Q & A with Dr. Rani Bhat

Menopause: Why It Happens & What To Expect


Menopause affects women in different ways as they enter a new and significant phase of life. Like many life-altering conditions, menopause may have emotional repercussions as well as physical. Some women feel a sense of loss with their infertility and decreased sex drive, the anxiety can send many women to depression. Some women may develop mood swings and sleeping disorders. Then there are women who are actually glad that they will no longer have to cope with menstrual cycles.

Even at the physical level, menopause manifests through various symptoms in different women. As many as 25% of women will display no symptoms at all. The other three-fourths may experience a wide variety of symptoms from hot flushes, weight gain, aching joints, sleeplessness, and inability to focus. Women start menopause at different ages, usually between 45 and 55 years and the average age is generally taken to be 51 years. There are exceptional cases where a woman is struck with menopause in her thirties, a condition also called premature ovarian insufficiency.

In many cases these physical and emotional symptoms are mild. However, they can be troubling at times; in such cases, only health care professional can help you deal with whatever is happening to your physiology. We can customize the treatment to your individual requirements. Some of your questions and doubts may be answered here. This article may be particularly useful to women who have perimenopause, i.e. the condition, in which the body is making the transition to menopause.

Menopause explained

Oestrogen Levels

Oestrogen levels

Menopause is that threshold in every woman’s life when her menstrual cycles stop and her ovaries lose their reproductive capability. This condition is brought about by hormonal changes. During her fertile years, a woman produces an egg each month due to the release of three reproductive hormones called oestradiol, oestrone and oestriol. Collectively these hormones are simply known as oestrogen. The hormones are chiefly produced by the ovaries but small amounts are also generated by the adrenal glands, and by the placenta during pregnancy.

The same oestrogen gives rise to female physical characteristics at puberty and regulates a woman’s reproductive cycles thereafter: the ovulation, in which an egg is released each month and implanted in the womb (uterus). Oestrogen is also responsible for the thickening of the lining of the womb to protect the fertilized egg. Monthly periods happen when there is no implantation in the womb. If there is no pregnancy, the lining of the womb is shed in the form of blood.

As women age, number of eggs in the ovary is decreased with a correspondence reduction in the ability to conceive. This also triggers lower oestrogen production and causes an alteration in biological characteristics. The process towards the stoppage of oestrogen production takes several years and accelerates during the months of the perimenopause when the symptoms begin to manifest. Even the menstrual blood flow reduces till the woman reaches the age of 51 or 52 when the menstruation stops altogether and menopause happens. There will be no more ovulations, no menstrual cycles and no further pregnancies.

What happens in the body?

Menopause symptoms

Menopause symptoms

Menopause is more of a physiological change than a medical condition. That said, the diminishing production of oestrogen can cause distressing symptoms, which needs medical attention.

The most common symptom of menopause is:

  1. Hot flushes, occurring in three out of four women

  2. Sweating at night

  3. Dryness in the vagina

  4. Sleeplessness

  5. Urinary incontinence & urinary tract infections

  6. Skin irritation

  7. Mood swings and

  8. Weakened sexual desire

The symptoms hugely vary among individual women in their severity, duration and how they impact the women. Lack of adequate oestrogen affects many other parts of the body. It affects the brain with changes in emotional health and influences the elasticity and thickness of the skin. It also has long-term health implications. Changes caused to the body due to lack of oestrogen affect the density and the strength of bones, increasing the risk for osteoporosis or thinning of bones. The female skeleton depends on oestrogen to maintain bone strength and protect against fracture. There is some evidence to suggest that oestrogen deficiency leads to chemical changes in the body, which increase the risk of heart disease or stroke in post-menopausal women.

Confirmation of menopause

Hot flushes

Hot flushes

Since menopause is a progressive phenomenon, it is not always easy to identify the actual time of menopause. Though irregular periods and hot flushes are sure signs of perimenopause, pinpointing the arrival of menopause is quite difficult, particularly for women who are on the OC pill or those taking Hormone Replacement Therapy (HRT) for the alleviation of perimenopausal symptoms.

Confirmation of menopause may sound like a moot point, but it is better to know the date of your final period. This helps you to respond to symptoms in a more appropriate manner and also aids in decisions pertaining to contraceptives. No wonder, most health care practitioners will advise menopausal women in their forties to continue being protecting during sex for two years after the last period or for one year if you have crossed 50.

