Vaginismus

What is Vaginismus?  

Something to do with the vagina?   

Yup! Vaginismus is when the muscles around the vaginal area tense up involuntarily whenever something tries to go in, be it a tampon, a penis, or even during a pelvic exam. Vaginismus tension can cause discomfort or pain, making penetration difficult or even impossible. It’s a condition that can affect intimacy and sometimes reduce sexual desire because let’s face it, pain and pleasure don’t exactly go hand-in-hand.  

  

Shhhh! Are You Too Shy to Talk About It?  

We get it—talking about vaginas isn’t everyone’s idea of light conversation over kopi. But here’s a surprising fact: vaginismus is one of the top sexual health concerns among Singaporean women.   

According to KK Women’s and Children’s Hospital (KKH), 9 out of 10 patients at their Sexual Health Clinic are diagnosed with vaginismus. That’s a lot! And it’s likely underreported because talking about sex-related issues can still feel paiseh in our culture.  

  

What Causes Vaginismus?  

There’s no single cause of vaginismus, but vaginismus often stems from a mix of emotional, psychological, or social factors such as:  

  • Trauma or Negative Experiences: Past sexual abuse or trauma can trigger an involuntary fear response.  

  • Psychological Factors: Anxiety about pain, whether from fears of tearing the hymen or worries about the penis being “too big”, can create a mental block that the body physically reacts to.  

  • Cultural and Social Influences: Growing up in environments where sex is considered taboo or shameful can lead to anxiety and aversion to intimacy.  

Other possible causes include prior injuries or medical conditions.  

  

Vaginismus and Your Mental Health  

Here’s where the mind-body connection comes into play. Anxiety is often at the root, creating a frustrating cycle: the fear of pain causes muscle tightening, which leads to pain, which then reinforces the fear and repeats the cycle.  

Over time, this can affect self-esteem, with thoughts like, “Am I abnormal?” or “Am I failing as a partner?” are all too common. Partners may also feel confused or frustrated, especially if they don’t understand what’s happening. Without support, this stress can lead to depression.  

  

Can I Ever Experience Comfortable Intercourse Again?  

Here’s the good news: vaginismus is treatable, and we don’t have to face it alone. Options like pelvic floor therapy, counselling, and gradual desensitisation can work wonders. A good first step is speaking with a gynaecologist or psychologist to uncover the underlying causes and find the best way forward.  

If anxiety is a key factor, here are some psychological strategies to try:  

Ψ Self-compassion
Remind yourself that painful or uncomfortable intercourse is not your fault. Vaginismus is a physical and emotional response, not a reflection of your feelings or capabilities.

Reframing your thoughts and tell yourself “It’s not that I don’t love my partner; it’s just that this feels painful right now.” Allow yourself to take some time and accept that you might be experiencing vaginismus and remember that treatments are available.

Ψ Relax your body

  1. Mindful breathing

  2. Progressive muscle relaxation

  3. Guided imaginary   

    • Sit or lie down in a quiet and cosy spot.  

    • Close your eyes and take deep breaths.  

    • Picture a serene place, like a quiet beach with the sound of waves. Imagine what you can see, hear, smell, touch and taste.  

    • Visualise your body relaxing, rooted to the ground (especially around the pelvic area – hips, back, abdomen), and with each exhale, feel the tension leaving your body.   

    • Hold onto this peaceful image, breathing slowly and deeply, for a few minutes. Let the calm wash over you.  

 And of course, communicate openly with your partner! Honestly share your feelings and struggles while explaining what you’re going through. Together, you can discuss ways to approach intimacy that feels safe and comfortable.  

  

How do I support my partner who has vaginismus?   

 Ψ “Take it slow.” 
Patience and understanding would be the greatest gift you can offer. Avoid forcing, blaming, or guilt-tripping your loved one when they are not ready for intimacy. A slow and steady pace is often what they need to feel safe, allow them to set the pace and respect it.  

Ψ “You are not alone, I can help.”
Learning more about vaginismus to understand what they are going through will help you approach the conversation with sensitivity and care. Show empathy by listening to their feelings and experiences by asking open-ended questions like, “How can I support you?” or “What would make this easier for you?”.   

You can also offer practical help, like accompanying them to medical or therapy appointments if they feel comfortable. Your presence can provide reassurance and show that they are not alone in this journey. 

Disordered Eating

Misconceptions of Disordered Eating
Credit: TEDx Talks

Wait! Disordered eating or eating disorder? Aren’t they the same?

Not exactly! While they share some similarities, they are different.

