What menopause is
Menopause is the time when a woman's periods stop permanently because the ovaries stop releasing eggs and make much less of the hormone oestrogen. A woman is said to have reached menopause when she has had no period for 12 months in a row. In India, it commonly happens between the mid-forties and early fifties, sometimes a little earlier than in Western countries.
The years leading up to it, called perimenopause, can last several years. During this time periods become irregular, heavier or lighter, and symptoms often begin. Menopause before age 40 is called premature menopause and needs medical review, as does menopause after surgery to remove the ovaries.
Common symptoms of menopause
Every woman's experience is different. Some have few symptoms, while others find them hard to manage at home and at work. Symptoms can last from a few months to several years and usually become milder with time. Many women do not realise these changes are linked to menopause, so knowing the signs helps.
- Hot flushes: sudden waves of heat in the face and chest, with sweating
- Night sweats and trouble sleeping
- Mood changes, irritability, anxiety or low mood
- Poor concentration and forgetfulness
- Vaginal dryness, discomfort during sex and more urine infections
- Joint aches, tiredness and lower interest in sex
- Weight gain around the waist
Long-term health changes
Oestrogen helps protect bones and the heart. After menopause, bone loss speeds up, raising the risk of osteoporosis, a condition in which bones become thin and break easily, even after a minor fall. Many Indian women already have low calcium and vitamin D intake, which adds to this risk.
The risk of heart disease, high blood pressure, raised cholesterol and diabetes also rises after menopause, partly because of hormone changes and partly because of weight gain and less activity. Regular check-ups become more important from this stage of life, along with screening for breast and cervical cancer as advised by your doctor.
Diagnosis and useful tests
For most women over 45 with typical symptoms and irregular or stopped periods, the doctor can diagnose menopause without blood tests. Hormone tests such as FSH may be used when menopause seems to be happening early, or when symptoms are unclear, because hormone levels change a lot during perimenopause.
Your doctor may suggest tests to check your overall health, such as blood sugar, lipid profile, thyroid function, vitamin D and a bone density (DEXA) scan. Any bleeding after periods have stopped for a year needs to be checked with a pelvic ultrasound and other tests.
Treatment options for menopause
Hormone replacement therapy (HRT) is the most effective treatment for hot flushes and night sweats and also helps protect bones. It is given only on a doctor's prescription after weighing benefits and risks, such as breast cancer, blood clots and stroke, based on your age and health history. It is not suitable for everyone.
Women who cannot or prefer not to take HRT have other options. Some non-hormonal prescription medicines can reduce hot flushes. Vaginal moisturisers and low-dose vaginal oestrogen treat dryness. Calcium and vitamin D supplements, and sometimes bone-strengthening medicines, are used when needed. Herbal and soy products have limited evidence, so ask your doctor before trying them.
Healthy habits for this stage
Lifestyle changes ease many symptoms and protect long-term bone and heart health. Small, steady changes are easier to keep up than sudden big ones, and the whole family can join in. Try these steps, and give each one a few weeks before judging whether it helps.
- Do weight-bearing exercise such as brisk walking, plus some strength exercise
- Eat calcium-rich foods such as milk, curd, ragi, sesame and green leafy vegetables
- Get some sunlight and ask your doctor about vitamin D levels
- Dress in layers, keep a fan nearby and limit spicy food, tea, coffee and alcohol if they trigger flushes
- Stop smoking and keep a healthy weight
- Practise relaxation, and talk to family about how you feel
When to see a doctor for menopause
See a doctor if symptoms affect your sleep, work or relationships, if periods stop before age 40, or if you have any bleeding after menopause. Women with a history of breast cancer, blood clots, liver disease or heart disease need specialist advice before any hormone treatment. A doctor or pharmacist can help you understand your options and plan regular health checks.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Hormone replacement therapy (oestrogen, with progestogen if the womb is present)Relieves hot flushes, night sweats and vaginal dryness, and helps protect bones.Only on a doctor's prescription after assessing personal risks; needs regular review.
- Vaginal moisturisers and lubricantsEase vaginal dryness and discomfort during sex.Follow the label or your pharmacist's advice.
- Low-dose vaginal oestrogen cream or tabletsTreat vaginal dryness and reduce repeated urine infections.Only on a doctor's prescription.
- Non-hormonal medicines such as certain SSRIs, SNRIs or gabapentinCan reduce hot flushes in women who cannot take HRT.Only on a doctor's prescription; do not start or stop on your own.
- Calcium and vitamin D supplementsSupport bone health when diet or sunlight is not enough.Take as advised by your doctor, especially if you have kidney stones or kidney disease.
See a doctor urgently if
- See a doctor urgently if you have any vaginal bleeding after your periods have stopped for a year.
- See a doctor urgently if you have chest pain, breathlessness, or sudden leg swelling and pain while on hormone therapy.
- See a doctor soon if you notice a lump in the breast or changes in the nipple.
- See a doctor soon if your periods stop before age 40.
- See a doctor soon if low mood, anxiety or poor sleep are affecting daily life.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.