Breaking India’s silence on menopause

Menopause remains a taboo topic in India, leaving many women without proper support and vulnerable to chronic conditions linked to this transition. Raising awareness is crucial to breaking stigma and supporting wellbeing.

In India, patriarchy and cultural attitudes ensure that menopause hardly receives any public acknowledgement. Photo: Loren Joseph

Sandhya Patel was 45 when she started to notice changes in her behaviour. She had always been a calm person, but this resident of Indore in India’s Madhya Pradesh state found herself losing her temper with her family, which comprised her husband, two children, and mother-in-law, over minor matters. She also fell into depression.

“I did not know what was going on. I had a lot of anxiety and felt disconnected with the world,” Patel says.

Things came to a head when one day she was overwhelmed by an urge to end it all. She went to the top floor of her house, all ready to jump—until the thought of her children stopped her: they might never recover from the trauma.

“It was just a moment that saved me,” Patel says now. “Had it not occurred, I might have jumped. That’s when I knew that I had to find out what was happening to me.”

She went online and discovered that the changes in her mental health and behaviour were correlated with menopause. She had always known her periods would become irregular and eventually stop altogether. “But I was taken by surprise when they were accompanied by other changes; some very fundamental to my physical and mental health.”

In India, patriarchy and cultural attitudes ensure that menopause hardly receives any public acknowledgement as women’s health is mainly viewed through the lens of reproduction. Because it marks the end of fertility, menopause receives little attention from society or the health system. With limited knowledge about its impact, many women remain unaware of the health effects of declining oestrogen—and how to manage them.

Menopause: A taboo topic in India

Most women reach menopause—the permanent end of menstruation and the reproductive years, defined as 12 consecutive months without a period—between the ages of 45 and 55. Perimenopause, the transitional period before menopause when the ovaries produce less of the hormone oestrogen, can cause symptoms like hot flushes, brain fog, and mood swings that have significant impact on women’s lives.

In the coming decades, the number of Indian women who will reach menopausal age is expected to rise sharply, up from 96 million who were 45 or older as of the 2011 census, to 401 million by 2026.

“Though stigma around menstruation persists in many societies, menopause has another layer of stigmatisation. It’s not talked about since it marks the end of a woman’s reproductive period.”

Despite the growing cohort of women and a gradual openness around menstruation, menopause is an under-discussed topic. “There is complete silence about menopause in our society,” explains Dr Sampurna Kundu, a post-doctoral research fellow in epidemiology in the Faculty of Health and Life Sciences at the University of Exeter.

“We have started to talk about periods and what adolescent girls go through. We have come a long way in terms of menstruation and are even talking about period leave. Though stigma around menstruation persists in many societies, menopause has another layer of stigmatisation. It’s not talked about since it marks the end of a woman’s reproductive period.”

In Indian society, as across much of the globe, women's health programmes target maternal and reproductive health. Menopause is not something the country’s health system has adequately addressed, leaving a significant gap in care and awareness.

This means women are often left to navigate this transition without medical guidance, emotional support, or reliable information.

“I learnt coping mechanisms on my own,” Patel says. “I started yoga and other exercises, which was helpful in reducing stress. Whenever I felt anxious or angry, I went window shopping to distract myself. I did it all by myself, thanks to the internet.”

Increased risk of non-communicable diseases

Societal attitudes and lack of awareness leave women in India more vulnerable not only to shorter-term symptoms associated with perimenopause and menopause, but also to non-communicable diseases (NCDs) as oestrogen levels decline. These include cardiovascular disease, osteoporosis, and stroke. They are also at increased risk of depression and anxiety, especially if they have been diagnosed with a mental health condition earlier in life.

Women in India are at increased risk of non-communicable diseases as oestrogen levels decline. Photo: Antoine Bernardini

“Menopause can lead to weakening of bones, which can further result in osteoporosis and increased possibility of bone fracture. It may also lead to weakening of muscles. We have seen cases where women fall while just standing,” says Dr Suvarna Khadilkar, secretary general at the Federation of Obstetric and Gynaecological Societies of India (FOGSI). 

