How menopause treatments evolved from horse urine to a new non-hormonal drug that targets hot flashes

Very few women in Singapore are on MHT to manage their menopausal symptoms – less than 2 per cent, said Associate Professor Yong Tze Tein, a senior consultant with Singapore General Hospital’s (SGH) Department of Obstetrics and Gynaecology. These could be the reasons:

• Repercussions of the 2002 US Women’s Health Initiative (WHI)

Hormone replacement therapy and hormones developed “exaggerated negative connotations” after the WHI study, said Assoc Prof Yong. “This fear also runs amongst healthcare professionals, especially those who do not treat menopausal symptoms often, and may not be up to date with the latest evidence.”  

Dr Carmen Gan, an obstetrics and gynaecology specialist, and a consultant at Raffles Women’s Centre was also personally affected by the misconceptions. “When I was growing up, my mother used to tell me to avoid hormones as they can cause cancer and are generally regarded as bad,” she said. “Until I became a gynaecologist, I had always told myself to avoid all hormones as a result.” 

• MHT medications don’t quite fit Asian women’s needs

MHT typically targets vasomotor symptoms such as hot flashes and night sweats. Comparatively, “the top five menopausal symptoms [in Singapore] were joint and muscle discomfort, sleep problems, vaginal dryness, physical and mental exhaustion, and hot flashes,” said Dr Lisa Webber from SGH’s Department of Obstetrics and Gynaecology, citing a National University Hospital Singapore study involving 1,054 women from ages 45 to 69.

• Sexual symptoms may be under-reported

Cultural norms, especially for women born in the 70s or earlier, may have led to the under-reporting of sexual symptoms such as vaginal dryness. 

Dr Anthony Siow, Gleneagles Hospital’s obstetrician and gynaecologist, said that when he suggests the use of local oestrogen during sex to reduce vaginal dryness, he is often met with comments such as “completed family already, no need sex” and “so old already, still want sex?”. 

• Too busy to get treatment

The average age of menopause onset is 49, a time when many women are still too busy working or caring for families to consider hormonal therapy, Dr Siow observed. Those who do see a specialist – and maybe consider MHT – do so only if they get the correct information.