Menopause is not just hot flashes—it's a full-body reboot nobody talks about

Time of India

6 hours ago

Menopause refers to the stage of women's life which marks the end of her reproductive cycle and is diagnosed after 12 consecutive months without mensuration. While being a natural biological transition, the timing of its onset is influenced by a variety of factors such as genetics, lifestyle, nutrition, environmental exposure and socio-economic conditions.
According to studies, Indian women tend to reach menopause nearly five years earlier than women in many Western countries. While the global average age is around 51 years, Indian women typically experience it around the age of 46 or 47. A major reason for this could be nutritional deficiencies particularly among women from low-income and rural backgrounds. Chronic undernutrition and lack of micronutrients like iron, calcium, and Vitamin D are known to impact hormonal balance and accelerate ovarian aging.
Hitting menopause early carries significant implications on women's health.
Though inevitable, menopause is surrounded by silence. It is spoken of only in the form of jokes regarding hot flashes or referrals to "the change." Yet, menopause involves deep physical, emotional, and social transformation that have the potential to significantly affect a woman's quality of life. Like other issues of reproductive health, heightened awareness and early treatment are necessary.
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Talking about menopause in a holistic way can also serve to break down gendered health inequalities. As with infertility, where women get the blame and stigma—menopausal women are usually misunderstood, disregarded, or medically ignored. These are gendered trends that reinforce inequality, lower dignity, and undermine long-term health.
Understanding the unspoken side of menopause
For many, menopause conjures up feelings of embarrassment, hot flushes, mood swings and sleep disturbance.
It is something uncomfortable, private, and seen as a "women's issue". There is societal stigma and taboos associated with menopause that affect a woman's ability to openly talk about it, seek information and healthcare services.
This lack of openness doesn't just affect personal spaces, it extends into professional settings as well. Even in urban workspaces, it is not seen or recognised as a workplace issue. Even now, a recognition that menopause is a diversity and inclusion, and a business issue has not sunk in.
Research has shown women experiencing perimenopause and menopause-related symptoms have often been misdiagnosed as suffering from mental ill-health or other conditions, and have also at times been misjudged as having attitude issues, lower engagement at work, lowered aspirations etc. This in turn has led to t heir lower motivation with higher intention to quit their job when wrongly assessed.
Although few women change with hardly any symptoms, most suffer life-affecting ramifications that extend past unpredictable cycles. Typical but underdiagnosed symptoms are:
Mood Disturbance: Irritability, depression, and anxiety caused by hormonal changes.
Cognitive impairment: Trouble concentrating, memory lapses, and "foggy" mind.
Sexual function problems: Vaginal dryness, painful intercourse, and decreased libido.
Metabolic alterations: Weight gain, increased risk of diabetes, and elevated cholesterol.
Bone and cardiovascular health risks: Estrogen deficiency accelerates the risk of osteoporosis and cardiovascular disease.
The physiology of menopause: What's actually happening to the body
At the core of menopause is a natural decline in ovarian function.
The ovaries slowly decrease production of estrogen and progesterone, the hormones that cycle the menstrual cycle and underpin many other bodily systems. The hormonal transition derails the hypothalamic-pituitary-ovarian (HPO) axis, which regulates reproductive function.
The loss of estrogen specifically has far-reaching consequences:
Thermoregulation: Estrogen is crucial in the regulation of temperature.
Its decrease impacts the hypothalamus, resulting in hot flashes and night sweats.
Vaginal tissue: Decreased estrogen leads to thinning, dryness, and reduced elasticity of the vaginal lining, causing pain and discomfort during intercourse.
Declining estrogen levels during menopause can lead to reduced bladder tone and contribute to urinary incontinence. Estrogen helps maintain the health of the lining of the bladder.
Bone metabolism: Estrogen retains bone density by regulating osteoblast (bone-forming) and osteoclast (bone-resorbing) activity. Its deficiency hastens bone loss, making osteoporosis more likely.
Cardiovascular system: Healthy cholesterol and blood vessel elasticity are supported by estrogen. Post-menopausal women have increased risks of atherosclerosis and heart disease.
Neurotransmitters: Estrogen affects serotonin and dopamine—neurochemicals of mood and cognition.
Deficiencies in these can result in emotional instability and memory problems.
Appreciation of these physiological shifts emphasizes the value of hormone surveillance, nutrition counselling, and preventive health tests in women in midlife. Modalities such as bone density scans, lipid panels, and psychiatric evaluations need to become routine during and after menopause.
Menopause requires a holistic, proactive management approach.
One of the most common treatments for menopause-related symptoms is hormone replacement therapy (HRT). HRT supplements the body with estrogen, either alone or in combination with progesterone, and helps to alleviate symptoms such as hot flashes, night sweats, and vaginal dryness. Studies also suggest that early use of HRT can reduce the risk of osteoporosis and fractures, as well as offer potential cardiovascular benefits.
For women experiencing severe menopausal symptoms that significantly impact their quality of life, HRT can offer substantial improvements in well-being and daily functioning.
There are two main types of hormone replacement therapy (HRT): estrogen therapy and combination therapy. Estrogen therapy involves taking estrogen alone, which is typically prescribed in a low dose and can be administered through various forms such as pills, patches, gels, vaginal rings, creams, or sprays.
This option is usually recommended for women who have had a hysterectomy. On the other hand, combination therapy, also known as estrogen-progesterone therapy (EPT), includes both estrogen and progesterone (or a progestin) and is necessary for women who still have a uterus, as progestins help reduce the risk of uterine cancer.
Combination therapy is available in pills, patches, and sometimes in IUDs. Your healthcare provider will recommend the best option based on your symptoms and medical history.
Addressing the often-overlooked struggles of menstruation, reproduction, and menopause calls for a multi-pronged approach. Normalizing menopause through sustained media content — including expert voices and real stories — can drive awareness, tackle stigma, and reach women beyond just those nearing midlife.
Preventive care must replace reactive treatment. Healthcare providers should initiate early conversations on hormonal health and well-being from the mid-30s, helping women prepare for this life stage.
Workplaces, too, must integrate menopause into DEI and wellness policies, with flexible work options, sensitized leadership, telehealth access, and insurance support as key enablers.
Dr Surbhi Singh, Cosmetic Gynaecologist, Beau Monde clinic, GK 1
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