Silent Crisis: Early menopause plagues Indian women

Premature menopause is on the rise in India due to a combination of factors such as increasing stress levels, changing lifestyle patterns, and environmental pollutants, leading to hormonal imbalances in women.

Last Updated on July 25, 2023 by Neelam Singh

Geeta Tiwari, who is 45 years old and lives in Motimala village in the Dhanpatganj block of Sultanpur, Uttar Pradesh, had no idea what had happened to her eight years ago. The people around her were clueless about what these bizarre symptoms that had plagued her meant. She wasn’t sure, but she thought she could connect it to her irregular periods. Geeta would have unexpected hot flashes, restless nights, and always feel exhausted. She occasionally questioned whether she had conceived.

Geeta had peri-menopause and finally menopause at the age of 37 while caring for her elderly mother-in-law and cooking for a family of five that included her two boys, her in-laws, and herself. Her husband lived in another city for work. It was a community health worker from ASHA who suggested she meet a gynae to confirm if she was going through peri-menopause.

A Disorder

Premature Ovarian Insufficiency (POI), often known as premature menopause, is a disorder that affects women under the age of 40 and results in improper ovarian function. For affected women, this condition may have substantial physical, mental, and reproductive effects. Menopause typically occurs between the ages of 45 and 55, but unfortunately, premature menopause is now rather common among women.

A 2016 survey by The Institute for Social and Economic Change (ISEC) found that between the ages of 29 and 34, roughly 4% of Indian women start to show signs of menopause. Additionally, the percentage increases to 8% for women between the ages of 35 and 39.

In a study titled “Premature Menopause Among Women in India: Evidence from the National Family Health Survey-IV“, published in the Journal of Obstetrics and Gynaecology Research, the prevalence and risk factors for premature menopause were investigated among 302 557 Indian women between the ages of 25 and 39. The National Family Health Survey-IV (NFHS-4)’s fourth cycle, which was conducted in India between 2015 and 2016, was used as secondary data for this study. According to the findings, 3.7% of the Indian women in this sample experienced premature menopause, of which 2.1% had natural menopause and 1.7% had undergone surgical menopause.

Ground reality and causes

In India, a sizable portion of women experience menopause too early. In addition, rural women, women with higher parity, women who had children earlier in life, and women who smoked had relatively higher rates of premature menopause. This problem does not only affect women in rural areas. Urban women also experience a high rate of premature menopause.

OBG and Gyanae

Earlier premature menopause cases used to be under 1%, according to Dr. Gayathri Karthik Nagesh, HOD and Consultant, Obstetrics and Gynaecology, Manipal Hospital, Old Airport Road, Bangalore. It is now between 1.5% and 2%.

Last week, she had three patients with early menopause symptoms. “One of them had unknowingly taken a medicine during childhood that has contributed to menopause, whereas the other one had undergone IVF treatment. The third one had no plausible reason. I was shocked and upset to have three patients within a month. Earlier, I used to have 2-3 such cases in 6 months, but now it’s 2-3 within a month,” says Dr. Gayathri.

Doctors attribute premature menopause to a number of factors. A decrease in the quantity of functional eggs in a woman’s ovaries is the main factor contributing to early menopause. Genetics, autoimmune disorders, and medical procedures like chemotherapy and radiation, smoking, a bad diet, a lack of exercise, and even the use of IVF treatments and side effects of medication are also responsible for it.

The condition is also brought on by pollution and stress, as well as sedentary habits and variable job schedules. The resulting hormonal imbalances have an effect on their ovaries’ capacity to function normally, which results in an early menopause.

Mumbai-based media professional Anita Bhatia, reached menopause in her 40s and started to have symptoms by the time she turned 38. “It was largely hot flashes, extensive sweating and mood swings. I was unaware that it was pre-menopause or the early onset of menopause. My periods tapered down and then suddenly stopped. I would get spotting once in a while. I was perpetually tired, and if I couldn’t sleep, I’d get cranky,” says Bhatia, who also gained weight during this transitional phase.

Consequences of surgical menopause

Gyanecologist

While Dr Vidya V Bhat, Medical Director, RadhaKrishna Multispeciality Hospital in Bangalore agrees that incidences of early menopause have spiked of which large numbers belong to the category of surgical menopause. When a woman experiences menopause due to surgery rather than ageing naturally, this is referred to as surgical menopause. Surgical menopause occurs after an oophorectomy, which involves removing the ovaries, or a hysterectomy, which involves removing the uterus.

Oestrogen is mostly produced by the ovaries in a female body. No matter the patient’s age, removing them results in an immediate menopause. Estrogen protects the circulatory system, which is good for the heart. It also helps to keep blood pressure at a steady level.

When estrogen levels are high, blood triglyceride levels are kept low, HDL cholesterol (the good cholesterol) is increased, and LDL cholesterol (the bad cholesterol) is decreased.

“It’s really disheartening to see many women opting for hysterectomy because the uterus is not there to just bear children or for your menstrual cycle and there are 101 ways to save the uterus,” voices Dr.Bhat.

Dr. Bhat opposes surgical menopause as it leads to several complications. Surgical menopause or otherwise, menopause is a difficult time, particularly in the years preceding it. 50-year-old Priyal Awasthi, a media professional from Noida, recalls harrowing eczema that had plagued her for years before she hit menopause in her late 30s. She hadn’t removed her uterus and had had normal periods all her life. A working professional who was raising two school going boys at the time had no other choice but to go with the flow, literally. “Suddenly, I had blood gushing while sneezing or coughing. Along with it came profuse sweating and sleepless nights. I also developed severe eczema over my entire body, especially my eyelids at the onset of menopause. The investigations revealed that the uterus developed a thickened uterus lining so I underwent a D&C, a surgical procedure, to remove the lining,” says Awasthi. After three years, she hit menopause naturally.

A taboo topic

Indifference results from a lack of knowledge of this issue in our society. Family and coworkers are insensitive to a woman’s situation since they are unaware of what she is going through. Some even go so far as to make fun of it or mention it casually. I overheard what several coworkers say to another coworker, “I think she’s going through menopause because she’s being cranky or rejecting ideas. This is precisely how we discuss PMS. Therefore, it is incorrect to attribute everything to a woman who is experiencing PMS or menopause, according to Priyal.

Premature menopause would be more difficult to deal with in a culture where there is a lack of sympathy and understanding for menstruation.

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