An “eating disorder” is a clinical diagnosis, with specific criteria for conditions like anorexia or bulimia.

On the other hand, “disordered eating” refers to unhealthy eating behaviours or patterns that don’t meet the full criteria for an eating disorder.

Someone with disordered eating may not have an eating disorder, but people with eating disorders often exhibit disordered eating behaviours. Disordered eating is quite common and can often go unnoticed, as it may show up in small actions you might do daily without realising.

How do I know if I have disordered eating and not an eating disorder?

While there is no single, perfect guideline on what constitutes “normal eating” as each of our bodies is different, healthy eating is about nourishing our body in a balanced and flexible way. Not overly restrictive, preoccupied, or obsessed (binging, excessive calorie counting).

The golden rule: eat when hungry and stop when satiated (not when you’re about to unbutton your pants).

Whether it’s 3 regular meals a day, or smaller portions but more frequently, our food intake should have all the necessary nutrients our body needs.

In contrast, disordered eating can fly under the radar because its signs are usually more subtle. In contrast, eating disorders are generally more severe and easier to spot. For more information, read more about eating disorders here.

But when it comes to disordered eating, here are a few behaviours to take note of:

Ψ     Eating when stressed or for comfort
Ψ     Eating when not hungry or not for nourishment
Ψ     Following restrictive diets
Ψ     Fasting for extended periods (more than 24 hours)
Ψ     Regularly skipping meals
Ψ     Episodes of binge eating
Ψ     Using diet pills to control weight
Ψ     Misusing diuretics, laxatives, or enemas
Ψ     Feeling guilty after eating or for eating certain foods

If any of these sound familiar, it may be time to reflect on our relationship with food.

Here’s a short summary of the differences between disordered eating and eating disorders:

Disordered Eating

Eating Disorders

Eating for emotional reasons

Frequently thinking about food

Eating to cope with distress

Extreme calorie concern

Rigid rituals or routines around food and exercise

Fixation on weight and body shape

Occasional calorie restriction or bingeing

Disruption in daily life

Selective eating

Significant weight changes

Disordered Eating and Mental Health: The Connection

While disordered eating might seem less severe than an eating disorder, it can still impact both physical and mental health over time.

Disordered eating often stems from emotional reasons, particularly to cope with distress. This distress may come from feeling heightened stress in our lives, or anxiety about our weight, health or appearance.

For example, finding ourselves rummaging through the office pantry right after lunch because we’re feeling stressed or skipping dinner because we’re already full from snacks, telling ourselves, "I need to lose weight.”

Soon after, feelings of regret and guilt may arise, whether from eating or restricting food. This can lead to anxiety, low self-esteem, or feeling unsatisfied, prompting behaviours like skipping meals or overeating. This cycle of stress, eating, guilt and restriction can create a pattern that’s hard to break.

If you notice the signs, it might be time to check in on your emotional needs.

Okay, I think... I might have it. So, what should I do now to stop it?

The key is to start from within. Addressing disordered eating isn't just about changing eating habits – it's also about understanding the emotional and mental factors that drive these behaviours. Here are some steps you can take:

Ψ    Gather knowledge and check in with yourself often

Start by learning the signs of disordered eating and eating disorders, just like you’re doing now! Recognising these patterns early can help you catch them before they become more ingrained.

Mindfulness plays a big role here. Stay grounded and present and be aware of your emotions and physical cues. Eat when you’re hungry and try to differentiate between physical hunger and emotional hunger.  

Ψ    Try alternative coping mechanisms

If you’re using food to deal with emotions like stress or sadness, or even binge eating when you’re feeling happy, try adopting healthier ways to manage your emotions and eating, such as:

  • Exercise: Physical activity can help relieve stress and improve mood.

  • Creative hobbies: Engage in activities like painting, writing, or crafting to channel your emotions in a productive way.

  • Heathy snacks: Opt for nutritious options like fruits.  

Ψ    Avoid fad diets

Fad diets often promise quick results but can harm your body and disrupt healthy eating habits.

Focused on balanced, long-term changes (choosing healthier options, or preparing your own meals) instead of drastic restrictions that can lead to disordered eating behaviours.

Ψ    Self-positive encouragement

Celebrate small victories! Even the tiniest steps toward healthier behaviours, deserve recognition. Use positive self-talk to motivate yourself. You could say things like:

  • “Good job to me! I didn’t overeat, even though I loved the food!”

  • “I made it! I didn’t skip any meals this week!”

