Rosy Devi, a 38-year-old woman from Bihar, India, is facing numerous health challenges. She finds herself experiencing constant body aches, difficulty with short walks, and easy breathlessness, which she attributes to her declining health since her 2019 hysterectomy, an operation that led to premature menopause.
“I walk and suddenly feel a wave of heat wash over me, followed by sweating and chest pain, almost like being hit from behind,” she shares. It’s hard for her to believe that menopause—which typically signifies a woman’s permanent end to menstruation—has hit her so hard. “Honestly, I feel ancient now. Everything about me has changed: my body, my face… it’s all different,” she remarks.
Devi thought she would experience menopause later in life, not so abruptly due to surgery, and she admits that the situation took her completely off guard.
But menopause is an inevitable transition that all women go through at some point, and Devi’s symptoms reflect a broader spectrum of impacts that are often less recognized.
While hot flashes and mood swings are commonly understood, experts emphasize that many women undergo various bodily changes during menopause. Unfortunately, the lack of awareness means that numerous women start dealing with these symptoms without understanding their origins.
So, what exactly is menopause, and why is there so little awareness about it?
What is menopause – and why don’t people know enough about it?
Menopause signifies the end of a woman’s menstrual cycle, officially marked when there are no periods for over a year, signaling the conclusion of reproductive years.
The World Health Organization (WHO) notes that most women globally face menopause between the ages of 45 and 55. However, research from the U.S. and South Korea indicates that around 9.4% (or roughly 1 in 10) women may experience menopause between ages 40 and 44; about 8.6% experience it before 40. In rare circumstances, some might begin menopause in their 20s, often following a hysterectomy or due to other medical conditions.
Natural menopause typically begins with a phase called perimenopause, during which the ovaries gradually reduce hormone production, leading to irregular menstrual cycles. Women might notice symptoms like erratic periods, hot flashes, sleep disturbances, and mood changes.
Perimenopause can start in the mid-30s and last between four to eight years, although many women have trouble recalling when it began. As Gayathri Delanerolle, a researcher associated with Hampshire and Isle of Wight Healthcare, points out, some women remember exactly when they experienced a hot flash, while others have no recollection at all. “Menopause hasn’t even come to mind for many,” she adds.
A study showed that a significant number of women have minimal knowledge about menopause. Of over 800 postmenopausal women surveyed, the majority hadn’t received any education about it during school, and a large portion felt uninformed. Many also reported that their doctors lacked the necessary knowledge, leaving them feeling unsupported after medical consultations. Similar findings emerged in other studies.
Joyce Harper, a professor at University College London, who co-authored the aforementioned study, commented that the findings highlight a “lack of education regarding this crucial stage of life… Combined with insufficient education from healthcare professionals, women often find themselves undiagnosed and unsupported.”
Menopause can happen in many ways and at different times
Menopause is termed “premature” when it occurs before age 40 and “early” before 45.
Research suggests that rates of early and premature menopause are increasing in low- and middle-income countries, with the overall average age for menopause apparently decreasing.
“Experiencing menopause earlier means dealing with its challenges for a longer time,” states Nikita Rajput, a scientific officer at Tata Memorial Centre in Navi Mumbai, India. Her studies show that women in rural India struggle with limited healthcare access and higher rates of premature menopause.
Different types of menopause exist, such as surgical menopause, which is triggered by a hysterectomy, or medical menopause, which results when treatments like chemotherapy or radiation impair ovarian function.
Concerns have arisen among health experts in India regarding the high prevalence of premature and early menopause, particularly related to hysterectomies. Young women with inadequate education and from lower-income backgrounds often feel they have no choice in pursuing hysterectomies when facing gynecological issues like excessive bleeding or fibroids, sometimes under pressure from family or doctors suggesting the surgery. Research indicates many women are unaware of the complete nature of the procedures they undergo.
The most prevalent symptoms of menopause include hot flashes and night sweats, which occur in about 80% of cases, according to The Menopause Society in the U.S. Other symptoms that commonly arise include vaginal dryness, urgency to urinate, sleep issues, and mood fluctuations, including anxiety and depression.
Delanerolle mentions that numerous women also report headaches and trouble sleeping. Many deal with incontinence, which can affect work and exercise activities.
Additionally, symptoms may encompass heart palpitations, joint and muscle pain, shifts in libido, reduced focus, weight gain, and hair loss, with some experiencing dry eyes and changes in vision. Moreover, increased bruising and other side effects, like dry mouth or acne, are also reported.
Delanerolle’s research has uncovered other symptoms too, such as an itchy scalp and skin. Some women, both in India and the UK, have even noted an uptick in libido.
