Menopause is discussed less openly in India than almost any other stage of a woman's health, and many women arrive in clinic having endured years of symptoms without connecting them to hormonal change. Indian women reach menopause on average around forty six to forty eight, several years earlier than in Western populations.
Understanding the transition makes it far easier to navigate.
Perimenopause Starts Earlier Than You Think
Menopause is technically a single point, twelve months after your last period. Everything leading up to it is perimenopause, and it commonly lasts four to eight years.
During this phase, oestrogen does not decline smoothly. It fluctuates erratically, sometimes higher than normal, sometimes very low. That instability, rather than simple deficiency, causes most perimenopausal symptoms, which is why they can be so unpredictable.
Periods typically become irregular, sometimes closer together at first, then further apart. Heavier bleeding is common and should still be assessed rather than assumed to be hormonal.
The Symptoms Beyond Hot Flushes
Vasomotor symptoms are the famous ones, but they are not the most disruptive for many women.
- Hot flushes and night sweats: sudden heat spreading through the chest and face, often waking you
- Sleep disruption: frequently independent of flushes, and profoundly wearing
- Mood changes: irritability, anxiety and low mood, which are hormonal rather than a character failing
- Brain fog: word finding difficulty and reduced concentration, which frightens women who fear early dementia
- Joint aches: extremely common and rarely attributed correctly
- Vaginal dryness and discomfort during intercourse
- Urinary urgency and recurrent urine infections
- Reduced libido
- Palpitations and skin changes
Joint pain and brain fog are the two most commonly misattributed. Both improve when the hormonal cause is recognised and addressed.
The Genitourinary Symptoms Nobody Mentions
Vaginal and urinary symptoms deserve separate attention because, unlike hot flushes, they do not improve with time. They progress.
Falling oestrogen thins and dries the vaginal and urethral tissue, causing discomfort, painful intercourse, urgency and recurrent urinary infections. Women often suffer for years without raising it, or are told it is simply part of ageing.
It responds very well to low dose local vaginal oestrogen, which acts on the tissue directly with minimal absorption into the bloodstream. This is safe for the large majority of women, including many who cannot take systemic hormone therapy. It is one of the most effective and most underused treatments in women's health.
Bone Health and the Silent Loss
Oestrogen protects bone. In the years immediately around menopause, women can lose bone density rapidly, and this happens without any symptom until a fracture occurs.
- Weight bearing exercise: walking, stair climbing, and resistance training
- Adequate calcium, primarily from diet including curd, milk, ragi and sesame
- Vitamin D, which is deficient in a large proportion of Indian women despite the climate
- Stopping smoking and limiting alcohol
- A bone density scan where there are risk factors such as early menopause, steroid use, low body weight or a family history of hip fracture
A wrist fracture from a minor fall in your fifties is a warning sign, not bad luck. Our orthopaedics department assesses fracture risk in this group.
Heart Risk Changes at Menopause
Before menopause, women have lower cardiovascular risk than men of the same age. That advantage narrows considerably afterwards, as cholesterol profiles shift unfavourably and blood pressure tends to rise.
This is the point at which a woman who has never had her lipids or blood sugar checked should start. Waiting until sixty misses the decade in which prevention is most effective. Our cardiology department sees a considerable number of women whose first assessment came too late.
Hormone Therapy: Where the Evidence Stands
Hormone replacement therapy was widely abandoned after early 2000s studies that were later reinterpreted. Current understanding is more nuanced and considerably more favourable for the right patients.
For women under sixty, or within ten years of menopause, with troublesome symptoms and no contraindications, the benefits generally outweigh the risks. It is the most effective treatment for hot flushes and night sweats by a wide margin, and it protects bone.
It is not suitable for everyone. Previous breast cancer, unexplained vaginal bleeding, active liver disease, and a history of blood clots or stroke are important contraindications. The decision is individual, and it should follow a proper discussion of your own history rather than a general rule.
Non Hormonal Approaches That Help
For women who cannot or prefer not to take hormones, several measures have genuine evidence behind them.
- Certain antidepressant medications reduce hot flushes independently of their mood effect
- Cognitive behavioural therapy improves both flushes and sleep
- Layered clothing, cotton bedding and a cooler bedroom, which matters in Chennai
- Identifying personal triggers, commonly spicy food, hot drinks, alcohol and stress
- Regular exercise, which improves mood, sleep and bone simultaneously
- Vaginal moisturisers and lubricants for local symptoms
Evidence for most over the counter herbal supplements is weak, and some interact with prescribed medicines. Mention anything you are taking.
Bleeding After Menopause Is Never Normal
Once you have gone twelve months without a period, any bleeding at all requires investigation. Every time, without exception.
Most causes turn out to be benign, commonly thinning of the lining or a polyp. But postmenopausal bleeding is the principal early symptom of endometrial cancer, and that condition is highly curable when caught early. Assessment usually involves an ultrasound and often a biopsy or hysteroscopy.
Do not wait to see if it happens again.
Menopause is a normal transition, not a disease, but the symptoms are real and treatable and the health changes that accompany it deserve attention. Suffering through it silently, which remains the norm, is not the only option.
Our menopause care service is part of the gynaecology department at T. Nagar, where Dr. Chellammal sees women through this transition.
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