Menopause can hit you before 40. Here’s how you can tackle it

Undergoing premature menopause can be a tumultuous time for women not only physically but also having to face the stigma surrounding it

For most Indian women, their physical pain and suffering are usually disbelieved. They are misdiagnosed, given tranquilisers when painkillers would suffice, and antidepressants in place of hormone replacement therapy (HRT) to relieve symptoms of menopause. In short: Most women are not trusted to make informed choices about their own bodies. 

Starting their period (known as menarche) is a watershed moment for most women, though what that means varies from person to person. It’s an event surrounded by cliches about ‘becoming’ a woman, instilling pride and a sense of ‘grown-up-ness’ in some women while instilling shame, anxiety, confusion, embarrassment, and pain in others. Of course, not all girls and women menstruate, and not everyone who menstruates is a girl or a woman—and falling into either of these camps comes with its own set of complex feelings and challenges. One in every 4,500 girls is born with Mayer Rokitansky Küster Hauser syndrome (MRKH), a congenital abnormality characterised by a “shortened vagina” and an absent cervix and womb. In India, nearly 1.25 lakh girls are born with MRKH. Most of these girls will discover they have MRKH during puberty, when they undergo all the normal changes, but don’t start their menstrual cycle.

Another one in 10,000 girls and young women under 20 globally will be affected by premature ovarian insufficiency (POI), or premature menopause, in which their periods either never start or disappear in the first few years after they arrive. The absence of periods can be a source of intense grief for these young women and trans girls—a reckoning with their bodies and fertility and a defining feature that marks them out from their peers. Similarly, for trans boys and non-binary young people assigned females at birth, the arrival of menstruation can be a distressing source of gender dysphoria, discomfort, and feeling betrayed by their bodies.

Breaking the stigma

According to Dr. Deepti Pinto Rosario, a gynaecologist, premature menopause affects a small percentage of women. Unfortunately, medical conditions which aren’t as commonly seen are rarely in focus. “It can be a tumultuous time for a woman undergoing premature menopause. It is usually something no woman expects, and accepting it is not easy. Getting the correct diagnosis is the first step, followed by a thorough understanding of what the diagnosis will mean for the woman and her life, how it will affect her work, her relationships, her sex life, and her plans to have kids,” says Dr. Rosario, who adds that when menopause approaches prematurely or early on, periods may begin to get irregular. One may skip a period or two, have longer, heavier periods, or experience random bleeding with no pattern. “This is followed by the complete absence of periods, which is typically associated with menopausal symptoms that may bring about subtle changes, including altered sleeping patterns, making one forgetful, the onset of brain fog, mood swings, irritability, and a progression to hot flashes, vaginal dryness, lower interest in or painful sex, hair loss, joint pains, a racing heart, headaches, difficulty sleeping, dry skin, dry eyes or a dry mouth. Any of these would warrant a trip to the gynaecologist to rule out early menopause. Tests would include a full physical examination, ultrasonography, blood tests, and hormonal profile,” she says. 

Numbers don’t lie

A 2016 study by The Institute for Social and Economic Change (ISEC) states that around four per cent of Indian women experience signs of menopause between 29 and 34 years of age. This figure increases to eight per cent in the case of women between 35 and 39 years. These statistics are particularly jarring, considering women in other parts of the world normally reach menopause between 45 and 55 years, with a mean age of around 51 years. Meanwhile, numerous studies have revealed that the age of menopause can be inherited. A strong relationship has also been observed between siblings, twins, mothers, and daughters when it comes to menopause patterns.

Furthermore, menopause appears accelerated in women whose mothers had early menopause or premature ovarian failure. The study concluded that, while heredity does play a role, the extent of that role is unknown.

A woman’s burden?

There’s a whole mythology surrounding periods, or in this case, the lack thereof, and their symptoms—from acne and mood swings related to pre-menstrual syndrome (PMS) to abdominal and breast pain. As most women are told, this is the “curse of Eve ''; a woman’s lot is to suffer, so they’re told to suck it up and get used to it. 

Dr. Tanaya, who goes by @dr_cuterus on Instagram, says menstrual and hormonal health have been hot topics in recent years, and it’s heartening to note that more and more women are shunning period taboos and speaking out about their monthly experiences. “In most cases, our healthcare system fails us when it comes to early detection of premature menopause. Most physicians are products of the same misogynistic society we live in. Our medical school curriculum is extremely patriarchal and paternalistic. Patients have no autonomy; by that, I mean women. There is an extremely important issue here, and that is the dismissal of concerns. It frequently leads to delayed diagnoses, which can be problematic in cases such as premature ovarian insufficiency or premature menopause, where early intervention can ease the transition,” she says.

Women can go through early or premature menopause for various reasons, including certain surgeries or cancer treatments. The cause of premature menopause is unknown in 90 per cent of women, adds Dr. Tanaya, who also believes oral contraceptive pills are especially beneficial for women transitioning from perimenopause or premature menopause to absolute menopause. “Yes, it can help to tide over the difficulties, but we must diagnose it in time to do so because if a healthcare professional dismisses it and delays care, it’s a woman who has to face the impact on her quality of life,” she says.

Living with POI

Deepti, an English professor in Kolkata, was in her early 30s when she experienced premature menopause. “I had a soft introduction to my diagnosis when my husband and I decided to get pregnant—I was 29 then. I expected it to happen right away, but it didn’t, so we tried a few more times, but it still wasn’t happening, so I did some research and took a blood test, and the results showed that I wasn’t experiencing premature menopause. So we considered IVF. The doctors were attempting to get my ovaries to produce a large number of eggs for the procedure, but they were only getting a fraction of what someone my age would produce, and every time, the eggs were of poor quality and fewer in number. I began experiencing menopausal symptoms shortly before my 32nd birthday,” she says. 

Deepti has discovered on her journey that society can be quite judgmental of couples who do not have children, subjecting her to intrusive questions like ‘when are you going to start a family?’ “It irritates me because people think we’re selfish for not having children and must spend all our time pampering ourselves,” she says.

Early or premature menopause can increase a woman’s risk of osteoporosis and cardiovascular disease. HRT is thought to reduce these risks while also controlling menopausal symptoms. In some cases, consuming foods predominantly made of refined carbohydrates such as rice or pasta could hasten the onset of menopause. On the other hand, eating oily fish, beans, and legumes may delay menopause. Two nutrients that push back menopause are Vitamin B6 and zinc.

Women experiencing early or premature menopause should be offered hormonal therapy unless there is a medical reason not to and should continue until they reach the average age of menopause. By doing so, the hormones that would normally be produced are replaced, says Dr. Rosario, who also believes that no matter how unpleasant a period is, it serves a purpose. “The hormones released during the menstrual cycle affect overall health. They are responsible for keeping skin supple, hair shiny, bones strong, and the brain sharp, ensuring fertility and preventing heart disease. For women to start feeling a lack of these things much before their peers in what should be their prime years can be a truly isolating and devastating experience. Fortunately, with modern medicine, some of these changes can be avoided with hormonal therapy. However, when it comes to fertility, this may not be possible without a ‘donor egg’ (an egg obtained from someone else) and IVF treatments,” she concludes.

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