Let’s talk about perimenopause, the hidden hormonal stage shrouded in secrecy

“How To Build A Singaporean Woman” is a Her World original docuseries which highlights the social and cultural issues that women in Singapore face, and asks: what does it mean to be a Singaporean woman today? 

In the tenth episode, “Understand When Her Body Changes”, Uma Thana Balasingam, Founder & CEO of the Elevate Group and Founder of Lean In Network Singapore, and Andrea De Cruz, Entrepreneur & one half of the women’s health podcast And One Should Know lift the veil on perimenopause as they open up about their personal experiences, frustrations, and the small wins in reclaiming their health and redefining womanhood on their own terms.

The stage before the stage: Understanding perimenopause

Most people assume menopause begins with hot flashes, but as Andrea points out, what we often refer to as “menopause” is actually perimenopause — the transitional phase that kicks off the body’s shift toward the end of menstruation. This stage typically begins in a woman’s late 30s or early 40s, though the timing can vary widely. Its symptoms can last for up to a decade before menopause officially sets in.

For Andrea, who has had a liver transplant, faced early-stage cervical cancer, and most recently discovered a brain aneurysm, health scares have made her acutely aware of her body. On the other hand, perimenopause crept up on Uma without her realising it. She hadn’t educated herself on the signs, and despite being well within the typical age range, none of the doctors she saw brought it up either. 

One of the earliest signs for Uma was unexpected weight gain, particularly visceral fat. She sensed something was off, but even when she raised it with her GP, perimenopause was never mentioned. And that’s where the problem lies — too often, women are left to connect the dots themselves. 

Uma emphasises the importance of taking charge of our own health by educating ourselves, so that we’re equipped to ask the right questions and advocate for our needs throughout our women’s health journey.

The transition before menopause: What your body is trying to tell you

Perimenopause doesn’t show up with a label, and no two women experience it the same way. But one thing’s certain: your body starts sending signals, whether you’re prepared or not.

Tiredness is one of the more common and frustrating symptoms of perimenopause, often creeping in even when you think you’ve had enough rest. As hormone levels begin to fluctuate, many women also notice changes in their menstrual cycle — it becomes more irregular and eventually tapers off as the body’s egg supply depletes. For many, these physical changes can feel deeply personal, as menstruation and fertility have long been tied to ideas of womanhood.

Another major shift that occurs during perimenopause is a vast drop in libido. This can drastically affect one’s intimate relationships and self-perception. However, Andrea notes that there are ways to manage and even improve libido levels, such as seeking help through sex therapy.

In Singapore, 6 in 10 women experience at least one moderate to extremely severe symptom during perimenopause or menopause. These symptoms can vary widely but often include irregular periods, hot flashes, night sweats, trouble sleeping, brain fog, mood swings, irritability, vaginal dryness, reduced libido, and frequent urination. Among all these, joint and muscle aches stand out as the most common symptom for women going through this phase.

 Is Hormone Replacement Therapy right for you?

Uma recalls that one of her good friends struggled with tinnitus and, despite seeing an ENT specialist, found no relief. However, after starting Hormone Replacement Therapy (HRT), her tinnitus disappeared and her brain fog lifted, marking a significant improvement.

HRT is a treatment that supplements the body with estrogen or progesterone to manage symptoms related to perimenopause and menopause. It’s not a magic fix, and it’s not for everyone, but it can dramatically improve quality of life for those who qualify.

Andrea stresses the importance of having a trusted gynaecologist who can assess your risk factors and determine if HRT is suitable. She also points out that for those who aren’t candidates for HRT, there are alternative topical treatments containing hormones to help relieve symptoms.

The bottom line? Women deserve options — and doctors who take their discomfort seriously.

Break the silence before it breaks you

Andrea highlights how societal norms, particularly in Asian communities, tend to view the discussion of perimenopause and menopause as too taboo, which leads to silence and isolation. This reluctance to talk openly can prevent women from seeking the support and information they need during this significant phase of their lives.

Reflecting this, 61% of Singaporean women felt that social stigma prevents them from openly discussing menopause symptoms and seeking support in the workplace. Andrea thus launched her podcast And One Should Know as a heartfelt tribute to the many women who sat in her salon chair and shared their personal health journeys with her. Their stories helped her prepare both mentally and physically for perimenopause.

A new kind of sexy

Andrea recounts the last time she got her period. “I was on a trip in Taiwan. I had gotten out of the car and suddenly there’s just this flow, which didn’t stop. It was like a tap that kept running. And it was really embarrassing,” she iterated. Andrea warns women to be prepared for the intensity of their final period, regardless of whether it’s been months or even up to a year since their last cycle. 

She explains that after menopause, women no longer have to worry about concerns like staying clean in white pants or on a white couch. It marks the end of having periods, and she encourages women to truly embrace this new chapter.

Andrea points out that many women in their 50s who are going through perimenopause or menopause might also be facing major life changes, such as relationship struggles or divorce. This overlap of emotional and physical challenges can lead some women to feel like it’s the end of the road for them.

Her advice? Seek support. “During this period of a woman’s life, it boils down to having support. There is nothing really as much as you’d like to say ‘I can handle this on my own. I don’t need any help.’ No, we all need help,” voices Andrea.

Ageing without apology

Uma reflects on the constant pressure women face to maintain a certain appearance, noting how this often leads to relentless self-criticism, whether it’s about our performance at work or how we look in the mirror. This internalised scrutiny can rob women of genuine happiness and self-acceptance, both in their careers and in their bodies. 

Andrea shares that staying active, whether it’s through a simple walk or lifting weights at the gym, can make the transition through perimenopause and menopause much smoother, both physically and emotionally. Maintaining a healthy lifestyle can ease symptoms and help women feel more in control of their bodies. 

Just as important, she emphasises the value of seeking support for your mental health during this time of change. Speaking to someone impartial can be incredibly helpful, and there’s absolutely no shame in asking for help.

No kids? No problem: Femininity isn’t measured by motherhood

Uma shares that many women often express sympathy toward her for not having children, but she doesn’t see it as something to be sorry about. For her, there are many other meaningful ways to embody and experience being a woman.

Andrea highlights the high cost of living in Singapore as a prominent factor influencing the decision not to have a child. Bringing a child into the world without the means to provide for their physical, emotional, and educational needs isn’t just challenging — it can be unfair to the child. It is not selfish but rather, it demonstrates foresight, responsibility, and a genuine commitment to ensuring a child’s well-being instead of yielding to societal pressures.