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The signs and symptoms of menopause can be challenging to treat. Many men, including myself, often don’t truly appreciate how menopause can negatively affect a woman’s quality of life.

For example, almost one out of five women will experience heavy menstrual bleeding as they approach menopause. To manage this heavy bleeding, there are several non-surgical treatments that can be first tried to avoid or delay a hysterectomy. Although many women begin menopause in their 40’s, some will experience menopause earlier because of surgical removal of the ovaries or other medical conditions.

Women’s health issues may be overlooked in Hong Kong. What follows is a story of a long-time Hong Kong resident and her challenges receiving appropriate care as she started menopause, and faced greater restrictions on physician choice with changes in her employer’s insurance policy. Here is Michelle’s* story in her own words.

Health Care in Hong Kong

Whether I was in need to major surgery for a recurrent cholesteatoma in my ear or the simple treatment at the start of menopause, I required medical and surgical assistance over a 20 year period in Hong Kong.

Twenty years ago my choice of surgeons was fabulous. Clearly the prominent airline staff medical provider has changed its goal posts significantly since then.

I’m lucky to have had the same fabulous surgeon who knows my case and deals with my complications as they arise. Today this doesn’t come without a fight.

Every six months, I am required to obtain a referral from a general practitioner (GP) before I make the appointment to see my surgeon (normal protocol). Nowadays, I am required to see the new panel appointed ear, nose, and throat doctor (ENT) who confesses right away “your case is too complicated for me, you must go back to see your original guy, I will write a letter of referral”. So now me and my insurance company have put more money into another GP referral and another ENT’s pocket to obtain the same result. Waste of time, money and resources.

My ENT also voiced their concerns as they have tried many times to reason with the health fund providers and employment institutions giving their patients the best options/solutions for care. Access to treatment appears to be political, and sadly not in the best interest of the patient.

Now to my perimenopause saga.

By the age of 38, I had 4 young children, and my breeding days were essentially over. Come period time, I started to bleed out. This went on for 3 years. I had many doctor consults, essentially monthly.

My ferritin levels got down to as low as 4, I was continually prescribed Ferrum Hausmann® (chewable iron tablets). I had a Mirena® intrauterine device put in one time under general anaesthetic by a well known lady doctor who had a practice in Central, Hong Kong. After it was inserted, I continually bled out for 6 months. The intrauterine device was eventually removed as it was ineffective. My iron levels essentially remained unmanaged during this time, only ever took the chewable iron tablets.

The gynaecologist I saw recommended a full hysterectomy at this stage, she wanted to book me into the Matilda Hospital and do it ASAP. No options were provided to manage my iron levels.  I couldn’t quite come to grips with ripping my insides out at the age of 40, and not given any other option, I declined the hysterectomy.

Three years later at the age of 41, we moved our children to Australia to school them. I am a private pilot, and had completed my pilot medical exam in Australia.

The aviation medicine doctor asked how I was, so I told her of my ordeal in Hong Kong. Her eyes shot wide open. I told the doctor how I had no energy, and gave her a copy of my recent blood results. We then discussed the options for fixing the heavy and persistent menstrual bleeding.

I explained that I was offered a hysterectomy and that I declined. She suggested that I do a 90 second procedure called ablation, explaining that I couldn’t have children after the procedure, but my insides remain intact. A full set of blood tests were also ordered, and I was sent home with a prescription for an intravenous iron infusion.Within 20 minutes I was sorted and I had an appropriate treatment and follow-up plan.

Two days later the phone rangit was the doctor with the lab results. My iron levels were still 4 (extremely low), after all these years of chewable iron tablets! My teeth are now a shade of yellow as a result of continuously munching on iron tablets for years.

I had a double iron infusion, and the 90 second endometrial ablation procedure. I haven’t had a period since, and my ferritin is at 130 (normal). I can now donate blood regularly and I have never felt better.

All after a basic pilot medical with a bulk billing doctor in Australia (I had to obviously pay for the aviation medical exam). I was gobsmacked at the chalk and cheese service compared to HK.

Moving forward with the menopause, I am now monitored constantly, using both blood and saliva for checking my hormonal levels and blood counts. Post 45 years of age, I now take 100 mg bioidentical progesterone, plus a transdermal patch 25 mcg/day of oestrogen. Unfortunately the oestrogen transdermal patches (Estradot®) are not available in HK. They really need to update their drug rules and laws.

If menopause was a major, common men’s health issue that affected 50% of the population, you can guarantee there would be legislative action in favour of moving with the times to assist 50% of the population with the latest and greatest options. How many women are in LegCo (Legislative Council)? Just saying. Women have a right to life changing simple medicine.


There appeared to be a lack of experience managing iron deficiency anemia because of the heavy bleeding in perimenopause. In my experience, most adults would be treated with solid (non-chewable) oral iron product. Liquid or chewable iron would only be considered in adults who have difficulty swallowing a tablet or capsule. It seems strange that an adult with no swallowing problems would be prescribed a chewable iron product, especially since a common side effect of liquid/chewable iron is tooth staining.

Indeed, transdermal estrogen patches are not registered in Hong Kong. This type of estrogen may have a lower risk of causing a blood clot, and may be preferred by some women. Not being a registered drug limits access for women who could benefit from this important first-line treatment.

Finally, there is a lack of women legislators in Hong Kong. Only 14% (10/70) of LegCo members are women, which may contribute to the lack of emphasis on women’s health issues.

I am happy that Michelle finally received the appropriate care she, and all women deserve. She has graciously shared her story to help raise awareness of the barriers to timely and appropriate treatment, that women can encounter in the Hong Kong health system. I hope her story encourages others to request safer and higher quality care from the government, insurers, and individual health care professionals.

*The patient’s name has been changed to protect her privacy.