Cover From changing symptoms to new treatment options, navigating menopause can raise plenty of questions. Women’s health experts offer guidance on what to expect and how to find the right support (Photo: Getty Images)
From changing symptoms to new treatment options, navigating menopause can raise plenty of questions. Women’s health experts offer guidance on what to expect and how to find the right support (Photo: Getty Images)
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From hormone therapy and strength training to supplements and health screenings, the advice on menopause can seem endless. Experts from around the region help sort out what deserves attention, what depends on individual needs and what can wait
There’s more information and support for women experiencing menopause than ever before—but that could also be a double-edged sword. All that knowledge is good, but it could also be overwhelming, especially when you’re being given an increasingly long health to-do list: lift weights, eat more protein, look after your bones, monitor your cholesterol and blood glucose, improve your sleep. Consider hormone therapy, creatine and supplements, too. Each recommendation comes with its own rationale; together, they can begin to resemble a full-time job.
Some women go through menopause with little disruption to their daily lives, while others experience symptoms that interfere with multiple areas of life. The realities Asian women face might also be different from what they see online, because so much of what’s out there describes the experiences of Western populations.
Also read: How to explain perimenopause to your partner
First, identify what is affecting your life
Dr Chua Yang is an obstetrician-gynaecologist at Mount Alvernia Hospital in Singapore, with a special interest in primary healthcare and midlife women’s health; she is also a former president of both the Asia Pacific Menopause Federation and the Menopause Research Society of Singapore. For Dr Chua, deciding what to tackle first means giving women the space to say what is actually going on.
“It is of utmost importance to give women time,” she advises. “A relationship requires time to build, even if it is a presumed relationship of trust, like the doctor-patient relationship. Women need time to build confidence to share their insecurities, their intimate concerns and all of what she thought was failing her in health and life. Sometimes, the last symptom she mentions is the one that she is in fact most bothered with.”
Dr Chua prefers to let patients explain their symptoms in their own words instead of starting with a checklist. Once she has worked out what seems to be the main concern, she checks with the patient that she has understood correctly. “In helping her manage her concerns, I would reaffirm with her which I thought was the one that most deeply troubled her and start from there to design a path forward.”
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Associate Professor Rukshini Puvanendran, co-director of the KK Menopause Centre and head and senior consultant of the Family Medicine Service at KK Women’s and Children’s Hospital in Singapore, is just as wary of assuming that every woman needs intervention. She co-chaired the workgroup behind Singapore’s first menopause-management guidelines, launched in February 2026, and co-authored the KKH research that helped shape them.
“Menopause is a transformational transition that every woman goes through, but it is important to recognise that not all women will experience problems moderate or severe enough to disrupt their lives,” she says. “Some women pass through this phase with little to no difficulty at all.”
When symptoms are disruptive, her team looks at a woman’s menstrual and medical history, her family risk factors and her emotional health. Furthermore, conditions that can mimic perimenopausal symptoms—such as thyroid disorders, anaemia and medication side effects—are examined before putting symptoms down to menopause.
Above Dr Chua Yang is a Singapore-based obstetrician and gynecologist at Mount Alvernia Hospital, with a special interest in midlife women’s health, perimenopause and menopause
Above Associate Professor Rukshini Puvanendran is Co-Director of the KK Menopause Centre as well as Head and Senior Consultant of the Family Medicine Service at KK Women’s and Children’s Hospital
Dr Chua Yang is a Singapore-based obstetrician and gynecologist at Mount Alvernia Hospital, with a special interest in midlife women’s health, perimenopause and menopause
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Puvanendran also considers how symptoms affect a woman's daily life: “If a woman is struggling to sleep, finding her mood unmanageable, or noticing that her concentration at work has deteriorated, those concerns take priority, not because the underlying biology is necessarily more serious, but because the lived impact is immediate and often underestimated by the women themselves.”
It’s easy to overlook how much symptoms weigh on daily life when menopause is equated almost entirely with hot flushes. The research published by KKH in 2026 that Puvanendran co-authored surveyed 1,461 women aged 45 to 65 in Singapore. Weight gain, difficulty sleeping and head or neck aches were the three most commonly reported moderate-to-severe symptoms, while vaginal dryness and joint or muscle aches also ranked highly. Puvanendran adds that hot flushes, often considered the defining symptom of menopause, ranked eighth.
Not everything requires medical treatment, but the findings also suggest that women may be putting up with symptoms that deserve attention, sometimes without recognising their connection to menopause. “The key is knowing the difference,” Puvanendran shares. “If symptoms are mild and manageable, lifestyle adjustments are usually sufficient. But if they are affecting your ability to function, your sleep, your work, your relationships, then it is worth speaking to a doctor to understand what is happening and what options are available.”
Protect the fundamentals: movement and sleep
For women wondering where to start, both doctors point back to the familiar essentials: regular physical activity, nutritious food, enough sleep, managing your weight, and avoiding smoking and too much alcohol. These remain central to both the Asia-Pacific Menopause Federation’s consensus published in 2025 and Singapore’s 2026 guidance.
