Pause and effect

Call it the storm that never calms. Menopause (and perimenopause) are more than just biological milestones — they are seismic shifts in a woman’s physical, mental, and emotional landscape. 

Menopause, or the final period, marks the end of ovarian function, throwing a woman’s emotional, physical and mental parameters off balance. Estrogen and progesterone plummet, leaving many women grappling with hot flushes, brain fog, night sweats, mood swings, anxiety, and depression — a virtual cascade of symptoms.

Despite such turmoil, many women, especially in India, navigate these changes alone, rarely seeking medical aid with family support and awareness both hard to come by. Very few pursue evidence-based science and seek a doctor, while the large majority resort to pills, potions, and propaganda. An International Journal of Life Sciences, Biotechnology and Pharma Research (IJLBPR) study found that globally, 91.5 per cent of working and 81.8 per cent of non-working peri-menopausal women self-medicated. Of these, 89.5 per cent didn’t see a doctor, citing symptoms as “non-serious.” Working women leaned towards allopathy and homoeopathy; non-working women, ayurvedic and unani. Self-medication fuelled by online aggregators has created a health void, with alternative therapies making hay while the sun shines, or in this case, while the menopausal woman burns up! The challenge is extracting science from exaggerated claims and responsibly addressing the imbalance amid a flood of pseudo-remedies.

Case study

Meera, 47, endured menopause with mood swings, irregular periods, anxiety, bloating, weight gain, muscle pain, and depression. Initially prescribed antidepressants by a psychiatrist, she learned her symptoms were hormonal. “I was saved at a low point when I was feeling broken,” she recalls. In collaboration with her psychiatrist, her doctor tapered her antidepressants and prescribed therapy, hormonal and non-hormonal. Happier today, she practises yoga and journals regularly. Her body, once at war, feels like home again.

Dr Komal Chauhan, Professor and Dean, NIFTIM-K, notes that Indian women typically enter menopause in their early 40s to 50s. With increased life expectancy, this phase encompasses one-third of their life. Disconcertingly, most don’t bother consulting a doctor, unaware of the importance of doing so. “Non-medical approaches, and diet without nutraceuticals have a significant impact. Supplements like calcium, vitamin D, and lactose combos are useful — but only if lab tests show a deficit,” adds Dr Chauhan.

Hand-in-hand with depression

Dr Hema Divakar, senior obstetrician-gynaecologist (OB-GYN) and medical director at a multi-speciality hospital in Bengaluru, notes that menopausal symptoms are often misdiagnosed as depression. “They consult psychiatrists until an OB-GYN links mood swings to hormones. Five years ago, many women would come straddled with a prescription from a psychiatrist. Awareness is slowly trickling in, but hormonal shifts can trigger a mental health crisis.”

Dr Chauhan concurs that women dismiss symptoms or seek unverified sources. “Supplements must be taken early (if required), ideally from age 30, not when biological changes have already occurred. Mental health must be addressed, overcoming stigma, through food, not just pills. Awareness and evidence-based scientific knowledge can bust myths that ‘Google University’ propagates. Let us normalise conversations around menopause!” She notes that the transition period might be 10 years or more. “Understand that menopause is not a weakness. It is biochemistry.”

Look beyond pills

Dr Usha Kapur, internal medicine specialist, cautions, “Supplements are medicine, not food. However, most vitamins and nutrients are best found, absorbed and efficacious in a nutritious diet,” she says and warns against “molecule manna”— ingesting isolated molecules without proof, for instance.

Darshit Patel, founder of a wellness and longevity-focused brand, sees the market flooded with hype and untested narratives. “Start lifestyle changes early in life. Find a trusted medical practitioner, follow the science.”

Dr Chauhan feels that a holistic approach, where the psychological, emotional, and physical state of the woman is analysed, is key. “There are many products to address hot flushes, mood swings, vaginal dryness, night sweats, insomnia and diseases, but generalised supplements are not greatly effective. Tailored diet-based personalised nutrition is the solution.”  A nutritious anti-oxidant and phytoestrogen-rich diet, and an active lifestyle will strengthen the body’s anti-oxidant defence system, and even delay the onset of symptoms.

Doctors insist that, overwhelming though this phase is, reassurance, encouragement and counselling help. “It is a time when 50 per cent of women battle hypertension, diabetes, heart problems, cataracts, bone issues, etc,” admits Dr Divakar.

Root cause versus symptoms

Dr Samatha Tulla, longevity physician and co-founder of a Hyderabad-based healthcare company, says, “Treat the root cause, not the symptom.” She warns that Asian women hit menopause earlier, and are more prone to POI (premature ovarian insufficiency), partly due to delayed childbearing and ovarian ageing. “We studied how fast ovaries are ageing, leading to POI and early ovarian failure. Globally too, menopausal age is no longer 52-55, but more 48-50,” says Dr Divakar.

