Opinion Kerala and Maharashtra have acknowledged menopause. Are the rest of us ready to?
Corporate hospitals, with their big money, AI and tech-aided tools, have made their menopause clinics an elite concern implementation
Hopefully, more states will come up with their models to help homemakers and career women in their turbulent 40s and 50s For long, menopause was an inconvenient truth, never given priority in public health narratives. At best, it has been seen as a sad denouement of a woman’s reproductive life, at worst, an irritable mood swing, a foible even. Considering that women’s health in general is circumscribed by their ability to birth a generation, with even chronic illnesses like heart disease coming with a gendered priority tag, menopause is largely seen as an end-of-life compromise or endurance.
Although menopause is one of the most significant biological transitions a woman undergoes after puberty and pregnancy, even advanced information highways in India maintain a radio silence on it. Yet, women spend nearly one-third of their lives in this phase, fending for themselves and suffering pain in the absence of guidance or therapies. The Indian Menopause Society projected that India would have over 100 million menopausal women by 2026, and more recent analyses suggest that it could probably go up to 140 million.
Some argue that it is not a disease, so it has been the least researched, least lobbied for, and least addressed. That’s why when the Maharashtra government launched the country’s first state-run menopause clinics across government hospitals and urban health facilities, a model followed by Kerala days later, it marked more than a significant shift in public health policy.
This policy acknowledges that almost half of India’s population (women make up approximately 48.5 per cent of India’s population) undergo a biological phase that challenges their productive years and can be managed through a mainstream health system. It recognises menopause as a serious risk factor of chronic illnesses like heart disease, obesity and diabetes among women. It gives clinical priority to mid-life health of women without the tag of ageism. The fact that the government is taking such clinics to the last mile indicates that menopause is as serious as cervical and breast cancer screening, the two most talked about campaigns for mid-life women.
It also points to how corporate hospitals, with their big money, AI and tech-aided tools, have made their menopause clinics an elite concern in the rarefied environs of metros, rarely stepping out beyond that. As menopause has been shaded by cultural invisibility, public health clinics indicate there’s a safe space to have conversations around swinging hormones, sexuality, mood changes, hot flushes, heart palpitations, unforced anxiety and depression. A space for everybody, not for privileged podcasters.
Clinically speaking, menopause exposes women to their most severe and unexpected health challenges. As the hormone oestrogen dips, it pushes up bad cholesterol or LDL levels, raising their cardiac risk more than that of men. They even have higher concentrations of total cholesterol than men. A post-menopausal woman is much more likely than a man to die within a year of having a heart attack.
Research geared towards male physiology has not been fair. Even the one on hormone replacement therapy (HRT), which has now been found to be biased and flawed, has denied women solace. Evidence now shows the benefits of HRT for treating menopause symptoms outweigh the risks for many women, particularly when initiated within 10 years of menopause or before age 60. Recent studies show significant reductions in mortality and risks of heart disease, osteoporosis and dementia.
Public menopause clinics are the first acknowledgement of what women need beyond their maternal issues. But challenges remain in implementation. Our health architecture is simply not geared up for counselling or care. Healthcare staff, including the Anganwadi workers, need to be trained in handling patient queries, draw them out in rural areas and spread awareness in communities and homes. Doctors need updated evidence on hormone therapy and lifestyle interventions. Most importantly, all services will have to be integrated with regular health campaigns and check-ups.
Finally, acknowledgement of menopause must also come from within the home rather than being outsourced to a mahila mandal session. Gender equity really comes from respecting changes in a woman’s body as much as a man’s. In a country where women are conditioned to put themselves at the end of the line and rarely get screened, much support must come from their families.
Some countries, namely the UK, Italy and Australia, have even acknowledged menopause as a workplace health issue, putting wellness and management policies in place. Considering that women will go through this biological phase for at least eight years in their work life, a little sensitivity will help them extend their tenure in the job and labour markets.
Hopefully, more states will come up with their models to help homemakers and career women in their turbulent 40s and 50s. Women do not need reassurance. But they don’t have to strap themselves in either.
The writer is senior associate editor, The Indian Express. rinku.ghosh@expressindia.com
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