Menopause: When Do You Know It’s Coming?

Menopausal symptoms could be manageable for some, and extremely severe for others.

Updated19 Dec 2019, 07:50 AM IST
Her Health
5 min read


Their absence, presence, abundance or lack of, determines to a significant extent our bodies’ physical (and often psychological) capabilities. In women, this translates itself into two broad phases: their menstrual and post-menstrual years.

When a woman does not get her period for an entire year, she is believed to have reached her menopause. This is caused by a natural decline in the reproductive hormones produced by her ovaries, such as estrogen and progesterone, marking an end to her fertility.

Menopausal age could begin from 46 to over 50 years of age. The average age for Indian women is around 46, but it is much later among women in the west (51 years).

While it is a natural biological process, this fall in the hormones could bring along a gazillion changes in the woman’s body, and invariably her mind. The lack of these hormones could make her more vulnerable to certain diseases and health problems, thus making a smooth and informative transition vital and extremely necessary.

Perimenopause: The First Knock on the Door

“Menopause is not abrupt or sudden,” says Dr Nupur Gupta, Director, Department of Obstetrics and Gynaecology at Fortis. The transition begins much earlier than menopause itself, with the symptoms appearing two to five years earlier (this duration could vary based on a host of factors).

Speaking to FIT, she lists down some common symptoms that could start appearing during perimenopause:

  • Irregular periods
  • Night sweats
  • Sleep disturbances
  • Dull aches and pains all over the body
  • Hot flashes
  • Mood swings and irritability
  • Frequent urination, urinary incontinence, and bladder infections
  • Drying of the vagina, vaginal itching, and consequent pain during intercourse
  • Lowering of libido
  • Difficulty in losing weight

In a significant number of women, these symptoms, and consequently menopause, occur even before the age of 40 (called premature menopause). This could happen because of a lot of reasons such as ovarian surgery, genetic disorders, infections, family history, or the cause may remain unknown. Among these women, the risks associated with menopause also appear early.

Caution: Diseases, Contraception & More

 Do women in perimenopause need contraception?  
Do women in perimenopause need contraception?  
(Photo: iStockphoto)

Dr Sudeshna Ray, Consultant & Co-ordinator, Obstetrics, and Gynaecology at Jaslok Hospital, talks of the importance of not reducing all of these symptoms to just menopause. Many women experience chest oppression or vague pains in parts of their bodies. Studies have shown how the risk of heart diseases, stroke, and osteoporosis increases in post-menopausal women, making it vital to rule out any cardiovascular or other issues, before bringing it down to menopause.

“The risk of certain diseases in women increases because of the change in the character of hormones now being produced. The potent hormone gets replaced by the less potent hormone, and thus, does not protect the bones, the brain or the heart as actively as it used to during the menstrual years.”
Dr Sudeshna Ray

Another important point to note is that the need for birth control continues to exist in the perimenopause stage. Dr Sudeshna says, “Contraception is important, because ovulation has not completely disappeared. There’s a possibility of spontaneous ovulation. So any woman above 40 must use contraception at least till a year after her last period, i.e. her menopause.”

Courses of Relief: Is Hormone Replacement Therapy a Good Option?

Menopausal symptoms could be manageable for some, and very severe for others. The bare minimum that needs to be done in order to better handle the changes — is making lifestyle alterations.

“We shouldn’t blame everything on menopause. A lot of these symptoms that appear in later ages could also be attributed to a sedentary and unhealthy lifestyle,” says Dr Gupta.

“As for menopausal symptoms, regular exercising, increased intake of vitamins and antioxidants, multivitamins, soya and calcium supplements, and avoiding alcohol, tea and coffee could be of help.”
Dr Nupur Gupta

In a lot of cases, however, the symptoms could be unbearable, affecting the day-to-day lives of the women. Hormone Replacement Therapy (HRT), or Menopausal Hormonal Therapy (MHT), is a commonly resorted-to medical intervention in these cases.

Is hormone replacement therapy a safe option?
Is hormone replacement therapy a safe option?
(Photo: iStockphoto)

In simple words, “Hormone replacement therapy (HRT) is supplementing women with hormones that are lost during the menopausal transition.” In this way, it can help provide relief from symptoms caused by the very absence of these hormones.

Dr Gupta explains that this therapy is not the first line of treatment for most women.

“When symptoms are severe, we customize and administer it. But it is only given for a short period, and usually, the symptoms get better in a few months. However, medical supervision is a must.”
Dr Nupur Gupta

While HRT or MHT has been the most effective treatment for women experiencing severe discomfort and signs, concerns regarding its associated risks came under the spotlight after a Women’s Health Initiative (WHI) study linked it to an increased risk of breast cancer. Following this, a substantial decrease in the number of women opting for hormone replacement therapy had been observed worldwide.

However, the medical community has maintained that if administered optimally and when absolutely necessary, the benefits of hormone therapy far outweigh the risks.

Dr Sudeshna Ray emphasizes that the WHI findings may be controversial and the study may not necessarily be ideal. Researchers are yet to come out with a proper and more age-relevant large scale risk analysis to be certain of how safe or unsafe this treatment is. Even with the WHI study, there was no absolute risk of breast cancer, but only a relative increase in risk after HRT.

“We don’t give the therapy for ‘protection’ from diseases or health problems, but only to provide relief from severe menopausal symptoms. The mantra here is: Smallest dose for the shortest duration under medical supervision and with regular follow-up.”
Dr Sudeshna Ray

There are other options as well, such as phytoestrogens and Selective Estrogen Receptor Modulators (SERM) that may be safer. But HRT still remains the most efficient option for women who are unable to deal with their symptoms.

In cases of premature menopause, for instance, HRT is one of the best methods to contain the risks associated with the fall in hormones. In an earlier article for FIT, Dr Duru Shah, Director, Gynaecworld, Center for Assisted Reproduction and Women’s Health, had written, “Hormone replacement therapy is important for these young women, contrary to women who have reached natural menopause in whom it is optional. One must remember, that in cases of premature menopause the benefits of hormone therapy definitely out-weigh the risks.”

“To conclude, you can safely give HRT when a patient really needs it. What’s important is for the woman to make an informed choice.”
Dr Sudeshna Ray

But when talking of alternative treatments, Dr Nupur also discusses cognitive behavioral therapy as an option.

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Published: 19 Dec 2019, 04:45 AM IST

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