Sometimes, enjoying a good meal can be a form of celebration – just remember to enjoy it in the right portion and be aware of when you feel satiated. 

Okay, but what is the right portion?
There’s a Chinese saying, “qi (7) fen bao, gang gang hao,” which means “eat until you’re 70% full.” This could be the balanced portion your body needs.

Ψ    Set realistic goals

Don’t expect to change everything overnight. Set achievable, small goals that focus on improving your relationship with food and your body. This could be as simple as:

  • Eating 3 regular meals per day

  • Reducing emotional eating from 5 times a week to 3 times

Lastly, if you’re struggling to manage disordered eating on your own, reaching out for professional support is a great next step. Therapists, dietitians, or counsellors specialised in eating behaviours can guide you toward healthier coping strategies and a balanced relationship with food.

Body Image & Self-Esteem

How do you view your body? What do you see when you look into the mirror? How do you feel?

Do you fear what others might be thinking about your body?


In these cases, our perception and feelings about our bodies are referred to as body image.

On the other hand, self-esteem is about our sense of self-worth and how we view ourselves as people.

Body Image and Self-Esteem

Similar in how both revolve around our feelings about ourselves, they can affect our behaviour and interactions with others.

Highly interconnected, body image issues can make us feel poorly about ourselves (low self-esteem), and low self-esteem can also lead to self-criticism, self-doubt and viewing our bodies more negatively (hyper-focusing on imperfections).

A negative body image may lead to hyper-fixation of food, appearances, or exercise. Paired with lower self-esteem, this may contribute to low self-confidence, social withdrawal or anxiety, difficulty expressing ourselves and needs, low moods and even people-pleasing for validation.

What are some signs of a negative body image?

Consider: Someone makes an offhand remark about your physical appearance. How do you feel about your own body after hearing the remark?

If you find yourself experiencing any of the below, you might have a negative body image:

Ψ Ruminating and nitpicking your body’s weight, shape, or appearance
Ψ Feeling ashamed, anxious, and self-conscious about your body
Ψ Frequently comparing your body with others’ and never feeling satisfied with your own body
Ψ Finding ways to change your body’s appearance, such as extreme dieting and fasting, vomiting, taking laxatives, cosmetic
procedures

Healthy Body Image

The ‘perfect’ body have always been defined by societal norms (like when voluptuous bodies were the ideal at some point in history). Even the people around us can sometimes affect the way we view our own bodies.

How then, do we inculcate a positive or healthy body image?

Changing our body image does not mean changing our bodies. What matters is changing how we think about our bodies. Healthy bodies come in all shapes and sizes – it’s rarely about the numbers. A healthy body is determined by how the body is functioning (think: immune system, illnesses, hormone levels, muscle-fat composition).

A positive body image means embracing all aspects of our bodies – warts and all. It means focusing and appreciating our body’s health and functionality.

Most importantly, it’s about feeling comfortable and proud about our bodies, regardless of body size and shape.

How do I improve the way I see my body?

Ψ Telling ourselves frequently:

o I have physical imperfections, and that’s okay
o   I am recognised and loved for who I am, not how I look
o   Physical health is not about shape or size

Ψ Being grateful, instead of judgmental, of our bodies

o Remind ourselves of the parts we like about our bodies – make a list!
o Giving yourself daily, verbal encouragements and reminders
o   Appreciating all that our bodies do:
§ Our limbs help us carry out daily activities
§ Our feet carry our weight as we move around
§ Our different systems work together to keep us functioning – digesting food, breathing, circulating blood and oxygen
§ Try a body scan to re-connect with the different parts of our bodies

Ψ Detoxing from or diversifying your social media

o Detoxing from social media for several weeks or months for a “reset” on how you define a healthy body
o Finding social media accounts that celebrate bodies of all kinds – be it in terms of shape, size and complexion

If it gets too hard trying to change how we think about our bodies, reach out to us.

Breast & Ovarian Cancer

(Source: World Health Organisation)

The Shock of a Breast or Ovarian Cancer Diagnosis: Understanding the Emotional Impact

The shock of receiving a diagnosis. The uncertainty of treatment, results or mortality. The feeling of everything being out of our control.

But first…

What is breast cancer? 

Breast cancer is a kind of cancer that begins as a growth of cells in the breast tissue.

Breast cancer in Singapore: Breast cancer is the most commonly occurring cancer among women in Singapore. It is estimated that 1 in 13 women in Singapore may develop breast cancer over her lifetime. Breast cancer usually occurs in older women above 50 but can also affect men and younger women.

