural decline in ovarian reserve over a woman’s lifetime,” Dr. Alex Ooi states.
Menopause typically occurs naturally, over the course of several years, as the body phases out its ability to bear children. A woman is considered to have reached menopause when she has not had a menstrual period for 12 consecutive months.
In some cases, menopause may occur earlier due to other factors. Surgical removal of the ovaries, as well as certain medical treatments such as chemotherapy or radiotherapy, can reduce egg reserves and trigger menopause prematurely.
On average, women enter menopause between the ages of 49 and 51.
In the years leading up to menopause, women may begin to notice physical and emotional changes as the ovaries gradually produce less oestrogen and progesterone. This hormonal shift often results in irregular menstrual cycles and other symptoms.
The stages of menopause include:
PerimenopausePerimenopause, also known as the menopause transition, can begin eight to 10 years before menopause. It most commonly starts in a woman’s 40s, although it may occur earlier for some. During this stage, hormone levels fluctuate, and women may experience symptoms such as irregular periods, hot flashes, night sweats and mood changes.
MenopauseMenopause is reached when a woman has gone without a menstrual period for 12 consecutive months. At this point, the ovaries no longer release eggs and oestrogen production drops significantly. Menopause itself is a single point in time rather than a prolonged stage.
PostmenopausePostmenopause refers to the years following menopause and continues for the rest of a woman’s life. While many menopausal symptoms gradually ease during this stage, some women may continue to experience mild symptoms for several years. Postmenopausal women are also at a higher risk of conditions such as osteoporosis and heart disease due to lower oestrogen levels.
Menopause is a natural life event and does not require a medical diagnosis or treatment in every case. However, many women experience symptoms in the years leading up to menopause and beyond. These may include:
According to Dr. Ooi, Muscle and joint pain are also commonly reported during menopause. When combined with reduced physical activity, this may contribute to muscle loss and changes in fat distribution, increasing the risk of conditions such as diabetes and high cholesterol.
Bone mass can decrease by as much as 20% during menopause. Together with reduced muscle strength, this may raise the risk of falls and fractures later in life.
Women who undergo menopause have been noted to have a markedly higher risk of developing cardiovascular disease due to a decline in oestrogen levels, a hormone that plays a protective role in women’s heart health.
Oestrogen has several beneficial effects, as Dr. Pinakin explains: “Before menopause, oestrogen helps keep a woman’s blood vessels more elastic and improves endothelial function. It also helps reduce inflammation and aids in the regulation of lipid metabolism and accumulation.”
After menopause, as oestrogen levels decrease, arteries gradually become stiffer and endothelial dysfunction increases, allowing plaque to build up more readily within the blood vessels.
Dr. Pinakin also highlights several other ways menopause can affect a woman’s cardiovascular health:
Menopause is a natural process, and for many women, symptoms are mild and require little or no treatment. However, if symptoms begin to disrupt daily life, a healthcare provider may recommend options to help manage them.
Treatment approaches may include:
Hormone replacement therapy (HRT) is a form of hormone therapy that is done with the purpose of replacing the natural hormones your body is no longer making. For menopausal women, oestrogen is used to replace your own body’s hormones and can come as skin patches, gels or sprays to put on the skin, or tablets.
“HRT is prescribed with the goal of relieving symptoms like hot flashes, night sweats, vaginal dryness and to improve bone density,” Dr. Ooi explains.
If you have a uterus, you will also need to take progesterone to protect your womb lining from the effects of oestrogen. Taking both oestrogen and progesterone is known as combined HRT.
“Fezolinetant is a hormone-free treatment option that works by blocking the pathway in your brain responsible for managing body temperature,” Dr. Ooi states. “Though helpful in modulating hot flashes and night sweats, side effects include abdominal pain, and potential liver and sleep problems.”
