Perimenopause, the transitional phase leading up to menopause, often presents with symptoms that can be mistaken for stress or normal aging, according to Dr. Chua Yang, an obstetrician and gynaecologist at Mount Alvernia Hospital in Singapore. She notes that this period may not always begin with the widely recognized hot flushes but can include more subtle signs such as disrupted sleep, joint pain, fatigue, and irregular menstrual cycles.
During perimenopause, which typically lasts four to five years, the ovaries gradually produce less oestrogen and progesterone. Menopause is confirmed after a woman has gone 12 consecutive months without a period. In Singapore, the average age for menopause is around 49 years. Menopause occurring between 40 and 45 years is considered early, while menopause before age 40 is classified as premature ovarian insufficiency. Although periods tend to become irregular during this time, significantly heavy or prolonged bleeding should be evaluated by a gynaecologist.
While hot flushes are often associated with menopause, women in Singapore more frequently report muscle and joint aches, poor sleep quality, exhaustion, and vaginal dryness during perimenopause. Additional symptoms may include night sweats, mood changes such as irritability and anxiety, and sexual difficulties. Dr. Chua emphasizes that these symptoms can also overlap with those caused by stress, aging, or medical conditions like thyroid disorders, complicating diagnosis. She adds that hormonal fluctuations may exacerbate existing issues; for example, women with pre-existing anxiety might notice a worsening of their symptoms during this period.
Health care providers recommend seeking medical advice if symptoms persist or significantly impact daily functioning. Maintaining a healthy lifestyle—including regular exercise, balanced nutrition, and weight management—can help alleviate symptoms. Women who engage in these practices often report fewer and less severe symptoms.
Such lifestyle factors are also important considerations for those exploring menopause hormone therapy (MHT). Women who do not smoke, maintain a healthy weight, and stay active typically face a lower risk of side effects like blood clots, which influences the suitability of MHT. For women experiencing premature ovarian insufficiency or early menopause, MHT is generally advised until the average age of natural menopause to reduce long-term health risks.
Dr. Chua further advises that establishing healthy habits early in life is beneficial in mitigating risks of cardiovascular disease and osteoporosis, which are more common among women who enter menopause prematurely.