What is ovarian cancer? 

Ovarian cancer is a kind of cancer that occurs when abnormal cells in ovaries or fallopian tubes grow and multiply out of control.

Ovarian cancer in Singapore: Ovarian cancer is the 5th (and rising) most common cancer amongst Singaporean women. It can be fatal when it is detected in the advanced stages of development and spread. 

The Cancer Journey

Here are the moments that women may struggle the most in the cancer journey:

  • 1 - Before Diagnosis

    • Noticing a concerning symptom

    • Anxiously waiting for test results

    2 - Initial Diagnosis

    • Receiving the news of the diagnosis for the first time

    3 - Anticipating treatment

    • Waiting to learn about the recommended treatment plan

    4 - Leaving the hospital

    5 - Completion or adjustment of treatment

    • Fear of finishing a treatment course or

    • Adapting to a change in the plan

    6 - Awaiting follow-up results

    • Waiting for the outcomes of follow-up tests

    • Persistent guilt (about family, children, responsibilities)

    • Fear of recurrence

    • Diminished self-esteem

    • Problems with social acceptance and body image

    • Difficulty in re-entry into previous life

    • Perceived and actual loss of employment and insurance discrimination

    • Concerns about infertility

    • Increased hopelessness or loss of faith in recovery, treatment

As treatment goes on, distress heightens and prolongs with all the physical and social difficulties, and little relief. It is then no surprise that these can culminate into mental health conditions like anxiety, depression and PTSD.

Coping with Breast or Ovarian Cancer: Navigating the Emotional Challenges

Receiving a cancer diagnosis is never easy. The shock and distress can be overwhelming, and we might not know how to cope with the impact of such complicated emotions and thoughts.

Yet, how we feel, think and cope with the diagnosis and treatment can greatly affect our physical health, treatment progress, adherence and recovery.

So let’s take time to prioritise ourselves – physically and mentally. Here are ways to cope with breast or ovarian cancer:

Ψ Building a Support System

Find your support pillars. Lean on trusted friends and family, they tend to be the reasons we keep going even in tough times.

Many have also gone through the same journey, and we do not need to fight cancer alone. Consider the links below to find communities of like-minded individuals who may share the same struggles as you:

  1. Singapore Cancer Society

  2. Totally Empowered, Actively Living (TEAL)

  3. Women’s Emotional Health Service (WEHS)

  4. Breast support group (for breast cancer)

  5. Cancer online resource library

 Ψ Look back within

How are you feeling? What emotions can you pinpoint exists? Was it fear, anxiety, shock, anger, regret, or hopelessness? What about your thoughts about this journey – from diagnosis to treatment?

What do your thoughts tell you about…

  • Cherished things and people

  • Personal hopes and dreams

Ψ Mindfulness and Cancer

We know we bring up mindfulness often, but bear with us. When time seems limited and more precious than ever, we often want to capture and “stay” in the moments we cherish the most.

This speaks to a part of us that wants more presence, and connection to what is going on around us. To do so, we need to pause, observe and engage.

Here’s our guide to being more mindful (general tips are at the bottom of the article). Stay present and connected in your journey.

Ψ Self-Compassion in Cancer Care

Your pain and suffering is valid. Your feelings are valid. The journey is not easy, and there is little that we can do to fight the facts of our reality.

Yet, how do we respond to our pain and emotions? What helps? Rather than wanting to lash out at the world?

 
 

Soothing. Like a mother soothing a child in pain, aim to soothe the pain and emotions within you. Always remember to show kindness to yourself in the face of adversities.

 

    • Cry it out

    • Calming music or smells

    • Visualise a place that is calming to you

      • Sunsets, starry night sky, pet café, comforts of a bed or bath

      • Focus on 5 senses

    • Repeat personal mantras

      • I can do this, I got this, this is hard, but this will pass

 

People differ in how they cope with difficult emotions and painful situations. There is no “best” method here, so find ways that you are comfortable with and personalise your recovery journey in your own way.

“It is during our darkest moments that we must focus to see the light.” – Aristotle

Perinatal Obsessive-Compulsive Disorder (OCD)

What if I harm my baby?

 

What is Perinatal Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by obsessive thoughts, and behavioural compulsions.

Ψ Obsessions are intrusive, unwanted and persistent thoughts and mental images.

Ψ Compulsions are repetitive acts, including avoidant behaviours, that aim to reduce the distress associated with the obsessive thoughts. They could look like cleaning rituals, repeated checks, counting, saying a particular word or phrase, or avoiding certain places or activities.

