Menopause Symptoms and When to See a Doctor

Menopause is something that every female has to go through. But many women arrive there with no clue of what’s ahead. One day the periods become irregular. After a while night sweats, sleeplessness, and mood swings occur, along with trouble with focus and memory. These symptoms may occur during menopause, but similar symptoms can have other causes. In this guide you will learn about what’s happening in your body, symptoms to look out for, causes of menopause, treatment and when to see a doctor. We also present what Indian research has to say as Indian women tend to experience menopause differently than women in the west. 

Quick summary

• Menopause is confirmed after 12 months without a period.
• Indian women experience menopause at an earlier age than their western counterparts.
• Symptoms may start years before the last period.
• Treatment options may help manage symptoms and support bone health, depending on individual assessment.
• If you are bleeding after menopause, you should see a doctor. 

What Is Menopause?

Menopause is the time when your periods cease permanently. It is confirmed by the doctor after 12 months without any period or bleeding or spotting. As a consequence to this, menopause is only diagnosed after the fact. It has been also defined by the Indian Menopause Society guidelines as a condition that is diagnosed in retrospect from history.

This occurs because your ovaries gradually produce fewer eggs and produce less estrogen and progesterone. These hormones regulate your menstrual periods. They also have effects on your bones, heart, skin, brain and mood which is why menopause can be felt throughout your body. 

At What Age Does Menopause Happen?

Many women think that menopause begins at 50 or older. This finding is largely from Western studies. A study conducted by PAN India across the 21 Indian Menopause Society chapters revealed that the age of menopause in India, on average, is 46.2 years, while the age in the west is 51 years. The IMS clinical guidelines have also reported an average age of approximately 46 years in India.

So if you are in your early or mid-40s and you have noticed changes, it could be the beginning of transition. If you notice these changes in your 40s, discuss them with a gynaecologist.

The Three Stages of Menopause

It’s helpful to view menopause as a three-part process.

1. Perimenopause (the transition)
This is a transition period before menopause. Your hormones change in an irregular manner and symptoms start to occur. It can last anywhere between 2 and 8 years. The IMS states that it starts at an average of approximately 4 years before the final period. 

2. Menopause
It is the only moment where you have been without a period for 12 consecutive months. 

3. Postmenopause
These are the post-menopause years. Certain symptoms, including hot flashes, can improve. This is a stage when other problems like bone loss and vaginal dryness can persist or develop. 

Common Menopause Symptoms

Menopause symptoms are highly individual. Some women do not even feel them, others find them difficult to handle. These are the most frequent ones. 

1. Irregular Periods

This is one of the initial indicators. Early perimenopause cycles can become shorter, which means they can be closer together. As menopause approaches, periods become more spaced out. You can either skip one month and Function as usual after, or skip several months and then do a few normal cycles again. Menstruation can also be heavier or lighter. 

2. Hot Flashes

A hot flash is a brief hot sensation, typically in the face, neck, and upper chest. You may have red skin and profuse sweating. It may only last a few seconds to minutes. One of the most popular reasons women receive treatment is for hot flashes. 

3. Night Sweats

These are night sweats caused by hot flashes during sleep. Clothing and bed sheets can sometimes be damp upon waking and may cause difficulty in getting back to sleep. 

4. Sleep Problems

There are many women who have trouble getting to sleep and staying asleep. One of the reasons is night sweats, but hormone fluctuations can disrupt sleep, as well. Tiredness, low mood and poor concentration are then the next consequence of poor sleep. 

5. Vaginal Dryness and Discomfort

When estrogen decreases, the vaginal tissue becomes thin, dry and less elastic. This can lead to itching, burning or pain during sexual intercourse. Many women are too embarrassed to discuss it, but it is a common symptom that can be assessed and managed with appropriate treatment. 

6. Mood Changes

You may be more irritated, anxious or depressed than normal. Some women burst into tears or become over-sensitive about little things. It can be due to hormone fluctuations, lack of sleep and stress. 

7. Brain Fog

Many women report forgetfulness, having lost items, or problems concentrating. This is commonly referred to as “Brain Fog”. Memory and concentration changes can occur during the menopausal transition, persistent or concerning symptoms should be assessed by a healthcare professional. 

