What is Menopause?

Menopause is a natural stage of a woman's life. When a woman reaches the age of 45 to 55, her ovaries produce less oestrogen and progesterone, and this affects the monthly thickening, sloughing and discharge of the endometrium. Menstruation becomes irregular in timing and amount. Generally, these changes persist for a period of time until menstruation stops completely. When a woman has not had menstruation for over one year, she is considered to have reached menopause.

Common Signs and Symptoms

The lowering of oestrogen levels in menopausal women results in other physiological and psychological changes. Some common menopausal symptoms are:

  • Hot Flushes
    The face and upper or whole body can experience a sudden sensation of heat and discomfort, lasting for a minute or two. Sweating and rapid heart rate may accompany these hot flushes.
  • Vaginal Dryness
    With the lowering of oestrogen levels in the body, the vaginal tissue becomes thin and loses some of its moisture and elasticity. The vagina is more prone to infection and itching, and sexual intercourse may be painful. In some women, the urinary tract is also affected with deterioration in bladder function leading to incontinence.
  • Osteoporosis
    Gradual drop in oestrogen levels in the body from the age of 40 onwards leads to loss of calcium and causes bone structure to become more porous, thus increasing chances of developing osteoporosis. Back pain is a common symptom and fractures may occur in more severe cases of osteoporosis.
  • Coronary and Arterial Changes
    In menopausal women, cholesterol has a higher tendency to remain in the arteries, predisposing them to atherosclerotic and coronary diseases.
  • Mood Swings
    Some women experience mood swings with occasional emotional depression and higher levels of irritability, anxiety and absentmindedness.

A positive attitude reduces tensions

  • Healthy Diet
    A balanced diet is good for people of all ages. To prevent osteoporosis, the diet should be rich in calcium. Milk and bean products such as cheese, yogurt, and bean curd are high calcium foods.
  • Refrain From Smoking and Drinking Alcohol
    The nicotine in cigarettes inhibits oestrogen production by the ovaries and affects bone cell formation. Alcohol affects the liver's regulation of oestrogen metabolism. Women approaching menopause should therefore stop smoking and limit alcohol intake.
  • Appropriate Exercise
    At least three exercise sessions each week, with weight bearing exercises such as walking and jogging ,can strengthen the bones. Walking in the sun also helps the body produce Vitamin D, which promotes calcium absorption.
  • Coping With Hot Flushes
    Loose garments made of light cotton are preferred. Spicy foods, alcohol, strong tea and coffee can enhance hot flushes and should be avoided. A warm shower can bring relief from the discomfort of hot flushes.
  • Understanding Menopause
    Some women are upset by the physiological and psychological changes of menopause. Through educational talks, women can increase their understanding of menopausal changes and so be psychologically prepared. They can also learn some relaxation exercises to ease the stress. Sharing feelings of anxiety and depression with family members, close friends or medical personnel can help to alleviate pressure and enable women to cope positively with their menopause.
  • Strengthening Self-Image
    Menopause is not a sign of old age. Instead, it is the beginning of a new phase of life. Women should actively set fresh goals, develop new interests and learn new skills to extend and enrich their own sphere of living.


Osteoporosis, a chronic disease of the bones, is a condition where formerly strong bones gradually thin and weaken and become susceptible to fractures. According to the International Osteoporosis Foundation, it is estimated that 1 in 3 women and 1 in 5 men, over age 50, will experience osteoporosis fractures in their remaining lifetimes. 

The most serious complication of osteoporosis is bone fracture, which occurs commonly in the spine, hip and wrist. In elderly people, hip fractures can be particularly dangerous because prolonged immobility during the healing process can lead to life-threatening complications. 

What Causes Osteoporosis?

Osteoporosis results from the loss of calcium in bone. Early in life, bone is broken down and replaced continuously. Starting from the mid-30s, bone breakdown outpaces bone build-up; the bones begin to lose calcium faster than they can replace it and therefore become porous. 

Although bone loss is a natural process, some people are at higher risk than others for developing osteoporosis. Oestrogen helps keep calcium in the bones, so women after menopause are more prone to the condition as the level of oestrogen in their body sharply declines and bone loss accelerates. 

Who Are at High Risk?

People at risk of osteoporosis include those who: 

  • are women after menopause; or whose ovaries have been surgically removed, especially before the age of 45
  • have a family history of osteoporosis
  • are thin or have a small frame
  • have insufficient dietary intake of calcium
  • smoke, drink excessive amounts of alcohol or caffeine (e.g. coffee or strong tea)
  • lack exercise and exposure to sunlight
  • have hyperthyroidism
  • are on long-term use of steroids, thyroid hormone or anti-seizure drugs
  • have chronic illness 

Can I Prevent Osteoporosis?

“Prevention is better than cure.” To prevent osteoporosis: 

  • Choose a calcium-rich diet containing dairy and bean products, dried fruits, nuts, seafood and leafy green vegetables
  • Avoid foods that can interfere with the body’s absorption of calcium, such as red meat, soft drinks, and excessive amounts of alcohol and caffeine
  • Stop smoking
  • Do weight-bearing exercises (e.g. jogging, brisk walking, tennis, aerobics and tai-chi) to strengthen the bone’s structure
  • Engage in more outdoor activities because exposure to sunlight helps the body produce vitamin D which enhances calcium absorption
  • Elderly people should pay attention to safety in their living environment to reduce the chance of falling 

What Are the Symptoms?

People are usually not aware that they have osteoporosis. The disease is often diagnosed only after a fracture has occurred. However, there may be some symptoms: 

  • Bone pain
  • Hunchback
  • A gradual loss of height 

How Do I Know If I Have Osteoporosis?

Talk to your doctor if you have such a concern. You may be recommended to take a bone density measurement should your doctor suspect you have osteoporosis. Dual Energy X-ray Absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. It involves low level of radiation. 

Bone Densitometry

Bone densitometry measures the density of spine, femur or wrist using computer technology and high resolution imaging. Post-menopausal women and people at risk of osteoporosis can consult their health care provider to arrange for such an examination.

Hormone Replacement Therapy

Hormone replacement therapy can alleviate the various symptoms caused by a rapid decrease in the body's hormone levels, including hot flushes, vaginal discomfort and mood swings. Osteoporosis and heart disease may also be prevented.

There are four forms of hormone replacement therapy: oral tablets, subdermal implants, gels or adhesive patches, and vaginal suppositories. The most common form is oral tablets containing oestrogen, progesterone and testosterone.

Hormone replacement therapy has side effects such as breasts tenderness, fluid retention causing weight gain, nausea, etc. The woman should therefore consult her doctor and undergo a detailed physical check-up before starting hormone replacement therapy.

Generally speaking, for most healthy women during their menopause, a balanced diet, appropriate exercise, a positive and optimistic attitude to life, together with regular physical check-ups, are better than medication in preparing them for the next stage of life.

Calcium Chart

The Calcium Chart is only available in Chinese.

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