Perinatal OCD occurs during pregnancy or a year after childbirth. It could be another manifestation of existing OCD or a sudden onset of a new condition.

Find out more about Obsessive-compulsive disorder

Symptoms of the condition often centre around the baby. They are associated with fears that the baby would be harmed, such as through contamination, inappropriate handling, etc. While individuals with perinatal OCD probably recognise that their obsessive thoughts and compulsive behaviours are irrational, they feel consumed by those thoughts and unable to break free from the rituals.

Often Undetected and Unspoken

Having a baby is stressful and overwhelming. As parents, it’s normal to feel anxious about caring for a young child, and worried that they will harm the child. This anxiety, at manageable level, could actually be helpful in ensuring that you avoid potential risks to your pregnancy and child. 

While many parents have that fear, people who suffer from perinatal OCD give undue importance to those thoughts, and believe that they are capable of causing harm.

These parents may be reluctant to disclose their anxious thoughts for fear that they may be regarded as the potentially dangerous and harmful parent.

Parents may also not be aware of the condition or recognise it as an illness. They may see themselves as an unreliable and unfit parent, or attribute their fears as “going crazy”. 

Failure to detect and address perinatal OCD can result in persistence of the distressing thoughts, and affect the relationship the parent has with the child and their family members. New fathers and mothers (or even those without children) with perinatal OCD may struggle to enjoy moments and bond with the child.

Depending on the severity of your condition, it can also impact your confidence in caregiving and overall quality of life as you spend the day worrying about your child being harmed.


How can I Cope with Perinatal OCD?

Ψ Learn more about OCD

Find out more about the condition. Understand that it is not your fault, and that you are not going mad.

It is often comforting to find an explanation for what you are going through. With better understanding of the condition, you could also make sense of the consuming thoughts and compulsions that you have.

Ψ Learn about your symptoms

Everyone’s triggers and symptoms would look different. It is always a good idea to note how your symptoms present and when they present. This give yourself and ideally your therapist a clearer idea of your presenting difficulties and how to manage them.

Ψ Talk to someone

Reach out to a loved one and share with them what you are going through. It can be relieving just to tell someone your feelings. It could be helpful to first write down your thoughts and feelings before you bring this up with someone.

It can be also reassuring to hear that similar anxious and distressing thoughts are experienced by other people too. Connect with support groups online or in your local community (e.g, OCDNetwork) to receive the emotional support much required in this journey.

Ψ Get practical support

Your anxiety may make you unavailable to care for your child for the time being. Reach out to your family and friends to help with the caregiving tasks.

Let them know how they can help (e.g., could you help to change the baby’s nappy)

Ψ Seek professional help

OCD can be managed with psychological therapy, and sometimes with the additional help of medication. Typically, Exposure and Response Prevention Therapy (ERP) and Acceptance and Commitment Therapy (ACT) are used to help individuals with OCD. They involve exposure to anxiety-provoking situations and accepting the intrusive thoughts while engaging in value-aligned behaviours respectively.

Your therapist will work with you to develop a management plan that best supports you. Things would get better, however overwhelming they seem now.

 

Supporting a Loved One Who is Struggling with Perinatal OCD

Many individuals who experience perinatal OCD worry that they get ostracized when others find out. Do not criticise their compulsions. Assure them that you are there to support them if they ever need it. 

Learn about the condition. With greater understanding of the condition, it may be easier for you to see why your loved one is acting the way they do. You would also realise that providing assurance (e.g., “I’ve sterilized the milk bottle”, “the baby is still breathing”) might not be the best form of support for them – counterintuitively it may sound. Instead consider staying by their side as they experience the discomfort rather than reinforce their rituals.

If you are concerned that you or someone you know is struggling with perinatal OCD, seek professional help. Feel free to reach out to us for support with coping with OCD.

Menopause: More Than Just Hot Flashes and the End of Periods – How You Can Cope

What is Menopause?

“It only happens to OLD women.” 
“It only lasts a few weeks, and then it’s over.” 

Oh no, no, no! These are just some of the many myths about menopause!  

Menopause refers to the end of the menstrual cycle, which is formally 12 months after a woman’s last menstrual period.   

Leading up to this point is a transitional phase called perimenopause, during which women may experience changes in their menstruation – irregular periods, heavier or lighter flow, shorter or longer periods, and symptoms that resemble menopause. During this time, the body reduces production of the hormones estrogen and progesterone.

