Breaking the taboo: How women are addressing the challenges of menopause, finding support

Twelve years ago, *Lakshmi, a teacher, began experiencing heavy bleeding during her periods that would sometimes go on for over 10 days. Alarmed, she consulted a gynaecologist, who, after routine checks and scans, concluded that she was in the perimenopausal stage. At 36 years, she says, her life had turned upside down. 

“I continued to experience painful cramps, heavy bleeding, and irregular periods and consulted many doctors. They gave me only two solutions—iron tablets and “pause” tablets for heavy bleeding. Most of them advised against hormonal treatments like HRT and a couple dismissed it as a “phase everyone has to go through,” Lakshmi tells HerStory. 

In addition to the mood swings and being irritable all the time, her symptoms were largely dismissed by medical experts and society. 

She is still in perimenopause–the transitional period before menopause when women go without their periods for 12 months in a row and their ovaries stop functioning.

Perimenopause and menopause are not just phases that a woman has to go through in her lifetime. The period leading to menopause can last several years, like in the case of Lakshmi, and is wrought with many challenges–physical, emotional, and social.

The physical symptoms of menopause

According to a survey conducted by Abbott-Ipsos among 1,200 women in seven cities, 87% women feel that menopause symptoms can significantly impact their quality of life, 82% believe it can impact their personal well being; nearly 48% mentioned experiencing severe menopausal symptoms; and only about 37% of women consulted a gynecologist for their symptoms.

“The most common symptoms include hot flashes, night sweats, irregular periods, mood swings, vaginal dryness, and sleep disturbances. Early menopause (before age 45) or premature menopause (before age 40) can have profound effects; including a higher risk for osteoporosis, cardiovascular issues, and emotional distress,” says Dr Aparna Jha, Consultant-OBGY, Apollo Cradle and Children's Hospital, Bengaluru.

For severe symptoms, she explains that treatment options include hormone replacement therapy (HRT), non-hormonal medications (like antidepressants for mood symptoms), and lifestyle modifications. 

“Regular exercise, maintaining a healthy weight, and reducing caffeine and alcohol can alleviate many symptoms. It’s important for women to consult their gynecologist to determine the best individualised treatment plan,” she adds.

The physical challenges of menopause are varying and numerous. Tina Vinod, Founder, Diversity Simplified, talks of weight gain despite being conscious about diet and exercise, and mood swings. Uma Achuthan, a HR professional, suffers from melasma on account of hormonal changes brought on by perimenopause.

“I faced constant headaches and also encountered severe episodes of vertigo. I experienced severe back pain and incidents of slip discs,” shares Shweta Powar, Founder, Aria Communication.

Ashwini*, a media professional from Kochi, says her incontinence has flared up. “I am afraid to sneeze, laugh or cough. My gynecologist suggested surgery but contrasting opinions from doctors about the procedure scared me.”

Shreya Krishnan, Managing Director, AnitaB.org India, who has been recognising symptoms like brain fog, floating, and irregular periods during the past year, thinks perimenopause is under-researched and under-represented. “Perimenopause is often misunderstood and women are left to gather information on their own, so having structured support in place, including counselling will help.”

Most of the women we spoke to are open to seeking both solutions and therapy for their menopause woes. Vinod has started on Menoveda pills. They also agree that we need more resources to address the challenges.

Impact on mental health and wellbeing

The years leading to menopause can take a huge toll on the mental health of women. While each woman may experience this period differently, there are important and common symptoms to watch out for, says Sareena Daredia, Psychologist at MPower. 

“Common mental health challenges at this time are anger and irritability, low mood and feelings of sadness and depression, anxiety, forgetfulness, brain fog, loss of motivation, loss of self-esteem due to physical changes, and problems with sleep.”

Eima Azim, Co-founder of the Khushtaar Initiative, says, when the perimenopause symptoms hit her in 2022, it was like a storm she never saw coming. “The weight gain was sudden and stubborn, hair loss noticeable, and insomnia relentless. My appetite vanished and mood swings hit without warning, making it difficult to complete even routine tasks,” she says.

“Doctors need better training to recognise the interconnected nature of health challenges. Many women don’t seek help until their symptoms become unbearable. When they finally do, they’re often treated for isolated conditions rather than their overall well-being,” she adds.

For Powar, mood swings added to the complexity of other symptoms and Ashwini speaks of an “unnatural rage” and breaking down for little things. 

Besides weight gain, the “menopause belly”, and dry skin, Daredia warns that menopause can also spur on body image problems and eating disorders. Also, in certain cases, the depressive symptoms can lead to full-blown Major Depressive Disorder and even psychosis. So, intervention for both physical and mental health symptoms are important.

Startups focusing on menopause

At the age of 42, Tamanna Singh, a serial entrepreneur, was experiencing a slew of unexplainable symptoms - feeling drained emotionally and prone to constant mood swings. She visited many doctors and while physical ailments were ruled out with tests, she was advised antidepressants, multivitamins and sleeping pills. They attributed it to an empty nest or the emotional effects of the Covid-19 pandemic. 

