New Delhi: The world recently marked Menstrual Hygiene Day on May 28, with an aim to raise awareness about menstrual hygiene management and break the unnecessary taboo and stigma associated with the subject. For the last two years, the day has been marked with the theme – ‘Making menstruation a normal fact of life by 2030’, with in a bid to work towards the overarching goal – to build a world by 2030 where no one is held back because they menstruate.
In the midst of raising awareness on menstrual health and hygiene, NDTV-Dettol Banega Swasth India focused its shift from menstruation to menopause, a stage in a woman’s life when she stops having her menstrual periods. We changed the focus to understand the symptoms and how to cope with the physical and emotional transition that a woman goes through during this critical phase. To help understand the matter, the team spoke with various experts, who detailed how complex menopause can be, what is the transformative journey a woman experiences and the significance of providing support, resources, and information to women navigating this period of transition.
Talking about if there has been a change in the society in hesitating aware from discussing menopause and the work done by multidisciplinary national society, ‘Indian Menopause Society’ has done in spreading awareness on the symptoms, Dr. Pushpa Sethi, senior practising gynaecologist, National President of Indian Menopause Society, said,
Menopause is a stage a woman has to pass through. So the Indian Menopause Society has been there for almost 28 years now and we have been working tirelessly to bring this message to every woman that the changes happening in our body at this point of time needs to be understood, such has vasomotor symptoms, hot flashes, changes in bone strength, psychological changes, changes in her vaginal mucosa and urinary infections among others.
It is important to make a woman aware that the problems she faces during the transition period needs to be conveyed to a doctor and not supposed to be born in silence, Dr. Sethi added.
We need to guide women properly about the changes she will see, the lifestyle management she has to take care of. The life that she lives beyond 47 years can be a really healthy one.
Explaining the pre-menopause and post-menopause stages, Dr. Vandana Narula, National Chairperson of the Indian Menopause Society, informed that the age of menopause in India is around 45-47 which is extendable to 50-52 years. So all the symptoms of perimenopause, the period where the menopause is approaching would be around after 35 or 37 years. And after 40, the woman may start experiencing certain problems associated with menstruation.
If the woman is careful during that period, the menopause is going to be a smooth ride. And once you get a menopause, the golden period where she can manage her symptoms is around five to six years, where if she’s very careful, the rest of the menopause is going to be a good one.
Detailing how menopause affects a woman’s heart, Dr. Ashok Taneja, Cardiodiabatologist, National President-elect for the Cardio-diabetes Society of India, said,
Firstly, it is to be noted that the postmenopausal period is unnatural, it is not a disorder. Secondly, when there is a postmenopausal period, there are certain changes in the hormonal levels in the body: oestrogen comes down, there is a chance of insulin resistance, and there is a chance of renal hypertension. When there are low insulin levels or it is not acting properly, it will raise the blood sugar levels, which further leads to more atherosclerosis, which means blockage inside the arteries of the heart, leading to heart problems. That is why the incidence of heart problems in the postmenopausal period will increase.
To prevent this, it is important for every woman to get regular health checkups done as a prevention key, he added. Dr. Taneja also laid emphasis on maintaining a healthy and nutritious diet, exercising regularly, and avoiding smoking.
Detailing the effects of menopause on a woman’s skin, Dr. Sachin Dhawan, Director of Skin and Smile, Gurgaon, said that the menopause stage affects every part of the body due to the relative reduction in oestrogen that takes place.
Menopause affects you from tip to toe, starting from the hair to the skin to other body areas as well. The oestrogen reduction takes place in skin cells, hair cells, colour-producing cells, oil glands, etc. As the levels reduce, the sweat production reduces, and the skin becomes dry, resulting in lines and wrinkles. Due to the dry skin, the woman is also prone to allergies, because there is no hydration in the skin. The external allergens can enter, and they can create a reaction and an allergic reaction.
Talking about the effect on the hair, Dr. Dhawan said,
In menopause, a female may experience extreme hair loss, which we call a female pattern hair loss and the facial hair growth tends to increase. So either hirsutism, which is thick hair, develops or hypotrichosis, which is thin facial visible hair, starts to develop around the perimenopausal age group, around 42–43 years.
Dr. Taneja said that at this stage, a woman may also experience hot flashes on the face, rosacea, and facial sensitivity.