However, if you are currently living with heart disease, it is best to consult your doctor to determine whether you are suitable for hormone replacement therapy (HRT). According to Dr. Pinakin, recommendations for HRT in women with heart disease are made on a case-by-case basis.
“If a woman’s condition is stable, with no recent heart attacks, and her cholesterol levels and blood pressure are well controlled, she may be considered for HRT after careful discussion with her physician,” Dr. Pinakin explains.
To support better heart health after menopause, Dr. Pinakin advises women to anticipate the changes the body may undergo due to hormonal shifts, manage existing risk factors, and take proactive steps to protect their heart health before menopause begins.
“I always tell my patients to anticipate these changes to their heart health, and that risk factor control should ideally start before menopause,” Dr. Pinakin says. “Some steps women can take include controlling blood pressure, cholesterol and blood sugar levels, reducing abdominal fat, engaging in both cardiovascular and strength-training exercises, attending regular health screenings, quitting smoking, and maintaining good sleep habits.”
Regular physical activity, together with a healthy and balanced diet rich in phytoestrogens, whole grains, and adequate amounts of dietary calcium and protein, may help alleviate menopausal symptoms while supporting bone health and maintaining muscle strength during and after menopause.
“Research shows that consuming foods rich in phytoestrogens may help relieve menopausal symptoms such as hot flushes and night sweats,” Ms. Wong explains. “These foods include soybeans, tempeh, miso, legumes, flaxseeds, and whole grains, which can be easily incorporated into the daily diet.”
As your metabolic rate decreases with age, menopausal women may find themselves putting on weight despite consuming the same amount of food as before. It is important to maintain a healthy weight to reduce your risk of diseases such as high blood pressure, diabetes, hot flushes and certain cancers.
Menopausal women are encouraged to consume a healthy and balanced diet that includes a variety of food choices from all food groups, following the Health Promotion Board’s My Healthy Plate as a practical guide. For those with excess body weight, moderating portion sizes - especially for foods high in fat, sugar, and calories - is important to prevent further weight gain. It is also essential to pay attention to the types of fats consumed, choosing healthier options to support overall wellbeing during this stage of life.
“Consider using healthier oils that contain monounsaturated and polyunsaturated fats, such as olive oil, canola oil, or flaxseed oil, as these can help reduce the risk of developing heart disease,” Ms. Wong adds.
Apart from weight gain, there is also the risk of osteoporosis due to the decrease in oestrogen, leading to a significant decrease in the blood levels of this hormone. Due to that, bones break down more quickly than they regenerate, resulting in them becoming increasingly brittle.
To reduce this risk, menopausal women are encouraged to consume a diet rich in calcium and essential vitamins such as vitamin D and vitamin K, along with key minerals including magnesium, potassium, and zinc. These nutrients play an important role in supporting bone health during menopause.
“Good sources of dietary calcium include low fat or non fat dairy products such as milk, cheese, and yogurt, as well as fish with edible bones like sardines and anchovies (ikan bilis), and calcium fortified foods such as soy milk and bread,” Ms. Wong states. “Other calcium rich options include soybean products such as taukwa and tofu, along with dark green leafy vegetables, although calcium from vegetables is generally less well absorbed.”
“For vitamin D, food sources include salmon, egg yolk, fish liver oil, and vitamin D fortified foods such as low fat or non fat milk and fortified breakfast cereals.”
Additional nutrients important during menopause can be obtained from a variety of foods.
Menopause is a natural life transition, but it does not look or feel the same for every woman. Understanding the stages of menopause, recognising symptoms early and knowing the available management options can make this phase of life more manageable and less overwhelming.
While some women move through menopause with minimal discomfort, others may benefit from medical support or lifestyle adjustments to maintain their quality of life. With the right guidance, from regular exercise and good nutrition to personalised medical care, women can navigate menopause confidently and continue to stay active, healthy and well in the years ahead.
If menopausal symptoms are affecting your daily life, speaking to a healthcare professional can help you explore the most suitable options for your individual needs.
