AskMeDoctor! Episode 4, Part 1 - Male & Female Menopause

AskMeDoctor is back with a new topic - Menopause and Fertility. For this episode, we have Dr. Tan Cheng, an Obstetrician and Gynaecologist from Tung Shin Hospital, Kuala Lumpur. To make it easier for you, we had divided into two categories. For this entry, we will focus on menopause for both women and men. Let's get right into the questions and answers! Q1: In Malaysia, what is the average age for a woman to reach menopause? Dr. Tan Cheng: Let's start with the definition of menopause. When you are aged over 45 and you have no period for the past 12 months, then you are considered to have reached menopause. The range is between 45 and 55 years of age. This is provided that you are currently not taking any other hormonal tablets or medications, such as HRP (Hormone Replacement Therapy). Q2: What are the early signs of menopause? Could someone before the age of 45 experience menopause? Dr. Tan Cheng: Coming to menopause symptoms, they differ between individuals. Majority will complain about vasomotor symptoms. They may experience hot flushes. They may feel waves of heat that cause them to sweat uncontrollably, even though they are in an air-conditioning environment. Some may have musculoskeletal symptoms, in which they complain about joint pain, muscle pain. Some may have changes in their mood. Some may find themselves feeling more depressed and experience lower mood than usual, while some may find themselves feeling more irritable than usual. Other symptoms include urogenital symptoms, in which they experience vaginal dryness. And some may complain of having lower libido and lower sexual desire. Q3: Can women in their 30s experience menopause? Dr. Tan Cheng: There is such a condition known as early menopause. Now, early menopause is also known as premature ovarian insufficiency. It is when a lady is below the age of 40 and is presented with menopausal symptoms. Yes, it is possible. What we normally do is we will arrange a blood test. Through this blood test, we are looking for a specific hormone, which is known as FSH (follicle-stimulating hormone). If this FSH is high, it means that you are already reaching menopausal stage. And normally, we will repeat this blood test again around 4 to 6 weeks apart to make sure that it remains high. Now when this is the case, what we will advise this lady is to start hormonal replacement therapy, at least until the age of natural menopause. Estrogen, which is the female hormone, is very important for the heart and important for the bones. So if women reach menopause early, it means that this estrogen is going to be much lower than what it is supposed to be. And therefore, we have to replenish it. Q4: Are there any medications or supplements that a woman who has reached menopause should take? Dr. Tan Cheng: Now, it actually depends on the individual. Let’s talk about supplements. When you reach menopause, we know that the estrogen level is low, and we generally recommend that ladies who have reached menopause take adequate calcium and Vitamin D to maintain bone health. Same thing for those who may feel that the symptoms are unbearable that they can’t cope with their everyday life. For these women, we recommend starting them on hormonal replacement therapy. Hormonal replacement therapy is not without its side effects. It is not suitable for everyone. So, we will have to go through the patient’s history and see if they have any contraindication to hormonal replacement therapy. Q5: If a woman’s period has stopped, does it mean that she can stop using contraceptives? Can she stop using protection? Dr. Tan Cheng: Let’s assume that the woman who is asking this question is more than the age of 45 years old and she does not have any menses for the past 12 months, and she is currently not taking any hormonal tablets or medications that may interfere with the menses, then yes, she is going through menopause. Once you reach menopause, it means your fertility age is over. You will not be able to get pregnant and therefore, you can stop taking contraceptives. But that does not mean that she can stop using protection, you should still protect yourself. Yes, in terms of pregnancy, you can stop taking contraceptives. But in terms of protecting yourself from sexually transmitted diseases, using barrier contraceptives like condoms is still required. Q6: Do men go through menopause? Source: drdianahoppe.com Dr. Tan Cheng: Let’s talk about women first. In women, ovulation ends. And when that ends, hormone production will reduce rapidly over a relatively short period of time, which is why we can say that it is between 45 and 55 years of age. For men, it is slightly different. Male hormones are known as testosterone. Testosterone levels will gradually reduce slowly as we age. Low testosterone levels may cause some changes in sexual functions, sleeping patterns, emotional and physical changes. And because this is happening over a long period of time, there is no sudden deterioration. Therefore, it is not very clear-cut for anyone to say at what age men will reach andropause. Q7: If a woman reaches menopause and she opts to have IVF, is it possible for her to get pregnant? Dr. Tan Cheng: It is possible to get pregnant after menopause with the help of IVF. There is a case report of a 73 year-old mother in India that was able to conceive through IVF. As we know, when a lady reaches menopause, it means her fertility age has ended. It means that there are no more eggs, no more oocytes available. However, you can always get an egg donor. By having an egg donor and your partner’s sperms, with the help of IVF, you can still get pregnant. Q8: Is it possible for a woman to experience period and menopause at the same time? Dr. Tan Cheng: Yes, it is possible. If someone is currently going through menopause and she is on hormonal replacement therapy, the period will continue. But that does not mean that she is at a fertile age. It means that she still experiences bleeding every month that is due to the effects of hormonal replacement therapy. Q9: Is it true that a woman who has trouble with inconsistent period cycles will face early menopause? Dr. Tan Cheng: Let’s say if she is having premature ovarian insufficiency, then yes, she will have trouble with her menses, and she is also reaching menopause early. But it does not mean everyone who has trouble with her period cycles will reach early menopause. It does not mean everyone will experience the same thing. Remember the question just now about premature menopause, in which a woman has the symptom of menstrual irregularities and her blood test shows that the FSH hormone is high (4-6 weeks apart)? Yes, it does mean that she is reaching premature menopause. But it does not mean that those who have irregular menses will reach early menopause. https://youtu.be/-ecYY3Q9Ru4 Check out AskMeDoctor! Episode 4 Part 2 on Fertility here. Stay tuned with us at our Facebook & Instagram page for more informative content.

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