Understanding Menopause: A Natural Transition in Every Woman’s Life
Menopause is a normal part of life when a woman’s periods stop permanently. It usually happens between ages 45 and 55. While it is natural, changing hormone levels can cause uncomfortable symptoms for many women. The good news is that effective help is available so you can feel better and stay healthy.
The time leading up to menopause is called perimenopause. During this stage, periods often become irregular, and symptoms may start.
Common Symptoms
Many women experience hot flashes and night sweats, trouble sleeping, mood changes, anxiety or feeling low. Some women may experience irregular or heavier periods during perimenopause. Over time, as the symptoms of estrogen deficiency become more prominent, vaginal drynes or discomfort during sex can increase. Some women also experience reduced libido, which can be caused directly from the hormonal changes or from the discomfort experienced during intercourse.
Not every woman has strong symptoms. Some have mild or none at all. If symptoms are affecting your daily life, work, sleep, or relationships, you do not have to simply put up with them.
Long-Term Health Considerations
Symptoms aside, menopause can also increase your risks of certain health conditions. These include osteoporosis (weaker bones and higher chance of fractures), heart diseases and changes in cholesterol levels.
Adopting healthy lifestyle habits during this time plays a key role in protecting your bones, heart, and overall well-being for many years to come. In fact, habits such as regular cardio exercise, weight-bearing activities, and strength training are most effective when started well before menopause. Building strong bones and peak bone mass in your younger years gives you a better foundation, so you enter menopause with higher bone density and greater protection against future bone loss.
Treatment and Management Options
Treatment is personalized—there is no one-size-fits-all approach. We choose options based on your symptoms, age, health history, and preferences.
1. Lifestyle Changes (often the first step).
– Regular exercise
– Balanced diet and maintaining a healthy weight
– Good sleep habits
– Reducing alcohol and stopping smoking
Menopausal Hormone Therapy (MHT or HRT)
Hormone therapy is the most effective treatment for hot flashes, night sweats, and vaginal dryness. It also helps protect bones, especially in the case of low bone mass or early menopause.
How it is given:
– Estrogen is the main hormone used. Currently, the gold standard is transdermal estrogen – estrogen patches, gels or sprays applied directly on the skin. These forms are often chosen because they bypass the liver and have a lower risk of blood clots compared with estrogen pills.
– If you still have your uterus, a progestogen (usually micronized progesterone) is added to protect the lining of the uterus and prevent overgrowth. This is called “combined” therapy. If you have had a hysterectomy (uterus removed), estrogen alone is used.
Before starting hormone therapy
Your doctor will first do a careful check-up that usually includes a detailed medical history and physical examination, blood tests to look at your complete blood count, liver and kidney function, blood sugar and cholesterol levels. Hormonal tests such as thyroid hormone levels may also be ordered. A mammogram will be ordered to screen for breast cancer, and cervical cancer screening (if due). Bone density scan may be prescribed if you are at higher risk of osteoporosis.
These tests help make sure hormone therapy is safe for you and rule out any other causes of your symptoms. Menopause hormone therapy may be recommended in women with moderate to severe hot flashes or night sweats, vaginal dryness or discomfort that does not improve with vaginal (local) hormonal treatments or vaginal moisturizers or other menopausal symptoms such as irritability, depressive mood or insomnia that are not attributable to other causes. Lastly, hormonal therapy may be recommended to you to prevent bone loss if you have a high risk of osteoporosis, for example in the case of early menopause.
When hormonal therapy is not recommended (contraindications)
Hormone therapy is usually not started if you have unexplained vaginal bleeding that have not been evaluated, history of breast cancer or other estrogen-sensitive cancers, history of blood clots, stroke, or heart attack, severe liver disease or known high risk of blood clots.
Is menopausal hormonal therapy safe?
For healthy women under age 60 or within 10 years of menopause, the benefits of hormonal therapy usually outweigh the risks when used at the lowest effective dose for the shortest time needed. Transdermal estrogen further improves the safety profile by lowering the chance of blood clots and possibly stroke. Regular follow-up visits (usually every 6–12 months) allow us to check that it is still the right choice for you.
Possible side effects
Most side effects are mild and often improve after the first few months. They may include breast tenderness or swelling, spotting or light bleeding (especially in the first months), mild bloating, or headache.
Serious side effects are rare, particularly when hormone therapy is started in healthy women under age 60 or within 10 years of menopause and used at the lowest effective dose. These can include blood clots (venous thromboembolism), stroke, or — with longer-term combined therapy — a small increase in the risk of breast cancer. The risk of blood clots and stroke appears lower with transdermal estrogen compared with oral forms. When a progestogen is needed (if the uterus is still present), micronized progesterone may be associated with a lower breast cancer risk than traditional synthetic progestins, though individual risks and benefits should always be discussed.
Your doctor will review your personal medical history in detail, weigh the benefits against any potential risks, and plan regular follow-up to ensure the treatment remains appropriate for you.
Non-Hormonal Medical Treatments and Complementary therapies
For women who cannot or prefer not to use hormones, options include certain antidepressants which may help with hot flashes.
There are also some complementary treatments that have sufficient evidence to support the menopausal transition. Cognitive behavioral therapy (CBT) can help reduce bothersome hot flashes and night sweats and improves sleep and mood. Clinical hypnosis involving guided relaxation and imagery has been shown to reduce the frequency and severity of hot flashes. Acupuncture and traditional chinese medicine has also been shown to be effective against hot flashes during the menopausal transition.
When to See Your Doctor
Please come in if your symptoms are interfering with your quality of life, if you have heavy or irregular bleeding, or if you would like to discuss ways to stay healthy through menopause.
Take the Next Step
Menopause can be the beginning of a healthy, vibrant new chapter. Schedule a consultation and we will create a personalized plan that fits your needs and helps you feel your best.
References
1. Berek JS, editor. Berek & Novak’s gynecology. 17th ed. Philadelphia: Wolters Kluwer; 2025.
2. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
3. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
4. World Health Organization. Menopause [Internet]. Geneva: WHO; 2024 Oct 16 [cited 2026 Apr 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/menopause.
5. Chaikittisilpa S, Orprayoon N, Vallibhakara O, et al. Summary of the 2023 Thai Menopause Society Clinical Practice Guideline on Menopausal Hormone Therapy. J Menopausal Med. 2024;30(1):24-36.
Maternal–Fetal Medicine Specialist in Bangkok
Dr. Narisra Srikureja Firer (Dr. Niti)
Dr. Niti is a Bangkok-based OBGYN with subspecialty training in Maternal–Fetal Medicine (MFM). She provides comprehensive care for women across all stages of life, including pregnancy care, deliveries, and general gynecological conditions.
She dedicates her time to private practice at Ruamjairak Hospital and Mission Hospital, and serves as a Maternal–Fetal Medicine Consultant at a large government tertiary care center.
To read Dr. Niti’s full bio, click here.
