Why We Need To Know More About Menopause

Menopause still remains a subject of silence in India. Here’s why we need to understand menopause and talk about it.

“I wanted to be alone, away from everyone,” says Beena Bhuvandas, 69, from Mangalore. She knew her menstrual days were nearing their end and struggled to identify the emotional and physical changes that were happening to her. She found herself easily irritated and experiencing heavy bleeding. Happiest being alone, Bhuvandas isolated herself without any outside distractions such as television or newspapers. Fortunately, her older sister offered her the emotional support she needed during this time. However, when her husband retired and was home more often, Bhuvandas recalls feeling annoyed with communicating with him, which she believes was a result of her emotional temperament during the perimenopausal years.

"I cry at the drop of a hat these days," says Sayantani (name changed on request), 49, a media researcher from Mumbai. She has also been experiencing insomnia, severe gut issues and bloating problems, which her doctor has attributed to the bodily changes she is undergoing during perimenopause. "Exercising and meditation have helped bring in some equanimity but even with that I'm floundering," she says.

“Little things made me very anxious during perimenopause. My periods were okay but my emotional temperament was fidgety,” says Nisha Dennis, 50, from Kozhikode, Kerala. She had difficulty sleeping and would quickly wake up at the slightest sound. Confused about what exactly she was going through, Nisha's daughter, a medical student, gave her an understanding of the symptoms of menopause. A subsequent doctor’s visit provided much-needed relief and understanding.

What Is Menopause? What Are Its Symptoms?

The menopause years are far from a breeze for most women. Menopause naturally occurs in the Indian female population from 45-50 years onwards. As women age, the number of mature eggs in their ovaries decreases and ovulation becomes less consistent. While no more monthly periods after menopause may seem appealing, it brings enough challenges. Menopause causes changes in the levels of estrogen and progesterone hormones in the body, leading to symptoms such as heavy or irregular bleeding, insomnia, hot flashes, night sweats, urinary urgency, vaginal dryness, irritability, and mood swings, among others.

Perimenopause or premenopause is the early period when the body starts transitioning into menopause. This phase can last from 12 months to a few years. Due to ovarian diseases like ovarian cancer or endometriosis, some women may even undergo a hysterectomy during this time, inducing an early onset of menopause. In such cases, gynaecologists administer hormone therapy to help relieve symptoms.

Vaginal dryness during menopause may contribute to fallouts like sexual dysfunction. “Oestrogen reduction combined with low calcium and Vitamin D may lead to osteoporosis or the weakening of bones. All women should take calcium and Vitamin D supplements at least a few months a year unless other medical concerns exist,” says Dr Aditya Raj MBBS, MS Obstetrics and Gynaecology (OBGYN), All India Institute of Medical Sciences; (AIIMS) Raipur, Chhattisgarh, advising further.

Post Menopause Care

There are many physical changes that a woman goes through after menopause. “These can start from the external appearance such as weight problems, skin changes and key health issues like cardiac health, bone health and brain health," says Dr Anbu Subbian, Gynecologic Oncologist and Robotic Surgeon, Kovai Medical Center and Hospital, Coimbatore. "Gynaecologic issues may include bleeding after menopause which could be a potential symptom of cancer and would need urgent medical attention.”  

Dr Subbian, a strong advocate of strength training and exercise for women suggests that many health check-ups can be done to ensure better health. These would include Diabetes and Hypertension screening and health check-ups that would identify vitamin and mineral deficiencies along with bone strength. Decreased Oestrogen at post-menopause makes women susceptible to heart diseases. "Early detection of chronic health diseases and cancer should be done through annual visits to the doctor." 

It's important to remember that each woman goes through different symptoms, hence there is no homogenous experience of menopause.

Impact Beyond The Body

70 per cent of Indian women were not familiar with the symptoms of menopause and 62 per cent of women respondents did not want to bother their families about their health concerns, according to a survey done in September 2022.  

It is only recently that there has been much talk online, in the media and on social media on menopause and its impact on women and the silence around it. The verdict is unanimous: Women often downplay their pain and physical ailments and when they do talk about their pain, such as the negative impacts of menopause, they’re not taken seriously enough due to the ignorance of others. 

The impact of menopause on women in the workplace is substantial, as revealed in a new report published in Time Magazine, in April 2023. It notes that the U.S. economy is suffering an annual loss of $26.6 billion due to reduced productivity and increased healthcare expenses associated with managing menopause symptoms. Conducted by Mayo Clinic, the study analyzed data from more than 4,400 women aged between 45 and 60. About 11 per cent of the women stated that they had missed work in the past year due to menopause symptoms like hot flashes and difficulty sleeping.

While there is no Indian study yet on it, Dr Subbian admits that menopause has an impact on women's careers in mid-life and may affect work performance.

“It certainly has an impact with insomnia being one reason. Poor focus, fatigue, and brain fog can add up to the mental strain apart from the physical stress that menopause can add,” she says. Dr Subbian also feels raising awareness is key since many men and families still ignore the topic as 'women's issues'. 

”Having that conversation with family and having them on the same page is vital. Families can and must provide the much-needed support and understanding during this phase,” she asserts.

Being Aware

Educating patients about menopause is crucial because it's a natural process, not a disease. Stigma and discrimination around women's health can hinder progress in many ways and thus we should have healthy discussions to raise awareness about menopause.

Dennis received support from her daughter and husband when going through menopause, helping her feel sorted and calmer.

It's time to speak openly about menopause, not just in India but globally. If dealt with the right way through healthy habits, a good diet and exercise, this big physical change could manifest into a new you too. 

“So many women I’ve talked to see menopause as an ending," TV host, author, and actor Oprah Winfrey was once quoted saying. "But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It's your opportunity to get clear about what matters to you and then pursue that with all of your energy, time and talent”.

-- With inputs from Reshmi Chakraborty

How have you/how did you deal with your menopause years? Do you think we need to speak about this important transition in a woman's life more? Share your comments with us below or mail us on editor@silvertalkies.com