“Lifestyle is the foundation of care for every woman going through this transition, regardless of whether she is on any treatment,” Puvanendran says. And if one has to pick just two starting points, choose movement and sleep: “Movement first, because our study of 1,461 women found that weight gain was the single most commonly reported moderate to severe symptom. And sleep second, because difficulty sleeping was the second most commonly reported symptom, and poor sleep amplifies almost everything else—mood, energy, concentration, and yes, weight gain too. Fix your sleep, and you give yourself a much better foundation to manage everything else.”
Above A Singapore study found that weight gain was the single most commonly reported moderate to severe symptom. Exercise could help alleviate this, wthout having to draw up an elaborate programme
A Singapore study found that weight gain was the single most commonly reported moderate to severe symptom. Exercise could help alleviate this, wthout having to draw up an elaborate programme
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Resistance training can help maintain muscle strength and function, while weight-bearing exercise also supports bone health. Women who already exercise may want to check whether their routines include both.
“Where menopause specifically changes the equation is around muscle. Women lose muscle mass from midlife, and the decline in estrogen accelerates this. So beyond general activity, strength training becomes particularly important as it helps counter the metabolic slowdown that makes weight management harder during this phase,” Puvanendran says. Sleep problems that persist, though, may need more than better habits, especially when night sweats or other symptoms keep interrupting rest.
In case you missed it: Menopause isn’t just a transition—it’s a hormone deficiency with health risks
When medical treatment makes sense
If symptoms are affecting your sleep, work, relationships or quality of life, medical treatment can be just as relevant as lifestyle changes. One option is menopausal hormone therapy (MHT), often called hormone replacement therapy (HRT), which remains the most effective treatment for bothersome hot flushes and night sweats. Both the 2025 European Society of Endocrinology guideline and the previously mentioned 2026 Singapore guidance stress assessing symptoms, individual risk and personal preferences before starting treatment.
“For women with moderate to severe symptoms, MHT is the most effective treatment to date, and the evidence for its safety is strong,” says Puvanendran. “For most symptomatic women under 60 or within 10 years of menopause who have no contraindications such as a history of breast cancer or blood clots, the benefits significantly outweigh the risks.”
It isn’t a blanket yes, though. The type of hormones, how they’re delivered, how long treatment lasts and a woman’s medical history all shape the decision. Women who have a uterus generally need a progestogen alongside systemic (whole-body) oestrogen to protect the womb lining. Guidelines also advise against using MHT solely to prevent cardiovascular disease or dementia in otherwise asymptomatic women reaching menopause at the usual age.
Above Menopausal hormone therapy (MHT), often called hormone replacement therapy (HRT), remains the most effective treatment for symptoms like hot flushes and night sweats
Menopausal hormone therapy (MHT), often called hormone replacement therapy (HRT), remains the most effective treatment for symptoms like hot flushes and night sweats
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Dr Chua says she generally reserves MHT for women with moderate-to-severe symptoms, especially when several symptoms can’t easily be treated one by one. She looks at how symptoms affect each woman’s life instead of relying on a standard severity score. “The assessment of severity is patient-centric. Similar frequency and severity of hot flushes, for example, may impact a homemaker, a school teacher and a sales executive very differently,” she explains.
Chua adds, “Some isolated symptoms like vaginal dryness and resulting sexual dysfunction, without other systemic symptoms, require only very safe and very effective topical treatment.” These may include vaginal lubricants and moisturisers. For many women, ultra-low-dose vaginal oestrogen, which is minimally absorbed into the bloodstream, may be prescribed to address these symptoms topically.
Read more: Menopause nutrition: What to eat, according to science
For women who can’t or would rather not use systemic MHT, there are effective alternatives for certain symptoms. The menopause guidance from the UK’s National Institute for Health and Care Excellence (NICE) recommends considering menopause-specific cognitive behavioural therapy for hot flushes and related sleep problems, and lists other options depending on the symptoms involved. A new or persistent depressive disorder needs its own assessment.
Puvanendran sums up her approach this way: “What I always tell patients is that not every woman needs treatment, but every woman deserves to make an informed choice.”
Not every woman needs treatment, but every woman deserves to make an informed choice
Review long-term risks
Menopause is also a sensible time to take stock of your longer-term health. Lower oestrogen speeds up bone loss around the final period, while ageing, family history and other risk factors shape cardiovascular and metabolic health. The aim is to work out what a particular woman should keep an eye on, not to sign up for every available check-up.
Puvanendran points to bone health, blood pressure, cholesterol and diabetes risk, along with appropriate breast and cervical screening. She also considers vitamin D testing, particularly when there are musculoskeletal symptoms such as muscle and joint aches. Think of these as prompts for an individual assessment, not a standing order for the same tests for everyone.
Bone scans are a good example. United States screening recommendations updated in 2025 advise bone-density screening at age 65, and earlier for postmenopausal women who have additional risk factors and an elevated estimated fracture risk. National guidance and individual circumstances vary; Singapore’s guidelines call for fracture-risk assessment after menopause rather than assuming that every woman needs an immediate scan.
