As a researcher on gender and health issues, I have often engaged in discussions on menstrual health and to my dismay have often received silence, annoyance, ridicule and anger among middle-aged and older women. Women in my family are no exception. It is all the more shocking that even when menarche (onset of menstruation/periods) in a young adolescent is celebrated in Indian society with elaborate worshipping, feasting and ‘coming off age’ ceremonies, menopause is conveniently forgotten and ignored despite being a crucial transitional stage in a woman’s life.
In Indian households, sexual issues have always been treated as a taboo subject. Women are taught to not be open about their sexual health problems in front of male family members and they often brush aside serious gynaecological health concerns under their burden of caregiving roles. Reaching menopause mostly goes unnoticed. Though postmenopausal women are predisposed to having associated health problems such as lifestyle diseases (obesity, cardiological ailments, hypertension), arthritis, osteoporosis, thyroid disorders, however, they continue to be largely ignored as they give their individual health less importance relative to that of their family.
This marginalisation of women stems from deep-rooted patriarchal norms and years of subjugation. We tend to normalise their social roles and stereotype them to being a ‘good mother, good wife, good grandmother and good homemaker’ and fail to look beyond.
Despite the psychosocial wellbeing for women above 45 years being multi-dimensional, they are a blind spot in gender studies. Unfortunately, the health and population policy in India also gives little attention to menopause discourse. Once the reproductive age is crossed, the state is silent.
Menopause is not a heavily researched topic in India. Women in their late 40s and early 50s are considered to be menopausal if they have not had a menstrual period for one year. Menopausal women are vulnerable to developing emotional, mental, post-reproductive health issues.
Associated health anomalies during menopause include irregular period issues, heavy bleeding, itchy skin, bladder issues such as uterine muscle weakening, urinary tract inconsistencies and infections, vaginal dryness, hot flushes, reduced libido, mood swings, sleep disturbances, poor memory and concentration. Gynaecologists believe that there are higher risks of cervical, uterine, breast cancer post-menopause. Medical interventions may include hormonal therapy and regular screenings, especially pap-smear and mammography. Doctors prescribe yoga, physical exercise and healthy diet as coping mechanisms to achieve a good quality of life.
In a study funded by the Ministry of Women and Child Development, holistic health was touched upon through the parameters of nutritional intake, sleep patterns and fitness regimes among middle-aged women. One-third of women who participated did not go for regular medical check-ups, which are essential after attaining menopause.
The study brought out the presence of widespread ignorance about menopausal health where only 30% women belonging to different socio-economic background had some awareness on menopause. Women in post-45 years age cohort a lack preparedness, knowledge on bodily changes and awareness on health vulnerabilities once menopause strikes. Hormonal changes, leading to alterations in the physical appearance, weight gain and body issues are prominent drivers of anxiety and stress among the menopausal women.
Another study discusses the need for making healthy food choices; postmenopausal women lacked information about nutritional requirements and likewise significant calcium and vitamin D deficiency was observed among them. Dietary diversity and healthy food choices have essential role in physical and mental health. According to a study done by InBody-Ipsos, 64% and 58% of women in Delhi-NCR reported having poor muscle health and inadequate protein content.
In today’s era of digital revolution, some enlightened, educated and liberated postmenopausal women do find courage to break the taboo and talk openly in social media about their experiences of menopause. They narrate how society perceives them from a different lens as if menopause is not confined to a bodily transformation but overnight, they are ‘no more attractive, are undesired’ and ‘become aunties’ and become ‘useless, neglected in eyes of children and partners’. When coaxed upon, my homemaker aunts divulged how they ‘felt lack of appreciation by family members’ ‘being taken for granted’ with ‘thoughts of worthlessness, low self-confidence’ often creeping in. Anita my maternal aunt goes on saying, ‘many women like me feel freedom from monthly cycles of those five days’ but simultaneously they find it difficult to embrace the associated fading of health and youth; ‘of growing wrinkles, palpating fatigue, dying stamina, pinching body aches, greying and thinning of hair’.
With no visible signs of ailment, redressal of mental health symptoms in postmenopausal women is not paid required attention, belittling the severity of the stress, anxiety and depression commonly experienced during this time. and thus, their psycho-social needs remain unfulfilled. The judgmental attitude and age stereotypical behaviour of the society acts as a major barrier to the wellbeing of middle-aged women. The domain of their interaction is narrowed to socially conformist roles and conduct ignoring their desires and personal physical and psychological needs.
Dr. Sudeshna Roy has a PhD from JNU and she writes on gender, health, livelihoods and urban issues.
Featured image credit: Reuters/Danish Ismail