“It was only when I was 44 that a doctor mentioned perimenopause and suggested HRT. I was sceptical as my body was already bearing the brunt of medicines. I spoke to experts and friends who asked me to look at natural or herbal remedies. I also wanted to look at the larger picture when I realised that menopause has over 40 symptoms and women could hardly name 10 of them,” she says.

The results of two extended surveys with over 20,000 women across India on menopause led to Menoveda, an Ayurvedic brand for menopause supplements. Menoveda offers Amaya (to improve joint pain, fatigue and other symptoms);  Akira to (improves sleep, hot flashes and others), Asaya for Dermal Health (for nail, hair and skin) and Aadya multivitamin supplements. These formulations have been developed by Ayurvedic doctors and certified formulators.

According to the Indian Menopause Society (IMS), 150 million women in India are currently experiencing menopause, with the average age being 46.2 years, which is younger than the global average of 51 years. 

Other startups have also begun to pay attention to this area of women’s health. Founded in 2021 by Swathi Kulkarni, Shubham Sharma, and Dr Ameya Kanakiya, Bengaluru-based Elda Health started off as a WhatsApp group focused on issues pertaining to middle-aged women’s health. 

“Today, our tech and programmatic health interventions including digital content, personalised programmes, at home diagnostics, nutrition and yoga counseling/sessions, care managers cater to health care needs of 85,000 through menopause education and interventions. While most of our customers today come from metros and Tier I towns, our free app is available on App Store and Play Store for women (and men) across the country,” says Kulkarni.

“Our app boasts an average engagement time of 20 minutes per user. Elda has been able to reach 20 million women in the span of three years through social media and 125 + workshops. Across customers who have taken 6000 programmes to manage their health issues have contributed to more than 30 million minutes of engagement with midlife women,” adds Dr Kanakiya.

Meanwhile, Miror, a femtech startup, is the result of one man’s mission to help women navigate the transformative phase of menopause and perimenopause. 

A few years ago, after hearing of experiences from his friends who were going through perimenopause, founder Sanjith Shetty decided to start a community to spark off a conversation, which he believes is still largely taboo.

“Miror is a 360-degree care platform for women in the critical phase of perimenopause. We normalise the conversation around it, connect women to doctors, have linkages with labs, expose them to the best medical advice and the latest in supplements. In this, community also plays a huge role,” he says.

The Miror communities on WhatsApp have over 1,500 women all talking about their challenges and sharing their experiences. It also offers advice from doctors, nutrition experts, and fitness experts on its platform. 

Miror also recently launched Revive, a multi-care supplement made with natural ingredients. Shetty hopes to add more products to the range in the coming months. It recently partnered with the National Health Mission and trained over 4,000 ASHA workers in Karnataka to start a dialogue on menopause in rural India.

Chennai-based Miyara Health started by Gayatri Muthukrishnan and Sanjana Rao provides awareness and digital symptom management self-guided programmes.

“Women can easily access our programmes to address common menopause-related issues such as insomnia, hot flashes, stress relief, and incontinence. We have also developed a 24/7 empathetic AI-chatbot companion to improve awareness, engagement, adherence and scalability,” says Muthukrishnan.

Menopause and the workplace

While conversations have already begun around menstruation and period leave, are organisations coming forward to break the menopause taboo and introduce initiatives for women?

Intuit has implemented Maven, a comprehensive online platform available 24/7, to support women experiencing menopause. 

“It ensures easy access for employees and their dependents during menopausal transition. We also offer support groups and community forums where employees can share experiences and seek guidance. We also organise educational initiatives to promote sensitivity and understanding among all employees regarding menopause,” says Jharna Thammaiah, Director & India site People & Places Leader, Intuit.

Meanwhile, Natwest offers free of cost menopause support and their partners globally through the Peppy app, which provides personalised and confidential online support for people going through any stage of menopause.  Employees seeking emotional support or counselling have the option to use the Employee Assistance Programme - a free, independent and confidential wellbeing service providing help and advice, 24/7, says Poulomi Saha, Head of Reward Pension and Benefits, International Hubs, NatWest Group. This year, it is focusing on the importance of ‘Staying Healthy Through Menopause’, and is organising Menopause Cafes - virtual cafes designed to engage with colleagues going through menopause or to support someone going through it.

Tina Vinod points out that senior women continue to face bias and discrimination leading to the lack of representation in leadership and a high attrition rate. 

“The lack of support women face during perimenopause and menopause stages can amplify these challenges further. From support groups, counselling, flexibility and sensitisation for managers and leaders, we still have a long way to go… ERGs, HR and DEI teams need to build in support for women. Each of our experiences differ, so trusting our needs and being respectful is important,” she says.

Achuthan believes organisations can create a culture where mental health check-ins are prioritised and routine. 

“Focused group sessions with a gynecologist and sensitising managers and leaders to stay alert on signs such as fatigue, depression, anxiety attack are important,” she adds.

(*Names changed on request)