It’s a natural part of ageing, though not always an easy one. And menopause isn’t just triggered by age. It can also occur due to the surgical removal of the womb or ovaries. 

 

Frustration with Menopause: The Symptoms

An inevitable transition with legitimate frustration. 

Menopause is a complex journey and affects each woman uniquely and in many ways.     

The body undergoes a big change, possibly experienced as weight gain, weaker bones, body aches, weaker bladder and reduced sex drive.   

Life on a day-to-day basis may involve hot flushes which can be intense enough to cause fatigue and disrupt sleep, and it can last for years after menopause! Sexual intercourse may also become painful or uncomfortable.   

Some women may experience irritability, moodiness or even depression. It might also be frustrating when they struggle with concentration and memory. Major bodily changes also affect their confidence and self-esteem.   

 Here’s the thing: every woman’s experience is unique. So, while one person might breeze through it, another may face significant challenges. 

The Menopause Journey

Menopause and Mental Health 

It’s not just the body that feels the shift, the mind can be deeply affected too. 


While external factors like ageing, stressful life events, or limited social support can contribute to mental health struggles, fluctuating hormones are a major player. 

Estrogen, in particular, has profound effects on mental functioning. It influences emotions, memory, cognition, and is a mood-regulating neurotransmitter. The result of reduced estrogen? An increased risk of depression and anxiety during this time. 

Depression
Mood swings are common during menopause, but when a low mood persists for over two weeks, it may indicate depression. Unlike typical emotional dips, depression is more intense and long-lasting. If you’re wondering whether it’s depression, it’s worth exploring the signs further (check here for more information). 

Anxiety
While depression takes the spotlight, anxiety also makes its cameo during menopause. Anxiety attacks can feel a lot like hot flashes. Both can cause racing heart, sweating, and a sense of heat. But here’s the key difference: anxiety can cause shortness of breath, while hot flashes don’t. You may check other symptoms here.

Tips to Manage Menopause


Navigating menopause can feel overwhelming, but there are ways to cope: 

Ψ Mindfulness 

Mindfulness is simply awareness. Pay attention to the difficult emotions and physical symptoms arising from menopause – the resentment, low mood, hot flushes and body pains. Notice your thoughts – are they kind or critical? Allow yourself to feel them all. Take a back seat and just observe them as they are, without judgement.   

It may also be helpful to take note of the things that trigger your hot flushes or mood swings so that you can avoid them or take steps to mitigate the effects.  

You may refer to our Guided Therapies for some mindfulness practices to increase your awareness to the present with your thoughts, feelings and bodily sensations. 

Ψ Radical acceptance 

Radical acceptance is about accepting life as it is instead of fighting reality or getting stuck in negative thoughts like “I hate being a woman”, “why do women have to go through this”, “this is so unfair”. It does not mean begrudgingly resigning yourself to fate or seeing yourself as helpless. It is the complete acceptance that the situation is beyond your control, even if it is not how you want them to be.

Accepting the reality will not remove your pain. Your hot flushes and body aches are still going to bother you. But when you choose to radically accept things that are not within your control, you avoid getting stuck in bitterness and despair. This frees up your energy to make changes in aspects of life that you can control, like finding ways to make life more comfortable or exciting for yourself and pursuing what truly matters to you in life.  

Ψ Relaxation 

Pursue your interests and hobbies, basically any activity that brings you joy. Given that menopause is a very personal experience, you would need to try out various options to see what works for you. Maybe it’s a walk in the neighbourhood, baking, or spending time with your friends and family.  

Getting adequate sleep can be a challenge for women going through menopause. This sets them up for frustration and stress. Some simple sleep hygiene tips include keeping our sleep environment cool and dark, and avoiding caffeine, nicotine and alcohol from late afternoon onwards. 

Ψ Professional support 

General practitioners (GPs) or OBGYNs are excellent first stops for tackling physical symptoms. They can provide guidance on treatments like Hormone Replacement Therapy (HRT), which may ease issues tied to declining estrogen levels, including mood changes and depressive symptoms. 

When hot flashes aren’t the only thing keeping you up at night—think constant worry, low mood, or feeling like you’re losing control, it might be the time to consider a psychologist especially if these challenges start affecting your relationships, work or overall quality of life. Psychologists aren’t just for “serious cases”; they offer invaluable support to women navigating the emotional, mental, and relational hurdles that menopause can bring. Whether it’s managing mood swings, addressing depression and anxiety, or navigating changes in relationships, psychologists provide a safe space to unpack what’s going on and strategies to move forward. 

