What is menopause?
Menopause is the natural culmination of the woman’s menstrual cycles. In India, the average age of menopause is between the ages of 46 and 48. However, different women have different experiences mostly determined by their medical and family histories. Some women may experience menopause anywhere between the ages of 41 and 50. Menopause before the age of 40 is referred to as premature menopause; and menopause after the age of 52 is considered delayed menopause.
Women may experience menopause over a 10-year period. It begins with a change in the frequency of the menstrual cycle, change in flow, erratic periods, hot flushes, sweating and sleep disturbances. Family support becomes very crucial.
Menopause brings in changes in many domains of a woman’s life
For most Indian women, menopause occurs during a time when their children have left home; it’s also the age at which they are dealing with being the caregiver to their parents and in-laws, or losing them. They may also pay greater attention to their health and find out about the existence of health issues: diabetes, cholesterol, risk of heart attack, hypertension or thyroid imbalance. Women who work may be at a stage in their career where they are required to take up roles of responsibility, and they may struggle to meet all the demands that these changes make of them.
Physical health problems
During menopause, the body stops producing estrogen. Estrogen is essential for cardiac, skin and bone health, and many women have complications around these. The bones get weaker, and the person experiences backaches, and shoulder and joint pains. Some women experience stress incontinence, which they may be embarrassed about.
Most women report problems with sleeping; they find it hard to fall asleep or have trouble sleeping through the night. (A gynecologist in Bangalore says that at least 20-25 per cent of her patients complain of insomnia during this period).
Menopause and mental health
There are many women who expect menopause and are prepared for it; they are able to cope with the changes it brings. But for some others, menopause becomes a very challenging life event, and they may need to seek help from a mental health professional.
“Some women find it hard to cope with the sudden realization that their body is aging physiologically, while they may be at the top of their careers or feel perfectly fit and young in their minds. Women who have set themselves high goals may see this as a reminder that a significant part of their life is already behind them. This realization could create anxiety, distress or hopelessness; the mind is still fit but their body begins moving in a different direction,” says Dr Sabina Rao, consultant psychiatrist, Sakra World Hospital.
What to expect during menopause
During menopause, you may undergo several hormonal, physiological and emotional changes, including:
When present in moderation, these symptoms are typical of menopause. But it is important to know when these symptoms stop being normal, and you need to seek help.
This is normal
Feeling tired and low on some days
Constantly feeling tired, low and a sense of hopelessness on more days than not, and frequent crying spells for at least two weeks; any suicidal ideation.
swings; feeling irritated, angry or sad at times; headaches and difficulty in concentrating
Frequent mood swings for at least two weeks; a sense of hopelessness or being unable to cope
, irritability, changes in appetite or sleep routines; feeling tense or exhausted at times
Anxious thoughts, tension or exhaustion lasting for more than two weeks at a stretch; or if your level of excitement about the future is very low.
Feeling sweaty, or having ‘shaky arms’; or feeling flushed at times
If you feel a sense of dread, fear, or have palpitations out of the blue, lasting for at least 15 minutes, you may be having a panic attack. If you experience a panic attack more than once, seek help immediately.
issues during menopause
At least one in five women suffers from depression during menopause. Women with a personal or family history of depression (including postpartum depression) are particularly vulnerable. Experts say that the discomfort caused by night sweats and hot flushes could lead to sleep disturbance, and affect mood stability.
Many women also experience problems with their cognitive function; they may have difficulty in remembering things or concentrating on specific tasks. Menopause may trigger schizophrenia, bipolar disorder, an anxiety or panic disorder in women already predisposed to these mental illnesses. Women who have had a mental illness earlier are also more vulnerable to a relapse.
When menopause isn’t ‘natural’
Women who undergo surgical menopause (removal of the ovaries, which leads to the end of their menstrual cycles) may experience distress, partly due to the fact that their menopause came out of the blue, without prior warning (natural menopause is experienced over a ten-year period, beginning with irregularities in the woman’s menstrual cycles). They may experience the loss of their uterus as unnatural, or see themselves as having lost the essence of being a woman; the change in hormone levels may lead to them putting on weight and developing body image issues. They may also develop symptoms of anxiety or depression.
Women in this category often find it easier to cope when they have good post-operative care, psychological support and family support. If you are experiencing surgical menopause, reach out to a counselor who can help you manage your thoughts and self-image.
Support from the family helps to cope with menopause
Whether the menopause is natural or surgical, the support from family – particularly from the spouse – can help a woman cope with the physical and emotional changes that menopause brings. Here’s what family can do to make this process easier for the woman:
Staying mentally well during menopause
Making some lifestyle changes can help you cope with the changes brought in by menopause and stay mentally well.
This article has been written with inputs from Dr Sabina Rao, consultant psychiatrist, Sakra World Hospital, Dr Aruna Muralidhar, consultant obstetrician and gynecologist, Apollo Cradle Jayanagar, and Dr Geetha Desai,additional professor of psychiatry, NIMHANS, Bangalore.