What menopause is
Menopause is the point when your periods stop for good because the ovaries no longer release eggs and make far less estrogen. Doctors confirm it once you have gone 12 months in a row without a period, with no other cause. For Indian women this often happens in the mid to late forties, which is somewhat earlier than in many Western countries.
Perimenopause
The years leading up to the last period are called perimenopause. Hormone levels rise and fall unevenly. Periods may come closer together, further apart, heavier or lighter. Pregnancy is still possible during this time, so contraception is advised until your doctor says it can be stopped.
Early and premature menopause
Menopause before 45 is called early, and before 40 it is called premature ovarian insufficiency. It can happen naturally, after removal of both ovaries or after some cancer treatments. Women in this group need a medical review, because low estrogen from a young age affects the bones and heart.
Common symptoms
Some women have very few symptoms. Others are troubled for several years. You may notice:
- Hot flushes and night sweats
- Trouble falling or staying asleep
- Mood swings, irritability, low mood or anxiety
- Vaginal dryness, itching or pain during sex
- Passing urine more often or repeated urine infections
- Aching joints and tiredness
- Difficulty concentrating or forgetfulness
- Lower interest in sex
These symptoms overlap with thyroid disease, anaemia, diabetes and depression. This is one reason a proper check is worthwhile instead of assuming everything is due to menopause.
How menopause is confirmed
In women over 45, doctors usually recognise menopause from your age, period pattern and symptoms. Blood tests are often not needed. Hormone tests such as FSH are more useful in younger women or when the picture is unclear. Your doctor may also suggest tests for thyroid function, blood sugar, cholesterol and haemoglobin, and sometimes a bone density scan.
Keeping a simple diary of your periods and symptoms for two or three months before the visit gives the doctor a clearer picture. Note what time of day flushes occur and anything that seems to set them off.
Ways to manage symptoms
Menopause itself is not an illness and does not always need treatment. Management aims to ease the symptoms that bother you and to protect your long-term health.
| Concern | Self-care steps | What a doctor may discuss |
|---|---|---|
| Hot flushes | Light cotton layers, cool room, less spicy food, caffeine and alcohol | Hormone therapy or non-hormonal medicines |
| Poor sleep | Fixed bedtime, no screens late at night | Treating night sweats, review of mood |
| Vaginal dryness | Water-based lubricants and moisturisers | Low-dose vaginal estrogen |
| Low mood | Exercise, talking to family and friends | Counselling or medicines |
| Bone health | Weight-bearing exercise, calcium-rich food, sunlight | Bone density test, supplements |
For moderate to severe flushes, hormone therapy is the most effective treatment, but it is not suitable for every woman. Your doctor weighs your age, time since menopause and medical history before suggesting it. Many herbal and over-the-counter products are sold for menopause. Evidence for most of them is weak and some interact with other medicines, so tell your doctor about anything you take.
Protecting your bones and heart
Estrogen helps keep bones strong and blood vessels healthy. After menopause, bone loss speeds up and the risk of heart disease gradually rises. Simple habits make a real difference over time. Walk briskly or do other weight-bearing activity most days. Eat enough protein and calcium from foods such as milk, curd, ragi, sesame and green leafy vegetables. Ask your doctor whether you need vitamin D. Stop tobacco in every form, keep alcohol low and have your blood pressure, sugar and cholesterol checked regularly.
Screening remains important at this age. Continue with breast checks and cervical cancer screening as your doctor advises.
What to expect at a menopause consultation
- Before the visit, note your last few period dates and the symptoms that trouble you most.
- The doctor asks about your symptoms, sleep, mood, sexual health, past illnesses and family history of breast cancer, heart disease and fractures.
- Blood pressure, weight and a breast and pelvic examination may be carried out.
- Tests are ordered if needed, based on your age and findings.
- The doctor explains the options, including doing nothing, lifestyle changes and medicines, with their benefits and risks.
- You agree on a plan and a review date, usually within a few months if treatment is started.
Costs vary by city, hospital and the tests required. A yearly gynecological check-up is a good time to review how you are doing.
When to see a gynecologist
Book a visit without delay if you have:
- Any vaginal bleeding or spotting after 12 months without periods
- Very heavy bleeding, or bleeding between periods or after sex, during perimenopause
- Periods that stop before the age of 40
- Hot flushes or sleep loss that disrupt work and home life
- Persistent sadness, anxiety or thoughts of harming yourself
- A breast lump, nipple discharge or skin change on the breast
- A fracture after a minor fall, or loss of height
Bleeding after menopause is often due to harmless causes, but it must always be examined to rule out cancer of the womb lining. This article is for general awareness and does not replace a doctor's advice.
This page is general information for readers in India. It is not medical advice. Speak to a qualified gynecologist about your own health.