This is also a time when people experiment with a lot of anti-ageing products, retinols, etc., and social media is full of it. A lot of patients come back to us with the reactions they face after using these products. These products, without guidance, accentuate the barrier breakage, which happens naturally as a result of lack of oestrogen. Typically tip to toe everything can change if care is not taken.
Menopause also affects bone density, said Dr. Sidhant Narula, Bone and Joint Specialist at Fortis, Gurgaon.
The bone density goes down about 10 per cent within five years of entering the menopause stage. Because of the hormonal changes, the bone density decreases because the oestrogen level falls down. So, during the menopause and around the peri-menopausal time the bone density decreases. There are ways to counter and one of them is maintaining your muscle mass. This will help in maintaining bone density.
Dr. Narula said that decreasing bone density makes a person more prone to fractures. Hence, it is important to increase the fibres and protein in the diet.
There were several citizens, who sent across their questions for doctors regarding menopause. Kanchan from Delhi is at her suffering menopause stage. She said that she did not receive any kind of support from her family during the transition period, when she was experiencing irritability, anxiety and sadness and other phases. Her family thought that she was going through serious health problems and needed treatment. She asks the doctors how could she make her family understand and overcome the challenges she is facing.
To this, Dr. Pushpa Sethi said,
When you enter the peri-menopausal age, the menopause and then the post menopause, the psychological changes are part of the whole plethora of changes happening during this time. The woman may experience depression, loss of sleep, loss of self esteem coupled with the family problem that may or may not prevail. So, at this point of time, it is not only the medications that are important, it is very important that the whole family understands what a woman is going through. A family’s support is more important than the medications.
Dr Taneja said that it is important to detox the body and mind.
Body detoxification includes your diet, from cutting down carbohydrates to increasing protein intake. One should also increase fibrous foods and avoid refined foods, from salt, sugar to flour, as these are detrimental to the health of the heart. Types of exercises are also important, especially aerobic ones, as they are another way of detoxifying.
Is there a psychological change among the women in their 40s about their skin and hair health issues, Dr. Dhawan said,
There are psychological changes in women. I see women who may have been coming to me from the 20s and 30s, with visible changes in their 40s, despite all the good work that we have been doing with them at the right time. I recommend that the right time to start procedures would be before the changes are set, so late 30s is the right time to start with something very basic and natural like platelet rich plasma therapy injections and having a good skincare regime.
Speaking of the prevention and care one can imbibe, Dr. Dhawan said that it includes lifestyle, dietary, and supplementary changes. The procedures should be the last resort after the first three factors are taken care of, Dr. Taneja added.
Lifestyle changes include eight hours of good sleep, reducing screen time and stress levels, increasing physical activities, and reducing the intake of alcohol and caffeine.
Dr. Vandan Narula emphasised the need for families undergoing counselling sessions to understand the stages of menopause, so they can empathise with and support the women in their families in their tension period. She said it is essential to normalise the conversation around the term “menopause, as it will lead to more discussions and raise awareness.
Dr. Sidhant Narula gave insights on women paying enough attention to their vitamin levels. Speaking of osteoporosis, a bone disease that develops when the bone mineral density decreases, he said it is experienced by multiple women and cannot be solely prevented by increasing vitamin D levels. A woman needs to focus on strength training, as it will help maintain muscle mass, posture, balance, and automatically increase bone mass.
Another citizen posed a question for Dr. Sethi, asking if menopause increases the risk of cancer, to which, Dr. Sethi said,
Normally, after 40, every woman must undergo a mammogram, maybe once every two years. But after 50 years of age, it should be done every year until at least the age of 75. This will help prevent any risk of breast cancer. Women should also know about breast self-examination, as it will help at the basic level to check if there are any lumps. Speaking of cervical cancer, a woman must get a pap smear test every two years after 40 years of age and should do so until the age of 70–75 years. When it comes to endometrial cancer, whenever you have inter-menstrual bleeding or post-menopausal bleeding, there is a high suspicion that you may be having endometrial cancer. So every year, a routine ultrasound of the lower abdomen is essential. That will also tell you the condition of your ovaries, whether there’s something changing or changes happening in them.
So, being aware, knowing symptoms, and preventing them is the right way to go forward during menopause, Dr. Sethi added.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diarrhoea and the country can become a Swasth or healthy India.