There is a lot of talk about sex, fertility, menstruation, and even PCOS. But menopause has remained a relatively undiscussed and delicate topic, one that hasn’t been spoken about much in India. Last month though, actors Vidya Balan and Dia Mirza broke that barrier by attending the book launch of ‘Finding Your Balance – Your 360o Guide to Perimenopause and Beyond’. Authored by Dr Nozer Sherier and Shonali Sabherwal, the book educates women about the years leading up to menopause, and how to deal with the shift.
What exactly is perimenopause? It is the phase of transition that women make to menopause. “The word perimenopause literally means ‘around menopause’,” says Pune-based gynaecologist Damini Kochchar. “When a woman’s reproductive years are ending, her ovaries stop releasing eggs and there are irregular menstrual cycles. Not only do the periods occur erratically, but the flow also varies and there may be times when you could skip them entirely. Hormonal changes occur within the body because estrogen levels fluctuate. Along with this, come other symptoms such as hot flashes, sweating, vaginal dryness, mood swings and irritability, insomnia, weight gain, and an increase in cholesterol. Menopause is said to be attained when a woman does not get her period at all for a full year. The entire phase leading up to this is considered perimenopause. It is a significant time in a woman’s life, but since it starts gradually and then tapers off, it might be hard for a lot of women to pinpoint the exact timeline. You can still get pregnant during perimenopause, so don’t throw caution to the winds on that front!”
The Indian Menopause Society says that the average age of Indian women attaining menopause is 46.2, as opposed to the global average of 51. Yet, the silence surrounding the topic of perimenopause is deafening. Why? Because it brings us back to something we have all been conditioned to stigmatise and deny – the process of ageing. Not just that, the symptoms that accompany perimenopause can be hard to deal with. Often, working women don’t want to cater to the perimenopausal trope of the irrational middle-aged woman with mood swings and hot flashes, and it is brushed under the carpet. And so, women also set aside the physical and mental toll it takes on them, to keep up with work.
Think back to last year’s Netflix series ‘Bombay Begums’, one of the very few Indian television shows to throw light on this topic. The lead character, essayed by Pooja Bhatt, is the CEO of a bank. Although she struggles with severe perimenopausal symptoms at the workplace, she would rather cope with it privately behind closed bathroom doors, rather than risk being judged negatively by her colleagues and subordinates.
Coping With Perimenopause Changes
“You have to take care of your physical and emotional health when you’re going through perimenopause,” says Urvashi Khanna, a Delhi-based nutritionist. “Eating right is the first step. First, let’s take a look at what you should avoid. Quit smoking. Quit caffeine and alcohol – or limit them. Quit refined carbs and switch to whole grains. Avoid saturated fats and sugar. Include a lot of fruits, vegetables, and legumes in your diet. These obviously come packed with vitamins and proteins, but they are also rich in phytoestrogens, which can help fight the estrogen dip in your body. Broccoli, carrots, oranges, beans, and peas are all foods to opt for during this period. Consult your doctor and include omega-3 supplements and calcium in your diet, especially if you’re deficient. This will help prevent other complications such as osteoporosis. You might be prescribed an oral contraceptive or other medications if your hormonal fluctuations are hard to control, but make sure you consult a doctor before you start popping these pills. Exercise is non-negotiable during this period. Stay emotionally strong, and don’t get affected by what people think about your struggle. Validate your feelings and get support from female friends. Seek professional help if you find your anxiety and other symptoms spiralling out of control.”
Although perimenopause usually begins between the ages of 40 and 50, it has been known to begin in women as young as 30 (leading to premature menopause) and as old as 55. It usually lasts around four years. Since the tell-tale signs are not standard, the need for a formal diagnosis also varies. Some women are able to make the transition quite easily, while others may need medical intervention to reassure them and help them cope. There is no quick fix unfortunately until you reach menopause. You can only treat the symptoms until then.
The Journey To Menopause Isn’t Smooth
Two years ago, Michelle Obama opened up about her journey with perimenopause in a podcast. “I’m dressed, I need to get out, walk into an event, and, literally, it was like somebody put a furnace in my core and turned it on high. Then, everything started melting and I thought, ‘Well this is crazy, I can’t do this.”
Naomi Watts has also gone on record to say, “I went into perimenopause earlier than my peers and there wasn’t a ton of conversation going on about menopause at the time. My own personal experience echoed what I went through with fertility, which I found to be very lonely and shameful, the notion of not being able to bear children was making me feel ‘less than.’ I knew if I was feeling this way that there were likely others feeling this way and that society’s perspective needs to change.”
When strong, successful women who are role models speak up about their own personal experiences and vulnerabilities with perimenopause, it allows the rest of us to feel empowered about embarking on this brave, new, unavoidable adventure!