Author

Dr. Patsama Vichinsartvichai — Thai Board of Obstetrics and Gynaecology; Thai Board of Reproductive Medicine; Diploma in Gynaecological Endoscopic Surgery; MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG.

What is menopause?

The number of ovarian follicles peaks while a girl is still in the womb, at around 20 weeks of gestation. From then on it falls steadily, leaving roughly 100,000 by the time periods begin. When the pool has fallen far enough that follicles no longer grow and ovulate, menopause arrives.

This period is divided into three stages.

Perimenopause — approaching menopause

Oestrogen levels begin to swing and become irregular
Periods become irregular — heavier, lighter, more frequent or further apart
Some women get menopausal symptoms: hot flushes, night sweats, irritability, vaginal dryness

Menopause

Twelve consecutive months without a period, counted from the final menstrual period (FMP).

Postmenopause

The years after menopause, when its lasting health consequences appear — osteoporosis, vaginal atrophy, metabolic syndrome and others.

When does menopause happen?

The average age at menopause for Thai women is 51

It can come earlier or later than this.

Before age 40 this is called premature ovarian insufficiency, seen in about 1 in 100 women; menopause before 30 occurs in about 1 in 1,000
Between 40 and 45 it is called early menopause
Removing both ovaries before menopause causes it immediately — surgical menopause
Some treatments — chemotherapy, pelvic radiotherapy — damage the ovaries prematurely, causing medical menopause

Diagnosing menopause

From age 45, symptoms alone are enough to make the diagnosis. No blood test is needed — hormone levels still fluctuate at this stage, so a blood result can mislead
Under 45, hormone testing is needed if there are symptoms and periods have been absent for more than four months. Two tests at least a month apart are required to confirm

Symptoms of menopause

Hot flushes
Night sweats
Mood changes
Weight gain
Urogenital symptoms
Symptoms severe enough to leave work

Long-term health effects of menopause

Cardiovascular disease
Atherosclerosis and metabolic syndrome — rising LDL and fasting blood sugar, larger waist circumference, higher blood pressure, falling HDL
Alzheimer’s disease
Urovaginal symptoms

Health checks during menopause

Test	Frequency
Mammogram + breast ultrasound	Annually
Cervical cytology	Every 3–5 years
Bone mineral density (BMD)	Every 3–5 years
Renal function	Every 1–2 years
Liver function	Every 1–2 years
Lipid profile and fasting blood sugar	Annually
Sex hormones	As indicated
Vitamin D3	As indicated

Treating menopausal symptoms

Lifestyle modifications

Wear loose, breathable clothing
Avoid caffeine
Avoid spicy food
Avoid monosodium glutamate (MSG)
Keep weight within the normal range
Calm the mind; meditate

Hormonal treatment

Oral
Patch
Topical gel or cream
Vaginal preparations

Non-hormonal treatment

SSRIs
SNRIs
Black cohosh (Cimicifuga racemosa)

The menopause health check at LIFE by Dr. Pat

Standard price 14,000 THB

Physical examination and consultation with a gynaecologist
Bone density (BMD) of the lumbar spine and hip
Mammogram and breast ultrasound
Cervical cancer and HPV screening (ThinPrep + HPV DNA)
Pelvic ultrasound
Hormone tests: FSH, LH, oestradiol
Vitamin D3 level
Full blood count (CBC)
Metabolic profile: fasting glucose, cholesterol, triglycerides, LDL, HDL
Renal function: BUN, creatinine
Liver function tests

References

Hamoda H, Panay N, Pedder H, Arya R, Savvas M. The British Menopause Society & Women's Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health. 2020 Dec;26(4):181-209.
Baber RJ, Panay N, Fenton A; IMS Writing Group. 2016 IMS recommendations on women's midlife health and menopause hormone therapy. Climacteric. 2016 Apr;19(2):109-50.
The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. Menopause. 2022 Jul 1;29(7):767-794.
Chaikittisilpa S, Orprayoon N, Vallibhakara O, Vallibhakara SA, Tanmahasamut P, Somboonporn W, Rattanachaiyanont M, Techatraisak K, Jaisamrarn U. Summary of the 2023 Thai Menopause Society clinical practice guideline on menopausal hormone therapy. J Menopausal Med. 2024 Apr;30(1):24-36.
Kutheerawong L, Vichinsartvichai P. The influence of body fat distribution patterns and body mass index on MENQOL in women living in an urban area. Climacteric. 2016;19(1):66-70.
Tanmahasamut P, Vichinsartvichai P, Rattanachaiyanont M, et al. Cimicifuga racemosa extract for relieving menopausal symptoms: a randomized controlled trial. Climacteric. 2015;18(1):79-85.
Vichinsartvichai P. Primary ovarian insufficiency associated with autosomal abnormalities: from chromosome to genome-wide and beyond. Menopause. 2016;23(7):806-15.
Vichinsartvichai P, Manolertthewan C, Promrungrueng P. Premature ovarian failure with 46,XX,t(1;4)(p34.1;q34): first case report and literature review. Climacteric. 2015;18(4):656-8.
Vichinsartvichai P, Sirirat S. Hematologic parameters as the predictors for metabolic syndrome in perimenopausal and postmenopausal women living in urban area: a preliminary report. Prz Menopauzalny. 2016;15(2):90-5.
Vichinsartvichai P, Teeramara R, Jirasawas T, et al. Comparison of urinary adiponectin in the presence of metabolic syndrome in peri- and postmenopausal women. BMC Womens Health. 2022;22(1):70.
Wattanapol P, Vichinsartvichai P, Sakoonwatanyoo P. Serum adiponectin is a potential biomarker for metabolic syndrome in peri- and postmenopausal women. Gynecol Endocrinol. 2020;36(7):620-25.
Wongapai P, Jirasawas T, Vichinsartvichai P. Thai postmenopausal woman's view in genitourinary syndrome of menopause. Post Reprod Health. 2024;30(3):157-65.

Walking into menopause with confidence