The HRT dilemma

In India, HRT (Hormone Replacement Therapy) uptake is low — just 5 per cent. Concerns over its links to breast cancer persist, thus most doctors opt for conventional methods. Dr Tulla notes that HRT ought to be the last line of treatment. Transdermal estrogen patches, gels and vaginal creams are safer options without the risk of vascular complications. In Western medicine, estrogen is supplemented with testosterone.

While promising, this demands close monitoring for side effects. The siblings — peri and post — have no particular code, peri can begin at 30, or not show up till late 40s. “The benefits of HRT might outweigh risks for those who start treatment before 60 or within 10 years of menopause. Risks depend on individual health and hence need frequent evaluation,” warns Dr Tulla, who finds that an estrogen standalone therapy taken over a long period, “risks gall bladder stones, deep vein thrombosis and pulmonary embolism.”  Thus, a risk-versus-benefit analysis must be made in each case, she advises.

The great supplement rush

Most Indians prefer non-hormonal therapies, making them vulnerable to nutraceutical marketing. “That is a big Pandora’s box,” agrees Dr Divakar. Unregulated over-the-counter products with unsubstantiated claims are preying on a woman’s vulnerability. What most ignore is the fact that a supplement is at best an add-on to a nutritious diet and not a replacement for whole foods. “Most Indian women are deficient in Vitamin D3, K2, B12, Omega 3, calcium, magnesium — only tests will show the way,” says Dr Divakar. Overuse or incorrect combinations can reduce efficacy and harm gut health. Dr Tulla adds, “Some supplements block absorption of others; timing and protocols matter. Nothing is generic.”

Most supplements piggyback on inconsequential studies, bloated claims, or molecule-based elixirs lacking proper double-blind, randomised, placebo-controlled clinical trials. Thanks to reels, many are ‘influenced’ and are self-medicating with herbal potions (black cohosh, maka root, primrose oil) or are on multiple pills.

A matter of quality control

Dr Deepak Saini, professor, IISC, flags the lack of supplement testing and clinical studies. “There is no clear data on the efficacy of supplements, as adequate testing has not been done. Quality check is a fundamental problem that must be addressed.” In India, some studies have revealed that 70 per cent of 36 popular protein supplements were mislabelled, and 14 per cent had toxins. Regulatory oversight is thin, with reports of only 2,500–3,000 food safety officers nationwide. “We demand ISI labelling and tighter policy control. How sure are you that a pill contains what it professes?” asks Dr Divakar.

Challenges persist

Post menopause, women grapple with loss in bone density, libido, urogenital health, inflammation and cognitive decline. Since sexual health is also worryingly overlooked due to stigma, Dr Divakar advises consulting an OB-GYN to address this oft-whispered woe. On the great calcium conundrum, she says: “Calcium buildup occurs due to exercise, so it is ideal to start exercising early on instead of plugging it with tablets. Calcium works like a bank; if an individual has not built it up by the age of 30, it cannot improve later on in life.” Dr Chauhan recommends a balanced fat intake (saturated, unsaturated, polyunsaturated in a 1:1:1 ratio) and phytoestrogens from plant-based elements like soya. Without these foundations, no supplement works effectively. “Without the right nutritional plan and activity, these supplements are not going to work,” warns Dr Divakar.

Cancer vigilance

During menopause, two types of cancers women ought to look out for are breast and cervical. Preventive health care and early screening are crucial. “A woman usually consults a doctor during pregnancy or family planning; that is the best time to feed in a message about annual health checkups — to check for lumps, or cervical cancer — both detectable, and treatable,” advises Dr Divakar. “Early diagnosis of breast cancer has a near 300 per cent survival rate.”

Incidence of cervical cancer in India is concerning — each year, one woman dies every eight minutes of cervical cancer, most detected at advanced stages. “Test for Human Papillomavirus at 35 and 45, and if it’s negative, the body’s immune system has tackled the virus and you are safe,” she shares.

Hormonal see-saw

The hormonal see-saw has adverse effects on skin — wrinkles, pigmentation, melasma, dryness, skin redness, hair loss and adult-onset acne are common. Dr Manoj Parekh, consultant dermatologist at a Bengaluru hospital, advises, “Consult a dermatologist. Use a neutral PH soap-free cleanser, moisturiser and broad-spectrum sunscreen. Follow a night routine with retinols, hyaluronic acid, vitamin C, and niacinamide creams. For pigmentation, try kojic acid, vitamin C, glycolic acid; for hair loss, peptides, PRP, and topical lotions can help.”

Orthopaedic and spinal surgeon Dr Thomas Kishan at a multi-speciality hospital in Bengaluru, stresses the importance of calcium, parathyroid and vitamin D tests, with further investigation, if required. “Post menopause osteoporosis is most neglected in India. A DEXA scan is used to diagnose, and blood tests help plan treatment. Fall prevention, balance and coordination are crucial. Muscle weakness is common, hence strengthening leg muscles with core and resistance training is vital.”

DISCLAIMER: This article is for information purposes only and is not a substitute for professional medical advice. Readers are advised to consult a qualified healthcare professional for any health concerns.