I cannot pinpoint exactly when the hot flashes began. Maybe it was a year ago. I just remember waking up in the dead of a cold night, my T-shirt drenched in sweat. After a few more nights, the reality dawned on me: perimenopause. It finally clicked: the muscle pain, frozen shoulder, brain fog, and irritability. It also explained stubborn belly fat that refused to melt despite consistent workouts and healthy eating. It is hard to believe that the passage of time has caught up with me.
According to the World Health Organization, 1.2 billion women worldwide will have reached menopause and the post-menopausal stage by 2030. With rising life expectancy, women now spend roughly one-third of their lives post-menopause. Menopause marks the end of a woman’s reproductive life. It is diagnosed retrospectively, after the absence of menstruation for twelve consecutive months. In Malaysia, the average age of natural menopause is 51. But menopause does not happen overnight. The process usually begins with perimenopause, a multi-year period of fluctuating hormone levels. Typically begins in the 40s. Though the average is 4 years, this period can last for a few months or up to 8 years.
In our society, menopause is regarded as an inherent and inevitable milestone in a woman’s life cycle. There is rarely public dialogue or community support. Women often lack the support and the language needed to explain what they are going through, turning a natural transition into a lonely ordeal. My sisters and I don’t talk about menopause. Our mother never mentioned her own experience. My aunts’ voices dropped to a whisper when they said the word “menopause”. So here I am, searching online, scouring medical journals, and reading books to empower myself as I go through this journey.
Malaysia’s multi-ethnic landscape offers a unique perspective on how cultural and religious backgrounds influence the perimenopause stage. Since the majority of women often frame this transition as a natural process, they tend not to report their symptoms as medical issues. Many view this as a time of liberation, freedom from the monthly cycle and risk of pregnancy. For Muslim women, this often translates into uninterrupted engagement with their faith.
Perimenopause has a multitude of symptoms. Every woman’s journey is unique; no two women experience perimenopause in exactly the same way. If you search for perimenopause symptoms online, the results almost always lead with hot flashes. This is a more common experience of Western women. In recent studies done in Malaysia, most women complained of joint pain, body aches, and fatigue. Many women attribute this physical pain to aging, general stress, or physical labor instead of hormonal change. For women in professional positions, many reported symptoms of brain fog and fatigue. They find these symptoms disruptive and hinder their work performance. While many experience symptoms of perimenopause, only a handful will seek evidence-based hormone treatment. Instead, they turn to natural remedies to help manage the symptoms quietly.
While the symptoms of perimenopause are undoubtedly troublesome—disrupting our daily lives, careers, and mental clarity—the long-term impact of post-menopause is far more worrisome. Estrogen receptors are found throughout the body. With estrogen depletion, we lose its protective effect. The health implications extend beyond reproductive health. The risk of chronic conditions increases sharply. Before menopause, estrogen helps store fat in safer areas (hips/thighs). As estrogen levels decline, the body undergoes a metabolic shift, redirecting fat storage to the abdomen (visceral fat). This visceral fat triggers insulin resistance and metabolic dysfunction. Consequently, during the post-menopausal stage, women’s risk of getting a heart attack doubled. Rapid bone loss during the first 5 years of menopause reduces bone density, increasing the risk of fractures.
We should regard menopause as a new phase of life. Take this period as an opportunity to pivot our health strategies, tailoring them to a body that has shifted its focus from reproduction to longevity. Empower ourselves with knowledge to understand the ‘why’ behind our symptoms, to ask our doctors better questions. Changing our habits now ensures that the next several decades of our lives are defined by strength and vitality, rather than decline.
By Dr. Ledia Engkasan from Khasiat
Dr. Ledia Engkasan earned her medical degree from Universiti Malaya. Her diverse medical journey spans community health clinics, wellness centers, and specialized medical research. Dedicated to bridging the gap between clinical science and daily life, Ledia translates complex medical journals into actionable everyday wellness. Her work focuses on empowering women’s health, promoting healthy aging, and exploring the preventive benefits of regional nutrition. Believing that health begins at home, she is an avid home cook, runner, and calisthenics enthusiast.