Therapeutic approaches psychologists may use include: 
Ψ Cognitive Behavioural Therapy (CBT) 
Ψ Acceptance and Commitment Therapy (ACT) 
Ψ Mindfulness-Based Interventions 

  How to Support a Loved One Going Through Menopause? 

Ψ Be an active listener 

“How do you feel?” as simple as this question may sound, it provides them an opportunity to talk about their feelings. Be sure to express compassion and empathy. They are grappling with this major life transition that is foreign and overwhelming to them. Do not dismiss, criticise or guilt-trip them when they share about their discomfort or ask for help.  

As much as you want them to feel better, do not rush to offer advice or problem-solve. We most probably cannot imagine their pain and discomfort so let’s not try to be an expert in their condition. Instead, take a curious and empathetic stance, ask them about how they feel and acknowledge that it is as bad as it feels to them. Be with them in the pain rather than trying to pull them of the pain. 

Ψ Provide practical support  

Learn more about menopause to understand what they are going through. Let them know that you are keen to help and ask how you could be of help. For instance, you could offer to run errands for them or help out with chores or simply being available. 

Ψ Reassure and uplift

Menopause can make women feel stuck in a box of frustration and loss – loss of attractiveness, health, or roles within work and family. Reassure them that their identity isn’t solely defined by these challenges. Highlight their strengths and achievements and remind them of the areas in life where they excel or have control. 

Losing a Baby to Miscarriage or Stillbirth

Both miscarriage and stillbirth refer to the loss of a baby during pregnancy. Whereas miscarriage occurs before 20-24 weeks of gestation, stillbirth is when a baby is born dead after 20-24 weeks of pregnancy.  

Statistics in Singapore

In Singapore, about 20% of pregnancies end up in a miscarriage while stillbirth happens in 0.5%-1% of pregnancies. In most cases, the cause cannot be established. Some known causes include infection, umbilical cord accidents, and placental complications.

A word from our clinical psychologist:

Perinatal loss is a term broadly used to describe losses before, during and after pregnancy. There are different types of losses during pregnancy, including miscarriage, stillbirth, ectopic pregnancies and medical termination for various reasons. No matter when or how the pregnancy loss happened, losing a baby has been described by some of the clients I have worked with, to be the worst kind of pain. Their loss experience defied their assumptions and expectations of a "normal" course of pregnancy through the trimesters until the smooth delivery of their healthy baby, just like everyone else! A "typical" path towards parenthood, towards forming a family (with children) is all that they had hoped for. Given this, a range of emotions - anger, sadness, grief, shock, guilt amongst others may result, as a part of the grieving parents' mourning process. 

For there is so much to mourn - the loss of their "healthy" baby, the loss of sense of "normalcy" in their lives, the loss of that anticipated future with baby as a part of the new family, and the loss of the new identity, hopes, dreams as soon-to-be parents. Instead of celebration of their baby's arrival, some grieving parents may find themselves confronted with the starkest reminder of their loss, in the form of a symbolic farewell ritual, or funeral ceremony and burial event for their baby. For some families who choose these practices, they shared that it can be very helpful for their grieving process and closure. But, there is no one way to grieve, so honour your own needs, beliefs, emotional and physical capacity to decide what is best for your unique situation. 

What can complicate perinatal grief is also in part due to the "invisible" nature of pregnancy loss, especially in the early stages. This can make it very hard to talk about it with others and for loved ones to fully acknowledge the deep, emotional and psychological impact of such losses. Hence, it is necessary to remind all that perinatal losses are as worthy of care and compassion as other types of relationship losses. This is because attachment relationship bonds has already formed between conceiving parents and baby, as soon as they learn about being pregnant. 

Given the tough, unbearable pain of perinatal losses, much compassion is needed all around. Grieving mothers/fathers need to learn to be more self-compassionate and manage their own harsh self-talk, especially those about failure and being unworthy as parents. Given that the nature of perinatal losses are often unexpected, resulting in a big sense of loss of control, it can be beneficial to find little ways of taking charge, for instance, of daily routines, or setting of boundaries about what you are comfortable discussing. This can assist with restoring some sense of normalcy and control as you navigate grief. 


A journey shrouded by shame and silence

Given that pregnancy losses are common, some women may feel that they do not deserve to grieve. On the other hand, despite the substantial occurrence rate, resources to support these women are scarce.

There has also been stigma and blame attached to pregnancy loss, where mothers are implied to have failed to take good care of their babies. Even well-intentioned advice could come across as insensitive and dismissive. This unspoken roller-coaster journey can feel unforeseeably lonely and difficult. 

