Source: Dr Ang Seng Bin
Mean age of menopause
| Region | Mean Age (95% CI) |
|---|---|
| Asia | 48.75 (48.08–49.42) |
| Australia | 51.25 (49.75–52.76) |
| Africa | 48.38 (48.12–48.65) |
| Europe | 50.54 (50.04–51.05) |
| Latin America | 47.24 (45.88–48.60) |
| Middle East | 47.37 (46.91–47.84) |
| USA | 49.11 (48.78–49.43) |
| Country | Mean Age | Year(s) |
|---|---|---|
| India | 46.2–48.4 | (2014, 2016) |
| Japan | 48.3–49.3 | (2006, 2018) |
| South Korea | 49.3 | (2018) |
| China | 49.0–49.5 | (2018) |
| Singapore | 49.0 | (2005) |
Source: Tang R. Liu Q, Yu Q. Manopausal symptoms: what are the ditferences between the West and the East? Climacteric. 2025 May 22:1-6
| Symptom | IWHP, 2014–2016 (%) | Loh, 2005 (%) | Ang, 2025 (unpublished) (%) |
|---|---|---|---|
| Joint and muscular pain | 32.9 | 12.7 | 20.0 |
| Sleep issues | 27.5 | 9.4 | 25.3 |
| Vaginal Dryness | 20.3 | 4.0 | 10.7 |
| Physical and mental exhaustion | 19.6 | 10.2 | 18.7 |
| Vasomotor symptoms | 18.6 | 6.7 | 18.7 |
| Sexual Problems | 15.7 | 6.7 | 18.0 |
| Bladder problems | 14.0 | 5.4 | 10.0 |
| Irritability | 12.1 | 4.7 | 12.7 |
| Depressive mood | 11.8 | 7.2 | 12.0 |
| Anxiety | 11.0 | 5.6 | 10.7 |
| Heart discomfort | 5.9 | 2.1 | 6.7 |
- West more hot flushes
- East more psychological
Evaluation of midlife women
History
- Detailed menstrual history (cycle, flow)
- Hot flushes: Sudden rush of heat, generally limited to the upper body
- Sleep: Issues initiating sleep or awakenings
- Mood
- Joint pain and bodyaches
- Other associated symptoms, ie: (Genitourinary symptoms of menopause) GSM symptoms, sexual function
- Fluctuation with holidays: When on holiday still have symptoms, is more likely biological
- Social history
- Lifestyle related
- Childhood: Adverse childhood experiences (ACE)
- Adult life: functional hypothalamic amenorrhea, polycystic ovarian syndrome, history of infertility, miscarriage, or stillbirth, Other gynaecological conditions
- Phx, Shx
Management of menopausal symptoms
- Conservative management
- Menopause hormonal treatment (MHT) is the gold standard
- Non hormonal treatment:
- NKT
- Fezolinetant is an NK3 : monthly LFT x 3/12: diarrhea, insomnia, 3x ULN consider stop, drug interaction: cipro, faverin
- Elinzanetant
Introduction
New guidelines recommend treatment of menopause for osteoporosis and cardiovascular events prevention
Can be started around the perimenopausal period as well.
Screening tools. Need to integrate with the CMS. Also need to run labs?
Research
- Currently reading
Menopause guidelinesCanada Pocket GuideOld CPG
- Need further research
I need to list down all the possible drugs in use in Singapore