By Ila Ananya
Mridula Koshy, 46-year-old Delhi-based novelist, experienced skipped heartbeats for the first time when she was pregnant. She remembers it as an “almost pleasurable hiccupping sensation,” until she felt it again, 18 years later, but didn’t know it was a symptom of perimenopause. This time it wasn’t pleasurable. It was a “sudden evacuating of my chest,” she says, as though there was a “small but strong animal” inside, that was trying to escape. She decided to see a general practitioner, who sent her to a specialist, who in turn made her do an EKG and wear a Holter monitor for 24 hours. The monitor showed nothing irregular, because in that 24 hour period, Koshy didn’t experience skipped heartbeats – as a result, the doctor showed mild disdain, deciding that she was not capable of accurately reporting her own symptoms.
“What helped me not enter an actual state of panic is a rather lonely search online, which told me that racing, pounding, skipped, or irregular heartbeats are quite often a part of perimenopause,” Koshy says, and adds that she will never know whether her doctor skipped the chapter on menopause in his textbooks, or was blinded by his inability to see past the idea of women being neurotic. What she cares about instead is the loneliness of the experience – perhaps it’s a loneliness that Mayuri Mittal also refers to when she talks about her perimenopause, that lasted until she joined Club 35+, started by Dr Jaideep Malhotra, gynaecologist and President of the Indian Menopause Society. The club aims to educate women not only about menopause, but also about women’s health after a certain age. Mittal, who attends the Agra chapter of the club (there are 42 chapters) that has around 140-150 women says, “The best part is that you meet so many women, and when you start talking, you suddenly realise you have similar symptoms that you didn’t know were symptoms.”
Ashu Mittal, who helps Malhotra run the events organised by Club 35+ says they have a WhatsApp group for its members, on which she puts out a list of topics – like breast cancer, diabetes, bone density – for sessions that happen every alternate month. The topic with the most votes is chosen, and the women are then invited to attend interactive sessions with doctors who talk about these problems. Mayuri Mittal remembers the session on breast cancer most clearly, during which around 150 women were taught how to examine their breasts. Malhotra says, “The idea is to simply make women aware of the different changes that take place in their body before menopause, and to keep them on the look-out for various problems like diabetes or cancer, whose risk increases with age.” The club also includes tests that women can take, for diabetes and heart problems, or conversations about their diet, and exercises that they can do.
The many symptoms of menopause include hot flashes or night sweats, depression, reduced interest in sexual activity, vaginal dryness, bladder discomfort, tiredness or joint ache, and can even cause an increased risk of osteoporosis or cardiovascular disease. Sometimes it may cause a rise in blood pressure, or diabetes, if there is a history of it in the family. Some women sometimes get breast lumps that are harmless but need to be screened either way, and while irregular periods are common, heavy bleeding needs to be investigated immediately, because it could also be a sign of cancer.
My aunt, a 52-year-old from Bangalore, has phases in which she feels extremely warm and begins to sweat, and then rushes to turn on the fan even when it’s perfectly cool outside – it’s so embarrassing, she says as she wipes her cheeks on her kurta – and she now carries lots of tissues with her every time she goes out, just in case of a hot flash. While she knew the reason she was getting hot flashes was because she was close to menopause, Sriya Mahesh*, who used to work as a software engineer in Hyderabad says that during her perimenopause, she didn’t know what was happening. She remembers how she would keep feeling really upset about small things that happened at home, but didn’t know why – “I thought I should meet a therapist,” she says.
Mahesh is perhaps one of many women who have been uncertain of the symptoms of menopause that can last from a few months to a few years both before and after it. In her case, it was also because she says she was 39 when this happened, and didn’t expect it – she spent a long time wondering about whether there was reason enough for her to meet a doctor. Recently, a study by the Institute for Social and Economic Change reported that there has been a drop in the age at which women hit menopause in India – 4 percent of women seem to be hitting menopause between the ages of 29 and 34, while 8 percent of women seem to hit menopause between 35 and 39 years. When Mahesh finally did go to a gynaecologist, she said that it was perhaps because of her smoking habit and stressful work lifestyle, before straying away from providing her with medical advice, to asking her if she was married, and adding that if she had been, then this would never have happened.
It’s strange that doctors either don’t seem to recognise the symptoms of perimenopause as serious ones, or don’t talk about women’s health as openly and without judgement as they should, even with their women patients themselves. While Malhotra suggests that a part of the problem might come from symptoms being ignored because they are considered well-expected and common, and therefore not serious enough to merit time and attention, a gynaecologist we spoke to who didn’t want to be named, says that very often, when women don’t realise they are going through perimenopause, they end up going to general practitioners or physicians, as Koshy did.
The women are then sent to do a bunch of tests, but nobody thinks of perimenopause as an explanation for their symptoms – “We have become so specialised in our fields, that very often we fail to make other connections, or assume that the patient has been to another doctor who has done their job,” the gynaecologist says. In most cases, Malhotra says, women who come to her with symptoms of perimenopause just seem to need some reassurance. She says, “They just need to be told that this phase can last for a couple of years, and that it’s because of hormonal changes. Doctors need to be able to give their patients that much time, just to listen to them. Listening can also throw up possible family issues that happen when nobody understands what she is going through, and in these cases, bringing in family might also help.”
Kavitha Hegde, who lives in Bangalore, says that going on walks every morning helped her deal with the mood swings that came with perimenopause, and Mayuri Mittal, who runs a generator factory with her husband in Agra, says that working helps her feel better. As Hegde said, “It’s important for women to create rhythms for themselves, and find things they enjoy doing, so that they don’t feel isolated during this period.” The experience of menopause doesn’t have to be isolating or scary: just talking about it, with friends, or in forums like the Club 35+, and seeking support can make the transition easier.