Two Best Friends in a Room, They Might Discuss Perimenopause

By Aruna Joshi

As I was coming down the stairs of my office, my throat tightened and my breath became shallower. Tears formed in my eyes, but I was cautious not to let them to fall. Consciously avoiding eye contact with anyone in the office, I hurriedly waved goodbye to my colleagues and rushed towards the parking lot.

Quickly getting into my car, I turned on the engine and that was it! The tears I had held back for so long started flowing incessantly. I continued to drive, wiping my tears that often blinded my vision, with the sole aim of reaching quickly to my comfort zone – my home.

After reaching home, I locked myself in my room and cried my heart out. My husband was worried seeing me in this condition. After I calmed down and came out, I could see the obvious question, “What happened?” on his face. I told him about an incident that happened in the office when a colleague said something mean to me.

“Oh! That’s it,” my husband gave a sigh of relief.

This irritated me further and I entered in to a big argument with him. And thus, the day ended on a really bad note.

However, a good night’s sleep considerably wiped off the damage. While having my morning cup of tea, I reflected on the sequence of events that occurred the previous day. It was clearly an overreaction on my part. And it was not the first time. People close to me had mentioned that I had become moody since the past few months.

Along with this emotional roller coaster, I was also going through a lot of physical discomfort. I often had hot flashes and chills irrespective of the time and climate. They were bad and embarrassing at times. Once, I was pretty sure I was in for a heart attack. But after a while, all symptoms faded and I was fine again.

I also had irregular periods. I was about 41 then and was advised to see a gynaecologist. She concluded that I was in my pre-menopause phase. I had not anticipated this to happen so soon! I had the impression that menopause occurred between 45 to 55 years of age. My mind was flooded with an avalanche of questions.

The emotional and physical changes I was going through became more pronounced. I started gaining weight, especially around my arms and lower abdomen. I could experience my self-esteem hitting an all-time low. I was fighting an unseen battle with myself.

I spoke to a few friends who were also passing through this phase and realised that I was not alone. Many women had similar symptoms associated with the pre-menopausal phase. In fact, they had a lot of questions and concerns, and all of them were trying to find answers in their own ways.

My friend and gynaecologist Dr Bhavini Shah played an important role during this phase of my life. She was my go-to person when I had any questions. And so, I decided to take all the questions I and my friends had about menopause to her. This is what she had to say.

What is the ideal age for menopause?

The total menopausal phase covers premenopausal, menopause and postmenopausal as perimenopausal period, which is from 40-55 years. Actual menopause may occur anywhere between 45 to 55 years. As per research, mean international age is 51 years. However, this is mere statistics and not a standard. It varies from individual to individual.

What leads to an early menopause?

It is generally believed to be genetic. However, in today’s age and time, lifestyle is a major factor. The amount of stress we go through, sedentary lifestyle, improper sleep, lack of proper nutrition and exercise, smoking and drinking habits – all this does contribute to an early menopause. Autoimmune diseases and other perennial health issues can also cause a premature menopause.

What is the impact of menopause on a woman’s body and psyche?

Physiological, psychological and multiple other body changes occur during this phase. Due to the ovarian function reduction, there are hormonal changes which lowers the levels of oestrogen and progesterone. These two are the most important hormones in a woman’s body. They generally act as protective shield to our body. Oestrogen contributes to cognitive health, bone health, the function of the cardiovascular system, and other essential bodily processes.

Both play important roles in a woman’s reproductive and sexual health. So, reduction in their levels causes a major impact on the body.

What are the general symptoms of menopause?

During the premenopausal phase women experience irregular period or heavy prolonged periods, spotting, vaginal dryness and so on. This may sometimes lead to anaemia. This period may last for couple of years and then menstruation ceases.

Psychological symptoms that can occur in any phase are headaches, fatigue, irritability, mood swings, hot flashes, memory lapses, depression and dementia. Other body changes like muscle weakness, palpitation, joint pains, vaginal infection, osteoporosis, cardiovascular problems, decreased sexual drive and loss of libido can also take place.

Can you please elaborate more on the psychological aspects?

This stage is very crucial in a women’s life when a woman generally feels lonely. If you have children, they are usually grown up and have their own world, your partner is at the peak of his career, and the worst part is that at this stage your hormones also leave you isolated.

This often leads to low self-esteem and even depression if not managed properly. You tend to become moody. During this time there could be vaginal atrophy leading to low sex drive. This in turn might affect the relationship with your partner.

Under what conditions is hormone replacement therapy (HRT) suggested and should one go for it?

Psychological symptoms can be treated with counselling. Family support is of utmost importance during this time. I always counsel the husband or partner to be there for the woman at this stage. There are certain phyto-oestrogens available that help in case of hot flushes or mood swings and many other symptoms. Vesical vaginal symptoms can be treated with certain non-hormonal gels.

So generally, HRT is the last resort when all other therapies fail. Very few patients require it.

Before prescribing HRT we generally note the history of the patient, breast and uterus evaluation, and pap smear to rule out malignancy. We discuss the plan with the patient as it needs continuous guidance from the doctor and a strict follow-up.

What tips would you give for self-care?

• Firstly, menopause is not a sickness, just like pregnancy is not. Take it as a natural process and go through it with grace.
• Make yoga or any form of exercise as an integral part of your routine.
• Drink plenty of fluids; minimum eight glasses of water every day is a must.
• Eat healthy food most of the time. Eat food that has more calcium, iron, proteins and fibre. Avoid high-fat foods. Keep your sugar and salt intake to a minimum
• Keep your weight in check.
• Reduce the consumption of alcohol.
• Keep stress at bay.
• Develop a support group.
• If need arises, take medical advice and support.
• Cultivate relationships. Have friends and talk to them or go out with them occasionally. Spend more time with your loved ones. Make each relationship in your life valuable and add value to people’s lives.
• Practice meditation. Any form of meditation will help you manage your menopausal symptoms well. It could be mindfulness, guided meditation, focusing on your breath or anything that suits you.
• Journaling helps vent out your emotions.
• Practice a creative pursuit. Pursue your hobby.
• Learn to deal with your emotions.
• Enjoy life.

Menopause is the time when your body calls out for extra attention. It is also a beautiful phase of life when you are more settled, you are wiser, and are more aware. Apart from keeping yourself physically fit during this phase of life, it is also important to cater to your psychological and spiritual needs.

Self-care is of paramount importance. This period can literally drive you crazy and not managed well, you might well end up with broken relationships. Hence taking care of yourself and keeping your self-worth high is of utmost importance. Don’t let your hormones rule you. Age gracefully.

Aruna Joshi is a Mumbai-based self-help author and happiness coach. She was an architect for 18 years until she found her true calling in writing. She is also an artist, painter and designer.