Some other tests may not be needed at all. For women over 45 with typical symptoms and menstrual changes, the UK’s National Institute for Care and Excellence and the 2025 European endocrine guideline advise diagnosing perimenopause or menopause from symptoms instead of relying on routine hormone blood tests. Hormone levels fluctuate, so a single result can mislead. A pelvic ultrasound has a role when there is a clinical reason to investigate, but it isn’t a routine menopause test.
Early menopause is a different situation, and it may call for tests and treatment that wouldn’t otherwise be needed. “For women with early menopause, hormone level testing is advised as part of evaluation,” Puvanendran says.
Chua puts particular weight on what menopause before the usual age means for long-term health. “The data is the clearest in terms of prescribing hormonal treatment for women who reach menopause early (between 40 and 45 years), especially those with premature ovarian insufficiency (below 40 years) as these groups of women have much higher risks of cardiovascular disease and osteoporosis due to loss of estrogen prematurely.”
The treatment conversation is therefore different for women with premature ovarian insufficiency or early menopause. For those with premature ovarian insufficiency, guidelines from the International Menopause Society and NICE recommend hormonal treatment until around the usual age of menopause, unless contraindicated. This can include hormone replacement therapy or, in appropriate cases, a combined hormonal contraceptive.
Be selective about the extras
The least urgent part of the menopause to-do list may also be the most heavily marketed. Products promising hormonal balance, a faster metabolism or protection against ageing are everywhere, but the evidence behind them is patchy.
Supplements can make sense for an identified deficiency or particular dietary needs. It doesn’t follow that every menopausal woman should take them. The Menopause Society’s 2023 evidence review did not recommend supplements or herbal remedies as treatments for hot flushes and night sweats.
Dr Chua advises against experimenting with over-the-counter herbal products without medical guidance. “Haphazardly trying over-the-counter ‘herbal remedies’ will not be helpful. These are often proven to have no benefits, and are largely unregulated. In fact, if self-medicated, they may create drug interactions and other health risks that go unchecked.”
Above Supplements may make sense for some conditions, but not all menopausal woman should take them. In fact, the Menopause Society’s 2023 evidence review did not recommend supplements or herbal remedies as treatments for hot flushes and night sweats
Supplements may make sense for some conditions, but not all menopausal woman should take them. In fact, the Menopause Society’s 2023 evidence review did not recommend supplements or herbal remedies as treatments for hot flushes and night sweats
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Some newer ideas have better, if still limited, evidence. A May 2026 review of seven randomised trials involving 608 postmenopausal women found small average improvements in lean mass and leg strength with creatine, mainly when it was combined with resistance training. So creatine may be worth discussing if you have particular exercise goals, though strength training remains the better-established starting point.
Continuous glucose monitoring is another example. A January 2026 review of 23 studies involving 1,074 people without diabetes found possible improvements in short-term glucose control and eating habits, especially in people with prediabetes, but no appreciable glycaemic benefit in people with normal blood sugar. It doesn’t show that healthy menopausal women need to wear glucose sensors as a matter of routine.
Before buying anything new, it helps to know what it is meant to change, whether the evidence applies to someone in your circumstances and whether a simpler measure would do as much.
The case for preparing early
There’s also something to be said for looking after your health well before menopause begins. Dr Chua believes that the healthier a woman is going into this stage of life, the better placed she may be to manage its symptoms and consider treatment if needed.
“Women should enter menopause healthy, just as they should be healthy through life!” she emphasises. She points out that women with obesity tend to experience more troublesome symptoms, including hot flushes, sleep disturbances, joint pain and fatigue.
There are implications for treatment, too. Smoking, obesity and excessive alcohol consumption can contribute to health risks that doctors need to consider when prescribing menopausal hormone therapy. On the other hand, women who enter menopause with fewer existing risk factors may have more treatment options available to them.
Make the choices that work for you
Having treatment options is one thing; deciding which ones to pursue is another. Dr Chua recognises that women may have concerns about medication even when the evidence suggests it could help. These are concerns she believes deserve to be heard and discussed. “We can never arm-twist patients to comply, even if we believe it is in their best interests,” she says. “Fear, even if illogical, is a debilitating thing.”
I wish for all women to prioritise [themselves]
She discusses individual risks, explains the current medical evidence and encourages patients to take the time they need to weigh their options. She also wants women to make room for their own wellbeing, comparing it with the commitment many have shown in raising children. “I wish for all women to prioritise [themselves],” she says.
For Puvanendran, prioritising health also means recognising when lifestyle changes are no longer enough. As she explains, “The other thing I always emphasise is that lifestyle and medical treatment are not alternatives. They work together.”
And if symptoms are still significantly affecting your quality of life despite lifestyle changes, “Please do seek help. [Our] study found that 70 per cent of women with moderate to severe symptoms had not sought medical attention,” Puvanendran says. “You do not have to simply endure this.”
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Kristine Fonacier is a widely published journalist and author, covering lifestyle, business, politics and travel. She was the editor in chief at the Philippine editions of Esquire and Entrepreneur, and the founding editor of Grid magazine. At Tatler, she was previously the regional editor for T-Labs, Power & Purpose and Asia’s Most Influential.
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