We have pain on a cycle for years and years and years, and then just when you feel you are making peace with it all, what happens? The menopause comes. The f****** menopause comes and it is the most … wonderful f****** thing in the world. Yes, your entire pelvic floor crumbles and you get f****** hot and no one cares, but then you are free. No longer a slave, no longer a machine with parts. You are just a person. In business.”
This raw, wry monologue from the popular series ‘Fleabag’ captures the complex mix of suffering and liberation that many women relate to when speaking of menopause. This October, as the world marks Menopause Awareness Month (leading up to World Menopause Day on October 18), the sentiment gains much significance.
After all, menopause continues to be whispered about, misunderstood, or reduced to jibes about hot flashes.
In the West, studies and discussions on the subject have gained considerable prominence over the past decade. In the US, the state of Rhode Island recently passed a law that mandates employers to ensure “reasonable workplace accommodations” for employees experiencing menopause and related medical conditions.
In the UK, the government maintains that the Equality Act provides “protection against unfair treatment of employees going through the menopause”.
Two years ago, it also launched a national Menopause Taskforce to “tackle issues surrounding the menopause including increasing access to treatment, and ending the taboos and stigmas that still surround conversations about the menopause, including in the workplace”.
India, too, has finally begun to acknowledge the subject, with the National Women’s Commission recently initiating a programme called ‘MENO-MIND’ to raise awareness about the mental and physical problems faced by women going through menopause.
Experts call for more such initiatives are needed, noting that only a very small percentage of women seek medical help to tackle menopause woes. Many are still unaware of the physiological and psychological changes it brings about.
To put it simply, menopause is a natural decline in reproductive hormones in women, typically between 45 and 55 years of age. It marks the stage when menstrual periods stop permanently, and natural pregnancy is no longer possible.
It’s important to note that menopause is not a disorder or disability, but a normal part of ageing. But it does come with a set of challenges.
“Hot flashes, night sweats, sleep problems including insomnia, mood changes, brain fog where one starts having trouble remembering… There are many symptoms that accompany menopause,” says Dr Lekha K L, a senior consultant gynaecologist and laparoscopic surgeon. “The symptoms begin a few years before menopause and may continue for a while.”
Oestrogen helps women in many ways — it prevents bone loss, supports cardiovascular health, and aids brain function. It also affects pelvic muscles, skin, hair, and metabolism. A dip in oestrogen levels can lead to several complications.
“For instance, during pregnancy and lactation, women lose a certain amount of calcium. When oestrogen levels decrease during menopause, bone density reduces again,” Dr Lekha explains.
The intensity of symptoms varies according to the individual and underlying conditions, says obstetrician-gynaecologist Dr Praveen Gopinath. “Not every woman’s daily life will be severely impacted by menopause. For many, it’s manageable,” he says.
“However, for some, it comes with insomnia, cognitive difficulties, and severe hot flashes — even inside AC rooms. Their daily routine gets severely affected. In India, not many seek help for menopausal symptoms.”
Treatment usually is simple, says Dr Lekha. “And if one starts treatment, within a month, the symptoms begin to alleviate,” she adds.
“Some just need reassurance that what they are experiencing is a natural process. For others, extended counselling may be required, and not always medicinal. Only when symptoms are severe do we begin medication.”
Treatment options
Hormone Replacement Therapy (HRT) is what most people hear about when it comes to menopause treatment.
“Over a decade ago, an unscientific study claimed HRT increased the risk of cancer. A bogey was created. Such misconceptions discourage a lot of women from seeking treatment,” says Dr Lekha.
“The first step is counselling, followed by medicines that mimic hormones. HRT comes into play only when symptoms persist and disrupt daily life.”
Dr Praveen too points out that the side effects of HRT are minimal. “It can help address issues such as osteoporosis,” he notes. “Besides medication, proper nutrition, maintaining a healthy sleep cycle, lifestyle changes, and vitamin supplements are also recommended.”
Emotional side
Hormonal fluctuation can cause psychological effects too. Lack of sleep, mood swings, and brain fog can disrupt daily life.
“One may start crying during the day, forget common things or tasks, or fall asleep during office hours,” says psychiatrist Dr Arun B Nair. “I had a patient who was a bank employee. She began forgetting tasks and making careless errors that she would never have made in her three-decade-long career. It reached a point where the organisation hinted she should take early retirement. Her husband told her it was common, that his mother had also gone through it. Her children teased her for ‘whining’.”
During a workshop at her bank for employees nearing retirement, she happened to attend a session led by psychiatrists. She discovered that her symptoms matched menopause and that treatment was easily available.
By the time she sought help, she had developed depression due to stress and lack of support. “Within a month of starting medication, she was back to normal. And within nine months, she could stop medication. Now, she continues to work and will retire gracefully at the official age — not a day early,” says Dr Arun.
He stresses that menopausal symptoms are easily treatable. “Within weeks, women can return to normalcy. Treatment is usually required only for a short period,” he smiles.
Yet, there is reluctance to seek help. “It is mostly highly educated and working women, especially those in high-stress environments, who seek treatment,” says Dr Lekha.
One common symptom of menopause is vaginal dryness. “This impacts sexual life and also leads to conditions like urinary tract infection (UTI),” says Dr Lekha. “Many women realise they are experiencing menopause only when they seek help for a urinary tract infection.”
For this to change, there needs to be more healthy conversations and awareness on making menopause a comfortable, if not ‘wonderful’, experience. First, within families. And then in society.
What’s HRT?
Hormone replacement therapy is generally administered at the onset of menopause. In India, the average age of menopause is the early 50s. It’s prescribed only if symptoms are debilitating and affect daily functioning. Oestrogen is the main component in HRT. Progesterone is also provided in some cases.
What’s perimenopause?
This is when periods become irregular, and the gap between each cycle widens
Perimenopause can begin in a woman’s 40s and ends with menopause — 12 months after her last period
For women who maintain a healthy lifestyle with regular exercise, symptoms are generally mild, experts say.
Common symptoms
Irregular or absent menstruation
Fatigue / Hot flashes
Night sweats / Sweating
Osteoporosis / Lack of sleep
Early waking
Dry hair & hair loss
Anxiety / Dry skin
Vaginal dryness / Irritability
Reduced sex drive
Mood swings
Pain during intercourse
Recurrent UTI
Lifestyle modifications
Regular exercise
Maintain a healthy sleep cycle; avoid screens before bed
Eat antioxidant-rich fruits
Avoid junk food
Include plenty of fruits, vegetables, whole grains, and lean proteins
Stay hydrated
Avoid smoking
Limit caffeine
Manage weight
Eat calcium-rich foods
Consult a doctor if required
