Beyond hot flashes: Menopause is India’s silent midlife crisis

CHENNAI: For 44-year-old Kripa Senthil, the hot flashes were unbearable, the night sweats disrupted her sleep for years and the brain fog made even simple tasks feel like she was climbing a mountain. When she finally made an effort to visit a gynaecologist, she was told it was just her hitting the “menopausal age” and to “manage it”.

This is the reality for millions of Indian women navigating menopause, a natural biological transition that, in the absence of awareness and medical support, becomes a silent struggle. As nearly 400 million women navigate this natural transition this year, India faces a healthcare system offering little support, scarce medication and a culture of silence that leaves millions suffering in isolation.

Scale of the crisis

India is expected to have about 400 million women aged 45 and older this year, with nearly 130 million estimated to be in the menopausal phase by 2030. Yet this natural biological transition remains one of the most neglected areas in public health.

Data from the National Family Health Survey (NFHS-5) indicates that 14.66% of women aged 30-49 are already in menopause, with the graph pointing significantly higher than the global average.

The average age of menopause in India is around 46 years, nearly four years earlier than the global average of 51. Doctors say that the early onset, especially in rural areas, exposes women to a longer duration of symptoms and a heightened risk of cardiovascular disease, bone density loss and other chronic conditions.

One of the biggest hurdles in addressing menopause is a serious lack of awareness that’s often compounded by deep-seated cultural taboos. Menopausal women in India face a dual burden of physical symptoms and social stigma.

A study from the Longitudinal Aging Study in India (LASI-1) found that 7.4% of women experience premature menopause before age 40, while 17.5% face early menopause between 40-44 years with states like Andhra Pradesh, Telangana, and Bihar showing a shockingly high rate of premature menopause.

Explaining the phenomenon, gynaecologist Dr Suruchi Jagadish said that while rural women often view menopause positively as an emancipation from menstrual restrictions, the acceptance comes at the cost of dismissing serious health concerns. “Meanwhile, urban women struggle with managing somatic symptoms while cultural norms prevent discussions with male family members, adding psychological distress,” she said.

A national survey of over 32,500 women from underprivileged communities revealed that half were unaware of menopause’s effects, and 62% had no knowledge of available treatments. “The staggering lack of awareness often compounds a cycle of neglect, leaving women without information or support during a critical life transition,” said the doctor.

Risk of cardiovascular issues

The consequences of ignoring menopause extend far beyond hot flashes and night sweats. As oestrogen levels decline, women face increased risks of cardiovascular disease which is already a leading cause of death among Indian women.

Explaining the other symptoms of menopause apart from the most obvious ones, gynaecologist Dr B Anu Jothi, who runs a private wellness clinic in Coimbatore said that that it also pushes women into osteoporosis and metabolic syndrome. “Menopause involves deep physical, emotional, and social transformation that can significantly affect a woman’s quality of life. Typical but under-diagnosed symptoms include mood disturbance, cognitive impairment, sexual function problems and metabolic alterations,” she added.

While the physical symptoms are a heavy burden to bear, the mental health concerns are equally alarming, warn doctors. “Symptoms like ‘accomplishing less than used to’, ‘dissatisfied with personal life’, and ‘avoiding intimacy’ are significantly higher in post-menopausal women. Yet mental health support remains virtually non-existent for this demographic,” noted Dr Anu.

Bias against modern treatments

While the need for treatment is acute, the path to relief is long and arduous, while examining the current scenario prevailing in the country. Hormone Replacement Therapy (HRT), a clinically recognised and effective treatment for managing moderate to severe menopausal symptoms, remains a contentious and often inaccessible option in India.

While globally, HRT is a standard part of menopause care, in India it has been long misunderstood, surrounded by outdated fears, incomplete information, and limited access to expert-led care. Many gynaecologists, influenced by decades-old studies and a lack of formal training in menopause management, remain hesitant to prescribe Menopausal Hormone Therapy (MHT).

“Most healthcare professionals in India receive minimal training on menopause management during their formal education, translating to poor patient care and widespread dissatisfaction among women seeking help,” says Dr Suruchi, who offers menopause counselling to patients beyond 40 in an effort to create awareness on the impending phase.

A study published in PubMed last year to evaluate the awareness of menopause and menopause hormone therapy in India revealed that although 95% of healthcare providers were aware of MHT’s indications, risks, and benefits, a staggering 57% use alternative therapies as first-line treatment, and 71% use them as an adjunct to MHT, revealing significant hesitancy in prescribing hormone therapy.

Gayathri (name changed), a 39-year-old school teacher who was diagnosed with early menopause, said that the whole journey has been one of shock at the lack of awareness and support and struggle in terms of finding the right kind of medical treatment for the issue. “I ended up hitting menopause at 37 and it took me a while to process the situation after I was hit with frequent hot flashes and insomnia.” she recalled.

Her gynaecologist simply shrugged it off as a “normal side-effect of ageing”. “I had to do my own research and find out about HRT to protect my bones from becoming frail and developing heart problems in the future,” rued Gayathri.

However, she noted that there were very few doctors who were willing to listen to patients. To add to the burden, it was very difficult to source oestrogen patches in India as opposed to the easily available pills.

“While pills have a lower absorption rate, transdermal patches are better for those who plan on taking HRT for a longer period of time. Unfortunately, these patches are not easily available in our country, which pushes those who can to source it from abroad,” said Dr Suruchi.

Call for policy, change

Unlike countries like the UK and Australia, India has no dedicated national policy on menopause. The National Program for Health Care of the Elderly suffers from implementation gaps, and there is a severe shortage of trained personnel in menopausal and geriatric medicine.

Experts say that a meaningful change in India’s menopause care scenario can be achieved only with a multi-pronged approach that bridges policy, medical education, workplace culture and societal attitudes.

While policy makers from all the states across the country have to take a collective initiative to establish a comprehensive national menopause policy, medical professionals must ensure that menopause management is taught at undergraduate and postgraduate levels, especially regarding hormone therapy and holistic care.

“Apart from this, society must break the deep-seated culture of silence that forces women to suffer alone. With women suddenly being forced to deal with fatigue, low libido, bone and heart related issues when they are hit with perimenopause and menopause, it’s time to examine the physical and mental toll it takes on them and come up with adequate solutions and support that’s required,” opined Dr Anu.

Karnataka, Maharashtra show the way

Ruthu Thare in Karnataka, India’s first menopause-focused women’s health policy, focuses on public awareness campaigns on peri-menopause and menopause, dedicated menopause screening programmes, district-level breast and bone health screening, nutrition and lifestyle counselling, and midlife women’s health clinics, and ASHA-led outreach to educate women in their communities.

According to the initiative, ASHA (Accredited Social Health Activists) workers will conduct a house-to-house survey to collect data on women in perimenopause and menopause stages and share basic information on health and lifestyle with them. Karnataka plans to begin with awareness, data collection, and support at the community level before taking the proposed women’s health policy forward.

Similarly, Maharashtra has also launched the nation’s first network of dedicated menopause clinics across government hospitals and urban health centres, providing comprehensive medical and psychological support for women navigating this transition. If such initiatives are implemented uniformly across the country, millions of women, especially in rural areas, who suffer in silence due to the lack of awareness about menopause would greatly benefit from it.