Menopause: Breaking the Silence Around a Biological Reality

By Suryavanshi, IAS

Once considered a hush-hush topic, menopause is finally stepping out of the shadows. From Hollywood celebrities to legislative corridors in Washington D.C., the conversation around menopause is growing louder and more serious. With growing recognition of its health, social, and policy dimensions, menopause is no longer a private ordeal — it is becoming a public health and gender equity issue.

As India works towards comprehensive health care and gender-responsive governance, there are critical lessons to be learned from these evolving global developments.

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🔬 What is Menopause?

Menopause marks the end of a woman's reproductive years, typically occurring between ages 45 and 55. It is diagnosed when 12 months have passed since a woman’s last menstrual cycle, brought on by declining levels of estrogen and progesterone.

Before menopause lies a longer, more confusing phase called perimenopause, which can last up to 10 years and is marked by:

• Irregular periods

• Hot flashes and night sweats

• Brain fog, mood swings

• Vaginal dryness and fatigue

After menopause, women enter postmenopause, which lasts for the rest of their lives.

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📊 Why This Matters: The Numbers Tell a Story

• 🌎 Globally, over 1 billion women will be postmenopausal by 2030.

• 🇮🇳 In India, approximately 40-45 million women are currently going through menopause, and this number will continue to rise with increasing life expectancy.

• ⚠️ Women may now spend a third of their lives in postmenopause, making it essential to address their evolving health needs.

Yet, for decades, menopause remained a neglected topic in health policies, research agendas, and public discourse.

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🩺 Hormonal Therapy: From Fear to Facts

Then:

In 2002, the U.S. Women’s Health Initiative study linked hormonal therapy (HT) to increased risks of breast cancer and heart disease. This triggered panic and led to a dramatic decline in its usage worldwide.

Now:

Recent re-evaluations show the earlier study had flaws:

• The average age of participants was 63, far beyond natural menopause age.

• It studied disease prevention, not symptom relief.

• Only one formulation of HT was evaluated.

New research suggests HT is safe and effective when started before age 60 or within 10 years of menopause, especially for:

• Hot flashes

• Vaginal discomfort

• Mood swings

• Sleep issues

HT is now available as pills, patches, gels, and vaginal suppositories, and can include bioidentical or synthetic hormones.

However, HT is not suitable for everyone, especially those with a history of estrogen-sensitive cancers or heart disease.

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💊 Beyond Hormones: New Frontiers in Treatment

• 🌡️ Fezolinetant (Veozah) became the first FDA-approved non-hormonal drug specifically for hot flashes and night sweats in 2023.

• 🧠 Antidepressants and anti-seizure medications are also prescribed off-label to treat mood and neurological symptoms.

• 🌱 Cognitive Behavioural Therapy (CBT) is now being recommended as a psychological aid for some menopausal symptoms.

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🇮🇳 Menopause in India: Silence, Stigma, and Systemic Gaps

In India, menopause is still steeped in taboo, misinformation, and invisibility.

Key challenges include:

• Limited awareness among women and healthcare providers

• Lack of specialised menopause clinics in public health systems

• Minimal medical education on women’s midlife health

• Deep-rooted societal stigma equating menopause with "end of value" or "old age"

This results in millions of women suffering in silence — and dropping out of the workforce, withdrawing socially, or becoming vulnerable to chronic illness due to unmanaged symptoms.

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🛣️ Policy and Healthcare Recommendations for India

As India builds its public health infrastructure, menopause must be integrated into the national agenda. Here’s how:

🏥 1. Menopause-inclusive healthcare

• Establish dedicated menopause clinics in district hospitals

• Train doctors and ASHA workers in perimenopause detection and support

📢 2. Mass awareness and education

• Include menopause in school curricula, women's self-help groups, and rural health missions

• Media campaigns to normalise menopause conversations

📜 3. Policy integration

• Add menopause and midlife women’s health to national health schemes like Ayushman Bharat

• Ensure insurance coverage for HT and non-hormonal treatments

🧑‍⚖️ 4. Workplace rights

• Introduce menopause-friendly workplace policies, including flexibility, medical leave, and counselling — especially in the unorganised sector

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🧠 UPSC Relevance

📚 GS Paper 2 – Health, Governance, Gender

• Right to health and gender equity

• Public health policy integration for women

• Stigma and awareness challenges

🔬 GS Paper 3 – Science & Tech

• Biomedical research in hormone therapy

• FDA approvals and drug development

✍️ Essay & Ethics

• "Breaking the silence: Menopause, dignity, and health equity."

• "When biology meets policy: The forgotten half of women’s health."

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🌺 Final Thought

Menopause is not a disease — it’s a biological transition. But ignoring it, stigmatizing it, and failing to treat its symptoms as legitimate, is a public health failure.

As the world moves forward with scientific rigor, empathy, and policy change, India too must rise to the occasion. For a nation to truly honour its women, their health across all life stages must be a priority — not just their reproductive years.

“A society’s maturity is measured not just by how it cares for its young, but how it supports its women through all phases of life.”