“Heart health also takes a hit. It is known that women have better heart health compared to men, mainly because of the presence of oestrogen which is found only in women. Therefore, reduction in oestrogen puts them at higher risk of heart-related health issues in the post-menopause period.”

Menopause also affects sexual health due to vaginal dryness and lower libido. “Oestrogen plays a huge protective role in women's lives,” explains Dr Harjit Singh Bhatti, a geriatrics doctor at the Sitaram Bhartia Institute of Science and Research, Delhi. “Its reduction makes it difficult for women to make sense of life when so many things start to happen suddenly. This is a phase when they need support within the family as well as through our health systems.”

“Cancers, diabetes, heart attacks, and arthritis are considered bigger problems. However, the truth is that if management of menopause is promoted, then the root cause of many of these conditions will also be treated.”

Despite such health implications, menopause-related conditions are often misunderstood or dismissed as an inevitable part of ageing. “We get patients at a very late stage when they have already suffered a lot. While it’s true that menopause comes at a certain age, the conditions it leads to can be treated or managed. They should not be dismissed as if nothing can be done about it,” Bhatti says.

Likewise, Kundu says menopause is often sidelined in favour of tackling “bigger health issues” that affect ageing populations. “Neglect of women’s issues is closely linked to the silence around menopause; cancers, diabetes, heart attacks, and arthritis are considered bigger problems. However, the truth is that if management of menopause is promoted, then the root cause of many of these conditions will also be treated,” she notes.

Premature menopause on the rise

Compounding the urgency is the growing proportion of Indian women experiencing premature menopause—when menstruation stops before the age of 40—which a 2024 study co-authored by Kundu estimated at 2.2%. The prevalence of early menopause (occurring between 40 and 44) was estimated at 16.2%.

There is a strong association between early onset of menopause and social factors such as illiteracy, low-income backgrounds, and poorer nutritional habits. The study found that women in rural settings are more likely to experience premature menopause than those in urban areas, a finding backed up by subsequent research.

Kundu notes the irony that early onset of menopause is actually driving more conversations about it than ever before. “This is because women are not able to reproduce when they are expected to, and that is creating problems for families.” But she cautions, “Even if menopause starts to be talked about in this context, it is still only about reproduction. Women's health is not the focus.”

Raise awareness to change the conversation

Experts point to increasing awareness as a crucial step to ensuring menopause is recognised, understood, and properly managed. Husbands and other family members usually are not able to deal sensitively with the changes that the woman is going through. “There is only one solution to such problems: raising awareness,” says Bhatti.

He recommends campaigns to educate people about the difference between normal ageing and abnormal ageing, where memory and behavioural changes occur due to factors other than ageing such as menopause.

Khadilkar says change is happening, albeit slowly, and is beginning to be reflected in more women seeking help and accessing medical care. “We are seeing more people talking about it and approaching doctors for treatment,” she says.

One of the most effective treatments is menopausal hormone therapy (MHT), which entails oestrogen, progesterone, and sometimes testosterone, to manage the symptoms.

“Contrary to common view, menopause and conditions arising out of it can be managed. Depending on medical condition and need, women can take MHT, which can help in reducing hot flashes and night sweating,” Khadilkar explains. “Bone loss, mood swings, sleep disturbances, and other symptoms can also be addressed. It can also slow down the onset of NCDs like osteoporosis and cardiovascular disease.”

However, MHT is expensive, beyond the reach of many households. It is not covered by the government’s flagship insurance programme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna (AB-PMJAY), and estimates suggest that the cost varies between Rs1,000-3,000 (US$12-35) a month, a sum only a few can afford.

“When we know that so many women in India are going to be affected by a condition, that should become a part of policy where they can approach health systems and get timely treatment.”

Khadilkar also recommends mandatory preventive checkups for women over 45 to help detect menopause-related health issues early and begin timely treatment or management.

Pointing out women’s health should be viewed more broadly, Kundu says, “When we know that so many women in India are going to be affected by a condition, that should become a part of policy where they can approach health systems and get timely treatment.”

Patel, the Indore native who found her answer without support, says spreading awareness is essential to ensure better access to health services.

“Women should be encouraged to form peer support groups so that they can share experiences and information,” she says. “I was able to manage because I am educated and knew how to go on the internet. Not every woman can do that.”