By Dr Ketoki Mazumdar, PhD, Assistant Professor (Psychology), Department of Psychological Sciences, School of Liberal Education, FLAME University, Pune and Aashika Shah (Final year, Psychology Major), FLAME University, Pune

Up until the last decade, the space to talk about menopause had been non-existent. Women tend to experience menopause around the age of 50-55 years; of which at least 75% experience debilitating symptoms associated with it including but not limited to hot flashes, disturbed sleep, and depression (Mansberg, 2020). A general lack of awareness around these symptoms and associated health problems is a cause of concern, especially for women who do not have access to quality health care. Exploring the health risks linked with menopause emphasizes the need to break the silence and promote an informed discussion about women's physical and mental health. It is vital to provide all women, regardless of their access to healthcare, with the knowledge and resources they require to navigate this important life transition.

Menopause is defined as the permanent cessation of menstruation for at least 12 months without a clear medical reason. The period that leads to this stage is called perimenopause, lasting on average for about 4 years, where a woman’s reproductive cycle makes some last runs. Eggs produced by the ovaries dip in number, causing an erratic release of estrogen and progesterone  (Dominus, 2023). It is during this time that women experience periods that are heavier or lighter than usual, accompanied by a range of other physiological and mental symptoms such as anxiety, depression, difficulties in memory and concentration,  sleep disruptions, decreased libido, and vasomotor symptoms.   Studies have revealed that early menopausal women are at risk for developing cardiovascular diseases, osteoporosis, and venereal cancers while late menopause is associated with breast and endometrial cancers. However, not just medical establishments but also mainstream media, policymakers, and employers have failed to help women navigate through these challenging times. 

In a UK cohort study with 409 women, the most common symptoms that were reported and prevailed across all occupations were vasomotor, psychological, sleep, and urinary. More than one-third of these women reported that they experienced difficulty coping at work which included adverse psychosocial work factors such as job insecurity, dissatisfaction, and feelings of underappreciation (D’Angelo et al., 2022). Rebecca Thurston, a Psychiatry Professor at the University of Pittsburgh who studies menopause, asserts that menopausal women have historically been overlooked, which she views as one of medicine's biggest blind spots. “It suggests that we have a high cultural tolerance for women's suffering,” Thurston went on to say. “It is not regarded as important.” The meaning of menopause is influenced by society's perception of older women and the female body as a reproductive system. Women fear their aging bodies, slammed by the cultural notion that they will no longer be able to bear children. The lack of conversation around psychological symptoms such as mood disturbances, depression, etc., results in women feeling their experience is not “real”. The dearth of research around this underemphasized topic has greatly affected the knowledge, empowerment, and decision-making related to their bodies. Over the last 10 years, some improvement and changes have been seen but more research focusing on racial, cultural, gender, and educational backgrounds to understand the uniqueness in experiences of menopause in a broader socio-cultural context  is still required. 

In the 1960s, menopause was defined as psychosomatic. The feminist movement transformed the perspective on menopause from a psychological to a physiological phenomenon. The notion of treating menopause as a sickness along with its medicalization was disputed. Researchers linked postmenopausal mood swings and depression to women's lack of confidence as a result of a culture that dismisses older women. The concept is supported by anthropological research that reveals older women who are appreciated by society have fewer recognized menopausal and perimenopausal symptoms (Chalouhi, 2017). One medical treatment, called the Hormone Replacement Therapy (HRT) has been notoriously famous since the 1960s for helping manage the symptoms. The perspectives varied; most of them being concerned about the safety of its usage. However, since 2002, several studies provide reassurance that healthy women under the age of 60, experiencing hot flashes can take HRT, for the benefits outweigh the costs (Dominus, 2023). Hormone treatment also provides long-term health advantages. It reduces osteoporosis, lowers the likelihood of Type 2 diabetes, and cures menopausal genitourinary syndrome symptoms such as painful sex, urine urgency, and recurrent urinary tract infections. However, given the damage to the reputation, many doctors continue to be hesitant in prescribing this treatment, and rightly so. Each woman’s body is different and their experience of menopause is clearly not the same. HRT may be popular in Western countries but in places where regional health care is compromised, other practical solutions need to be identified and implemented to decrease additional health risks.

When you are a woman experiencing the debilitating symptoms of menopause, you want solutions that will make you feel better without worrying about wasting your time. Cutting through non-credible information is necessary, which can only be done through serious, widespread education. Health centers, spread across higher education institutions will be a good starting point (Costa, 2023). Quality information can be shared through a team of medical experts and other professionals to filter out unnecessary chatter around the topic. Not only will this educate students and teaching staff on campus, but it will also help spread the campaign to the marginalized section, which includes the helping staff. Expecting costs of medicines and treatments to be lower is an unrealistic goal but education can help empower the community at large to take action on their own. Workshops, voluntary medical help, etc can help the underprivileged section to take advantage of the useful resources.

Above all, those living with health problems require some amount of flexibility in an otherwise structured life. A research analyzed diagnostic code data from 2001-2010 and concluded that employees with menopausal symptoms had 12.2% reduced hourly production and 10.9% lower yearly productivity (Kleinman et al., 2013). This highlights the need for management as well as employee knowledge, company support, and workplace flexibility (such as hours and temperature control) (Hickey et al., 2017). It can start with employers being caring and supportive, reviewing their sick-leave policies, and adjusting deadlines for those needing a break (Costa, 2023). As Ms Smriti Irani pointed out in a recent controversial Parliamentary debate, “Why should a woman's menstrual cycle be known to an employer … Can you imagine the harassment that a woman would have to face?” (NDTV, 2023). This approach reflects not just a lack of information, but also the societal shame associated with menstruation in India, thereby highlighting the urgent need for a cultural shift. Policy changes can only be expected at a stage where the maximum people are understanding and create an environment where a woman feels supported, informed, and empowered in her menopausal journey.  

In conclusion, the historical silence surrounding menopause has resulted in women enduring hardships alone. From the physical signs of perimenopause to the likely health hazards connected with early or late menopause, there is a clear lack of conversation and knowledge. Medical systems, media, lawmakers, and employers have all failed to provide adequate assistance for women throughout this crucial life change. Despite the progress made in the last decade, there is an urgent need for a larger societal acknowledgment and research that emphasizes the significance of changing cultural views toward women’s suffering.