Is Singapore ready for the menopause wave from an ageing society?

Ms A was a high-achieving teacher in a tuition centre when she started experiencing hot flushes and night sweats in her late 40s.

It affected her sleep and concentration and she started making mistakes at work, which led to negative feedback from students and parents.

After a poor work appraisal, her self-identity crumbled and she entertained thoughts of suicide. She quit her job.

During mental health counselling, she was advised to seek a medical assessment at KK Women’s and Children’s Hospital (KKH), says Associate Professor Rukshini Puvanendran, co-director of the KK Menopause Centre.

That was when Ms A found out she was in perimenopause.

This transition period before a woman’s last period is a time when hormones fluctuate wildly and periods may become irregular.

Symptoms, which may seem unrelated, can range from the irritating (itchy skin, dry mouth) to the embarrassing (incontinence, the urge to pee often) to the debilitating (anxiety and depression).

Perimenopause symptoms can last up to 10 years before a woman hits menopause, which is defined as 12 months without a period.

In Singapore, menopause typically occurs from ages 45 to 55. The average age of menopause here is 49, earlier than the Western society average of 51.

While menopause has always been a part of a woman’s life cycle, its social and economic repercussions are growing, thanks to rapidly ageing societies like Singapore and more women entering the workforce.

By 2025, an estimated 1.1 billion women worldwide will be postmenopausal, according to The Menopause Society (formerly known as The North American Menopause Society), a non-profit organisation of leading clinicians and other experts. That is about one in eight people in the world.

A staggering US$25 billion (S$33.3 billion) can be attributed to menopause-related medical costs in the United States alone, according to a study published in April 2023 in the journal Mayo Clinic Proceedings.

Lost work productivity linked to menopause symptoms is estimated to cost about US$1.8 billion a year in the US, the researchers said.

That figure does not include the cost of women scaling down their working hours, losing their jobs, retiring early or changing jobs because of symptoms, said the study, which surveyed some 5,000 women aged 45 to 60 who were patients at the Mayo Clinic.

Six in 10 have moderate to severe symptoms

Menopause awareness has skyrocketed in Western countries since around 2019, thanks to celebrity advocates, including talk-show hosts Oprah Winfrey and Drew Barrymore, former US first lady Michelle Obama and British television presenter Davina McCall.

Some of it has trickled down to Singapore as well.

Professor Tan Hak Koon, chairman of the division of obstetrics and gynaecology at KKH, notes: “While the number of women with perimenopausal and menopausal symptoms seen at KKH has almost tripled from 2009 to 2023, it is still a small proportion, given that Singapore is an ageing population. By 2030, one in four citizens will be aged 65 and above and women tend to outlive men.”

The hospital expanded its menopause service into a multidisciplinary KK Menopause Centre in October 2023 to cater to the anticipated demand.

Professor Yong Eu Leong, emeritus consultant in the department of obstetrics and gynaecology at the National University Hospital (NUH), has seen “a significant increase” in the number of women requesting menopausal consultations in recent years, although absolute figures are not available.

Since menopause is a stage of life and does not usually require hospitalisation, there is scant data to show the true extent of its effects on Singapore women.

Not every woman will seek treatment for her symptoms, which can vary over time, and not every doctor will link the wide-ranging symptoms to the menopause transition.

“Many women may manage menopausal symptoms at home or through primary-care physicians rather than seek hospital treatment. Consequently, it is challenging for hospitals to routinely record or track menopause cases,” Prof Yong says.

He adds: “Women will be living more than a third of their lives after menopause due to increasing lifespans. The problems with undiagnosed menopausal symptoms would correspondingly increase.”

NUH’s ongoing Integrated Women’s Health Programme (IWHP) gives a glimpse into the possible scale of the issue.

Started in 2014, this cohort study of 1,200 women aged 45 to 69 aims to holistically identify symptoms of menopause and its associated medical conditions. It has generated over 15 publications to date.

A study published in October 2023 found that over six in 10 of the women reported at least one moderate to extremely severe symptom, which is consistent with figures from other developed countries, Prof Yong says.

This article was first published in The Straits Times.