 

An unimaginable pain

The loss of a child, no matter how brief they have been in your life, is profound. It goes against the natural order of life and no parent can ever be prepared for it. The loss of a child is also the loss of an imagined future with them – the hopes and dreams that cannot be fulfilled.

With the devastation, there may also be guilt that you could have been more attentive to your diet and body, and anger that it had to happen to you. Mothers may also feel alone thinking that their partner does not understand their pain since their partners are not the one who carried the child.

 

How can I cope with a miscarriage or stillbirth?

Everyone grieves differently – in different ways and on different timelines.

Here are some ways we hope can help with your grief.

Ψ Make room for your feelings

Allow yourself to feel all that you feel – guilt, anger, confusion, panic. Observe where you are feeling these emotions in your body – aches in the stomach, tightness in chest? Let yourself be where you are at the moment. There is no prescribed timeline which states the stage of grief you should be at at any point of time.

Ψ Be compassionate to yourself

Understand that it is not your fault nor a personal failure.

As mentioned earlier, there is no timeline for grief; you will move along with your grief rather than moving on from it. Do not expect yourself to forget. Instead, expect yourself to feel triggered on the anniversaries or when you see other families with children. When that happens, allow yourself to take short breaks to grieve – it can be in a toilet cubicle or in a corner of a park. This place should be somewhere you feel safe and comfortable to express your emotions. 

Ψ Pay attention to unhelpful thoughts

Certain narratives may start playing in your head: “My life is worth nothing if I do not have children”, “I am not complete without children”, “It is all my fault”, “I’m a useless mother”. When played enough times in your mind, these thoughts may seem convincing. But they are not true.  

You could challenge these thoughts by asking these questions.

  • What's the evidence for and against these thoughts?

  • What would I tell a loved one who is going through the same situation? 

Ψ Grieve with your partner

An event like the loss of a child could bring a couple closer to each other or lead them to drift apart.

You and your partner may respond to the death of the baby differently – one may turn to crying, one may turn to work to avoid thinking about the pain. Some couples may not want to burden their partner with their anguish so they choose to keep their feelings to themselves. When you are unsure of how your partner feels about the loss, there is a chance that you feel that they are less affected by the loss. And this, will lead to emotional distance and tension in the relationship. 

Recognise that this is uncharted territory for both of you. Seek your partner to grieve as a team. Communicate with each other your sorrow, and try to understand how both of you will grieve in different ways, but together. 

Ψ Consider a grief ritual

For some, a grief ritual gives some form of closure to the episode. The symbolic ritual could be in the form of a scrapbook, memory box, journal entry or even a remembrance trip. 

Ψ Look after yourself

The miscarriage or stillbirth takes a toll on your physical body. The grief and emotional pain may take hold of your life, leaving you with no mental capacity to plan for your day. A routine may be helpful to ensure that your physical well-being is taken care of. You need your sleep, food and physical activity.

Ψ Seek support

Reach out to your family and friends. Be with your loved ones even if you do not feel like talking about the loss; their company in itself may be comforting.

To ease your return to work, we encourage you to speak with your bosses to let them know how you want your return to be managed (e.g., shorter hours, work-from-home arrangement, inform your colleagues to not broach the topic).

The pain of grief could be overwhelming. But you are never alone. Consider seeking professional psychological help in the forms of support group and therapy. Some support groups include:

  • Child Bereavement Support (Singapore)

  • Angel Hearts

  • Miscarriage, Stillbirth, & Child Loss Support Group

  • Pregnancy and Infant Loss Support Group Singapore

  • Pregnancy After Loss Support (PALS)

 

How family members can support their loved ones

This key idea should underlie all of your efforts to support them: Acknowledge and validate their pain.

Understand that the loss hurts them deeply, and it will take time for the pain to feel more bearable. Some may feel comforted by phrases like “I’m so sorry it happened”, “I cannot imagine your pain but I’m here for you”.

The aim is never to cheer them up – you would be disappointed if you want to do that because you cannot take their pain away; rather, it is to join them in their pain as they struggle with their intense and painful emotions.

On anniversaries or in situations where the parents may be reminded of their loss, you could check in on them gently by asking how they are feeling or if they want to spend time together.

If you notice that their grief has affecting their daily life for a concerning amount of time, let them know why you are concerned (i.e. what did you notice and explain why it is concerning), and encourage them to ask for professional help. You could also go the extra mile and accompany them to visit a psychologist.