The majority of doctors evaluate the menopausal status of a woman according to the accompanying symptoms like menstrual behaviour, the hot flushes and her general medical record. Though a simple blood test can measure the level of a reproductive hormone called Follicle-Stimulating Hormone (FSH) can indicate menopause, the results are not always accurate. Hence, elevated FSH levels are no longer taken into consideration in diagnosing perimenopause or menopause in women over 45 years of age.

Some women may have undergone a hysterectomy by the age of 50 and may also have their ovaries surgically removed for other medical reasons. Removal of ovaries results in an automatic onset of menopause irrespective of age and such women will experience all the symptoms and physiological repercussions of natural menopause.

Lifestyle changes during menopause

Lifestyle changes

Lifestyle changes

So how do you deal with menopause and how does it affect your normal life? a healthy lifestyle can mitigate some symptoms of menopause. Here are some ways to better love your body after menopause:

  1. Take care of your bones and heart: Since decreased levels of oestrogen can increase the risk of heart disease and osteoporosis, a healthy diet in favour of the heart and bones is essential. Keep your diet low in saturated fat and salt to protect against high blood pressure. At the same time make sure your food intake is rich in calcium and vitamin D, which strengthens the bones. Some women consume dietary supplements to get balanced nutrition.

  2. Exercising: Many menopausal women are troubled by increased anxiety. Regular exercise is a positive way to convert stress into actionable energy, which is also good for the heart. Try a daily regimen of physical exercise consisting of several activities like cycling, swimming, and aerobics or jogging.

  3. Quit smoking: Smoking can actually lead to early menopause and put you at a higher risk of developing Coronary Heart Disease (CHD) and osteoporosis. The former is the most common cause of death in women.

  4. Drink in moderation: Hormonal imbalance and excessive alcohol is a risky combination. Alcohol is associated with breast cancer in women and increases hot flushes. If you are a regular drinker, restrict the consumption of alcohol.

  5. Have regular check-ups: Though regular health screenings are anyway advisable after the age of 50, studies have linked late menopause to increased risk of breast cancer so ensure you include mammogram in your screening.

  6. Be calm and positive: Since hormonal imbalance is closely associated with stress, anxiety and even depression it is critical to be relaxed and maintain a positive frame of mind. If you find it difficult, learn relaxation techniques or consult a counsellor to help you cope with anxiety.

  7. Alternative therapies: Though complementary and alternative treatments have become popular with many women, there is little scientific evidence to support their effectiveness or even their safety. Still, some women may find them useful in alleviating their symptoms, though they cannot have a significant impact on bone density or the blood vessels of the heart.

There are many alternative and complementary therapies and finding the right one for you can be challenging. However, acupuncture, herbal supplements, aromatherapy, homoeopathy, yoga, reflexology and even hypnotherapy have been known to be useful during or after menopause.

Hormone replacement therapy (HRT)



HRT is the most popular form of treatment for menopausal symptoms. As the name suggests it is simply a procedure of replacing the lost hormone oestrogen during menopause. HRT relieves the troublesome symptoms caused by lack of oestrogen. The efficacy of HRT in alleviating symptoms like hot flushes, osteoporosis and vaginal dryness, sleep disorders and mood swings have been recorded.

However, it is equally widely known that some women under HRT for the first time experience deleterious side-effects such as leg cramps, breast tenderness, bloating, nausea, depression and irritability. Though these side-effects resolve themselves after a few months, changes may be required in the type or route of HRT and in the dosage of medication.

Though HRT is proven alleviator of menopause symptoms, there is much debate about its long-term safety on women’s health. Some experts have raised concerns that HRT may enhance the risk of breast cancer and heart disease. So, talk to your doctor before you start HRT.


Menopause is the natural termination of a woman’s fertility and presents itself as a medical condition with physiological changes in women’s bodies. These changes manifest in both emotional and physical symptoms, which have been enumerated above. The symptoms can range from mild to acute and depend on the physical health and frame of mind. While some women feel that their bodies are undergoing dramatic changes, others hardly notice the changes.

The important thing though is to be aware of the changes taking place in your body and take the advice of your doctor if you need medical help. There are various therapeutic interventions available to women who need help in alleviating their symptoms and maintaining their long-term health.

However, your health is your responsibility. To keep your body healthy and your mind strong, maintain a positive attitude and keep calm. You should also maintain a balanced diet and supplement it with calcium and vitamin D to strengthen your bones. Physical exercise is another way to convert anxiety into positive energy. The good news is menopause is a good time to treating your body the way it deserves to be treated.

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