At the inaugural Menopause Festival 2024 held in Singapore, a groundbreaking panel discussion brought together leading experts to explore how Singapore is reshaping menopause care. With insights from Associate Professor Rukshini Puvanendran, Professor Tan Thiam Chye, Dr June Tan Sheren, and Dr P. Buvanaswari, the session addressed the past misconceptions, present advancements, and future possibilities in managing menopause. This landmark event was a platform to normalize menopause conversations and empower women in Asia.
The WHI Study: A Landmark and Its Fallout
In the 1990s, hormone replacement therapy (HRT) was the go-to solution for menopause, often prescribed as soon as women reached their 50s. However, the 2002 Women’s Health Initiative (WHI) study shook the medical world. Assoc Prof Rukshini, Co-Director of KK Menopause Centre and Senior Consultant at KK Women's and Children's Hospital, recalls, “Regulatory bodies required a randomised controlled study to test the safety of HRT, and the WHI was the result.”
The study, however, included a major flaw: its participants ranged from 50 to 80 years old. “No doctor in usual practice starts or gives HRT to women in their 80s,” Assoc Prof Rukshini explains. Nevertheless, the results reported a 26% increased relative risk of breast cancer among HRT users. Dr. Tan points out the critical context often ignored: “That 26% increase translated to an actual risk of just 0.1%.”
The fallout was immense. General practitioners, once confident in prescribing HRT, stopped almost overnight.
“An entire generation of women was deprived of HRT and proper menopause care because of the WHI study,” Dr. Tan laments.
The study’s findings not only instilled fear in patients but also created confusion among doctors.
Reassessing HRT: Insights and Innovations
In the years since, follow-up studies have provided much-needed clarity. A 2017 study found that women who started HRT between ages 50-60 were healthier and had lower cardiovascular risks than their peers. “Older starters didn’t see much benefit, but those starting earlier reaped significant health advantages,” Assoc Prof Rukshini explains.
Bio-identical hormones have also revolutionized menopause care. Dr. June notes, “With better preparation of bio-identical hormones, there’s been a renaissance in HRT.” Options like transdermal patches, which deliver estrogen directly into the bloodstream, reduce risks associated with oral HRT, such as blood clots. This personalized approach marks a shift from the one-size-fits-all mindset of the past.
Understanding Menopause Beyond Physical Symptoms
Menopause is more than hot flushes and night sweats—it can significantly impact mental and emotional well-being. Dr. Buvanaswari, who worked at NUH’s Women’s Emotional Health clinic for seven years, recalls seeing women in their late 40s and early 50s struggling with insomnia, depression, and anxiety. “Unless you listen carefully, most people wouldn’t think of menopause as the cause,” she says.
Assoc Prof Rukshini explains, “Estrogen isn’t just a sex hormone; it’s a neural hormone. It affects every part of our body, including the brain.” Estrogen decline during menopause can lead to symptoms like memory lapses and mood swings.
Dr. June emphasizes the importance of this understanding:
“Women need to know their brain symptoms are linked to something tangible, not that they’re just ‘going nuts.’”
Addressing Lifestyle and Body Changes
For many women, menopause also brings significant body changes. “What scares women the most? Weight gain,” Dr. Tan says. Estrogen helps regulate metabolism, and its decline often leads to weight accumulation, particularly around the midsection. Dr. June observes, “It’s not just weight gain—it’s the shift in body shape. Everything moves to the midsection.”
Assoc Prof Rukshini highlights the role of lifestyle: “We need to be mindful of what we eat and, most importantly, exercise. Studies show that as we age, we don’t move as much. If we want to be active at 80, we need to start planning now.”
From climbing stairs to lifting suitcases, everyday activities require strength and mobility. “If you want to play with your grandkids or travel in your 90s, you need to build that foundation today,” she advises.
Singapore’s Evolving Menopause Care
Assoc Prof Rukshini emphasizes the importance of empowering women to take charge of their health.
“In a super-ageing society, women often put themselves last. It’s time we change that.”
However, systemic changes take time. “Menopause was half a column in the medical textbooks pre-WHI,” Dr. Buvanaswari notes. As awareness grows, doctors are better equipped to recognize and treat menopause-related symptoms.
Proactive Health Management - A Lifespan Approach
"A lot of people live the last 10-15 years in poor health due to chronic disease mismanagement,” Dr. Tan explains. HRT, when used responsibly, can play a role in extending healthspan.
For instance, it can be recommended for women with severe symptoms or conditions like osteopenia. However, thorough health assessments are crucial. “If the benefits far outweigh the risks, and the patient is fully informed, HRT can be a game-changer,” Dr. June affirms.
Assoc Prof Rukshini also addresses a common fear:
“Taking HRT increases breast cancer risk only slightly. When you compare 1,000 women not on HRT, and 1,000 women on HRT for 5 years, the HRT group will have about 5 more breast cancer cases than the non-HRT group. Breast cancer is common with or without HRT, so don’t blame yourself if you get it..”
The Road Ahead
Singapore’s approach to menopause care is setting a global example. By combining advanced research, innovative treatments, and personalized care, it empowers women to navigate menopause with confidence and dignity. Dr. Tan sums it up beautifully:
“For those who were on HRT pre-WHI and stayed on it for 20-30 years, I sometimes think I’ve got the wrong patient—they look 50 when they’re 80.”
As Singapore continues to refine its approach, it offers a beacon of hope for women worldwide. By prioritizing healthspan, addressing stigma, and empowering women with knowledge, Singapore is paving the way for a healthier, more vibrant future for midlife women everywhere.
Audience Questions - Key Takeaways
The session concluded with questions from the audience, reflecting real-world concerns:
Why are menopause symptoms often misdiagnosed?
Assoc Prof Rukshini responded, “The system is evolving, but women must advocate for themselves. Self-awareness is key.”
Can HRT be prescribed long-term to asymptomatic women?
“It depends,” said Dr. June. “For women at risk of conditions like osteoporosis, HRT might be recommended, but thorough health assessments are crucial.”
Does estrogen-only HRT increase breast cancer risk?
“It’s the synthetic progesterone that was linked to higher risks,” clarified Dr. Buvanaswari. “Today, bio-identical options offer safer alternatives.”
A New Era for Perimenopause and Menopause Care
The Menopause Festival 2024 marked a watershed moment in Singapore’s healthcare landscape, normalizing conversations about peimenopause, menopause and spotlighting the strides made in treatment and care.
“For those on HRT pre-WHI who stayed on it, they often look 50 when they’re 80,” shared Dr. Tan, a testament to the potential benefits of proper menopause management.
By combining cutting-edge research, personalized care, and open dialogue, Singapore is not only transforming menopause care for its women but also offering a blueprint for the world.
Missed the Menopause Festival 2024? Join Us in 2025!
This year’s Menopause Festival 2024 was a groundbreaking event, filled with insightful discussions, inspiring stories, and empowering resources for women navigating menopause.
If you missed it, don’t worry—we’re already gearing up for an even bigger and better festival in 2025!
Get ready for an even bigger and better experience at the Menopause & Midlife Festival 2025! This year, we’re opening up conversations that matter to both women and men, addressing topics that impact everyone as we navigate midlife together.
Enjoy interactive workshops, expert-led discussions, and a curated marketplace designed to provide resources and products that support well-being in midlife.
Join our waiting list NOW and be the first to know all event details!
Let’s celebrate, learn, and grow together – because midlife wellness is for everyone!