“I have got this offer for a menopause ad for the four of us!”
Twelve minutes into the first episode of the second season of ‘Fabulous Lives of Bollywood Wives’, Maheep Kapoor declares this to the group.
What follows is an almost eight-minute conversation on menopause in which the four glamorous women express, acceptance, denial, shame, reluctance to use the word vagina.
The highlight of this episode is a cool doctor who says “We are going to live one third of our life in the post-menopausal phase, so we better know what’s it all about.” Sadly, many women don’t know what menopause is all about.
Women’s health is a neglected topic, perhaps the only time their health seems to gain some societal importance is during pregnancy and childbirth, anything apart from this are ‘those things’ which should not be talked about in the open’ even within their intimate circle.
Menopause is one such a topic which falls under the label of ‘those things’. It’s one of ‘those things’ which we have expected women to quietly manage by themselves.
Unlike pregnancy or puberty which results in physical changes of the body, menopause sometimes remains unseen to others. Family members and friends may also not perceive menopause as something with which they need to engage. But, once a woman enters menopause, there is an invisibilisation of her reproductive health needs. To make matters worse, along with menopause comes the burden of ageism.
Apart from the stigma around women’s bodies, the stigma of ageism also prevents us from working towards a well thought of approach to address the needs of women during various phases of their menopause.
Geeta J, an activist who leads the Age not Cage campaign says, “Older people feel discriminated against at work and by society, especially women, as they are not deemed fertile and young."
"Most of the time their ageing bodies are seen from a male gaze. Women prefer to keep silent about menopause and its symptoms because of the fear of discrimination and being labelled as old.”Geeta J, Lead Activist, Age not Cage
Menopause occurs when a woman hasn’t menstruated in 12 consecutive months, and can no longer become pregnant naturally. It usually begins between the ages of 45 and 55, but can develop before or after this age range.
It is, as they say, a “normal” part of life and living. However, hidden within anxieties around fertility, ageing, and changing bodies, menopausal health is medically under-served and culturally blindsided.
Research shows that attitudes towards menstruation are defined by cultural context.
Cultural stigma has direct, measurable negative impacts on menopausal health. Because of imposed cultural silence, women face barriers to accessing healthcare, or even articulating the evolving need for care.
A menopause survey was recently conducted by women’s health start-up TheaCare and Dr. Meenakshi Ahuja, senior Gynaecologist and Obstetrician at Fortis Hospital, New Delhi.
It shows that cultures of patriarchy and silence prevent women from finding the right help at the right time, leading to various health challenges, and major emotional difficulties.
More than 75% of women said they were unprepared for menopause, nearly 80% said that they faced major emotional difficulties. Nearly 90% of respondents did not have a gynaecologist supporting them regularly through the menopausal phase, and some did not know that a doctor was even needed. 50% women reported that they experienced being impatient with people, had memory troubles, and felt tired or worn out. Lack of medical help causes strains on self-esteem, workplace dynamics and familial relationships.
An overwhelming 78% women said that better explanation of the role of nutrition and exercises in managing menopausal symptoms, is a change they want to see in healthcare.
Call To Action
In developing economies like India, we need to accelerate cultural change, medical response as well as public health messaging in order to improve women's health in the post-fertility stages. The path forward should include:
1. Dedicated policy changes and data
In 2019 Lok Sabha responding to a question on the need for a National Menopause Policy Smriti Irani the Women and Child Development then replied there is a need for more research and discussion. She was right because before formulation of a policy on menopause we need data which is currently lacking.
This is an area where the government’s pre-existing systems can be leveraged. The National Family Health Survey is one such exercise/program which has been collecting valuable data on women’s health.
Expanding the current scope to collect more data about menopause would be an important step to develop any scheme or policy to address the needs of people going through menopause.
2. Upskilling of doctors
Currently, the India Menopause Society founded in 1995 with more than 30 chapters is an important forum for medical and non-medical professionals to organize local events and Menopause Day celebrations. Forums such as these can help doctors be better equipped to help women in perimenopause and menopause to deal with medical and emotional aspects of this phase of life.
3. Better public health messaging around women's health post-50
Menopause can be built into existing programmes run by the government and NGOs, on sexual and reproductive health. This will increase the capacity of urban and rural primary health centres to address the needs of menopausal women.
4. Private sector players
Startups like Zomato and Swiggy have already paved the way with conversations around Menstrual Leaves. Women over 40 form an important part of the working population.
With women’s labour participation decreasing in the recent years, it is important to recognise menstruation, maternity as well as menopause as part of the workplace agenda.
According to the National Statistical Office’s Elderly in India 2021 report, by 2031 India would have 101 million women aged over 60. World Health Statistics report of 2021, says despite Indian women living longer they necessarily don’t lead healthier lives.
A lot of reproductive health ailments affect women as their bodies age. The repercussions go beyond the household and without proper care and support we may be looking at massive socio-economic costs to the country. Now is the time. We must write Menopause into the agenda.
(Mayuri is a menstrual health advocate and host of Dignity in Disasters podcast. Swarnima Bhattacharya is a FemTech entrepreneur currently building Gytree for women’s health. They are both part of World Economic Forum’s Global Shapers Community.)
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