“Menopause can be a very personal journey,” says Delanerolle, and since some symptoms overlap with other health conditions, it can be tough to definitively attribute them all to menopause.
She emphasizes that comprehensive research, public education—including school initiatives—and evidence-based training for healthcare professionals is essential.
Menopause and its symptoms generally persist for about seven years on average. It’s crucial for women to identify and comprehend what they are experiencing.
Post-menopause, women face increased risks of cardiovascular conditions, underscoring the necessity for active lifestyles and balanced diets. The significant decline in estrogen during menopause disrupts cholesterol and fat regulation, raising the risk for heart disease, heart attacks, and strokes, according to the British Heart Foundation, which notes that heart disease is a leading cause of death among women globally.
Additional research indicates a heightened risk of respiratory issues, like chronic obstructive pulmonary disease (COPD), particularly after premature menopause.
Om Kurmi, an associate professor in epidemiology at Coventry University in the UK, stresses that raising awareness can ensure women receive proper support and make necessary lifestyle adjustments to tackle the health risks associated with menopause.
Simple lifestyle modifications—quitting smoking, minimizing alcohol intake, increasing physical activity, managing stress, and shedding excess weight—can alleviate symptoms and mitigate risks of osteoporosis and heart disease. Mental health is another significant area often left unaddressed. While symptoms like irritability and insomnia are documented, there’s rising evidence of an increased risk for depression and anxiety.
“It’s essential for women to understand that experiencing menopause raises the likelihood of certain health challenges compared to those who don’t go through it,” Kurmi explains. “Once you recognize your symptoms…they can often be managed effectively.”
How can women manage menopause symptoms? And does this differ globally?
Globally, the primary treatment for menopause is hormone therapy (HRT), which replaces diminished hormones. Options include estrogen therapy—usually for those with prior hysterectomies—and a combination of estrogen and progesterone for others. HRT aims to ease symptoms and risks associated with menopause, typically lasting between two to five years, although some may require a longer duration. If treatment stops, symptoms often return.
However, hormone therapies tend to be more accessible in wealthy countries due to costs, availability of healthcare services, and practitioner knowledge on prescribing them. There’s also variation within affluent nations, as those with better financial means generally have broader access.
Although many women turn to HRT, potential side effects exist, including irregular bleeding, breast tenderness, and elevated risks of blood clots and gallbladder disease. There’s also a slight increase in risks for certain cancers, although, as Cancer Research UK states, the likelihood remains low and varies depending on different factors—therapy type, duration, age, and overall health and lifestyle. Experts recommend that women should carefully weigh their options and make informed decisions.
Medications are also available to help treat specific symptoms, like antidepressants for hot flashes. Many women prefer natural alternatives, such as herbal supplements, but health authorities generally advise caution due to insufficient evidence on their effectiveness and safety. Other approaches include vitamin supplements and lifestyle changes like quitting smoking, losing weight, and exercising, which can be more attainable for women in lower-income settings.
Research from the U.S. and five European countries found that most women with moderate to severe symptoms adapted their lifestyles for management. The most common treatment was hormone therapy, followed by antidepressants.
A recent decision in the U.S. to remove the alarming “black box warning” label from HRT products may encourage more women to choose this treatment. The FDA removed the warning regarding disease risks such as breast cancer, stating that the change was meant to end the “fear machine” that deters women from potentially life-changing therapies, according to FDA Commissioner Dr. Marty Makary.
Why women (and men) and policymakers need to sit up and pay attention
“The population is growing, and lifespans are extending, which means women—who make up half the global population—are also increasing,” explains Kurmi. The UN’s World Population Prospects 2024 emphasizes the necessity of addressing “gender-specific healthcare needs” and developing robust “social support systems to alleviate potential caregiving burdens.”
With more women over 40 and 50 nowadays, Kurmi, part of a research team stressing the urgent need for focus on menopause, indicates that health issues related to menopause are expected to rise.
Health policies in many lower- and middle-income countries, like India, still primarily allocate funds for women’s sexual and reproductive health—mainly due to critical public health issues like high maternal mortality rates. However, an increasing number of older women also require care, a need that current policies have yet to effectively address. “The government seems to view women solely as reproductive beings, not recognizing them post-reproduction,” notes Rajput. A policy focusing on post-reproductive health is essential, she argues.
The stigma surrounding menopause also needs a shift.
“Changing perceptions about menopause is vital, and much of it hinges on awareness,” asserts Delanerolle from the UK’s NHS. She believes that educating teenage girls about menopause could foster understanding, allowing them to see it not as a conclusion but as another chapter in life. “Just like a book, menopause is merely another chapter,” she expresses.