8. Low Energy

Fatigue is common and can be due to poor sleep, hormonal shifts. 

9. Other Changes

Some women also experience weight gain around their waist, dry skin, hair loss, and aching joints or decreased libido. 

It’s possible to get pregnant during perimenopause. Take a pregnancy test if you have missed a period and you are unsure of the reason. 

Menopause Causes

Ageing is not always the cause of menopause. These are the predominant causes. 

Natural Decline in Hormones

This is the most common cause. Ovaries start secreting less estrogen and progesterone from your late 30s. Periods are likely to change in your 40s: longer and/or shorter, heavier and/or lighter, more or less frequent. Eventually the ova cease to be produced and periods cease. 

Surgery to Remove the Ovaries

When both ovaries are removed (oophorectomy), menopause starts immediately. Decreases in hormones happen over a short period of time rather than over the years. For this reason symptoms may be more pronounced. 

Removal of the Uterus (Hysterectomy)

Periods stop immediately, and if the ovaries are kept, menopause may come a few years earlier. The ovaries usually keep producing hormones, but menopause may come a few years earlier than expected. 

chemotherapy or pelvic radiation

Treatment with radiation and/or chemotherapy in the pelvis may induce menopause. Hot flashes can happen during or immediately after treatment. Sometimes periods come back after chemotherapy, which means you can still get pregnant. Communicate with your doctor about birth control needs. 

Early Menopause and Premature Ovarian Insufficiency

Menopause before age 40 is called premature ovarian insufficiency (POI). May be connected with “genetic causes” or autoimmune illness, but sometimes the reason is not discovered. A large national study in India showed a prevalence of 1.5% of women having their menopause before 40. According to the IMS, POI is taking the place of the older diagnosis “premature menopause. Hormone therapy may be considered for premature ovarian insufficiency following an individualized assessment of benefits, risks and contraindications. 

Health Risks After Menopause

Estrogen gives protection to many organs in the body. If it falls, the potential health hazards increase. 

Weak bones (osteoporosis): Loss of bone density can be rapid during the early years after menopause. They become brittle and break easily, usually at the spine, hips and wrists. The Indian consensus experts have highlighted that osteopenia and loss of bone density raises the risk of fractures, a major issue among Indian women. Women concerned about bone health can discuss appropriate assessment and osteoporosis treatment options with a specialist.

Heart and blood vessel disease: Reduced oestrogen is associated with increased risk of heart disease. It is the common reason for death among women and men. 

Urinary problems:  Sudden urgencies to pass urine or incontinence when coughing, laughing, or lifting may occur due to changes in the tissues of the bladder and vagina. A urinary tract infection can also occur more frequently. 

Sexual health:  Sex may become uncomfortable because of the vaginal dryness, and decreased sensation can decrease desire. 

Weight gain: Many women gain weight during and after menopause as their body metabolism declines. 

Indian women go through menopause earlier, and researchers suspect these risks may be starting about 5 years (46 vs 51) than in Western women. This is why there’s a particular need for early awareness and periodic check-up. Specialist assessment may be appropriate for concerns about bone and cardiovascular health.

How Is Menopause Diagnosed?

The majority of women and doctors are able to identify it by the symptoms and the pattern of period. Tests are not always necessary.

In certain circumstances, your doctor might still recommend blood tests: 

• FSH and estradiol: FSH tends to increase, while estrogen decreases during menopause. However, during perimenopause levels of these hormones fluctuate, making it difficult to see meaningful results. 
• Thyroid test (TSH): An overactive thyroid may mimic symptoms associated with menopause, so physicians may overactive or underactive thyroid it as the source of these symptoms. 

Your doctor will recommend investigations based on your symptoms and clinical assessment.

What about home tests? There are some home tests that measure FSH in the urine. They can show high FSH but can’t confirm menopause. However, the level of FSH fluctuates in the course of your cycle, and these tests will not definitely diagnose menopause. A doctor’s diagnosis is more accurate. 

Menopause Treatment Options

Menopause is not a disease, but treatment may help manage symptoms; the benefits and risks depend on the treatment and individual health factors. Treatments may help you feel better and prevent issues associated with ageing. The plan is based on your symptoms and health record as well as your age. The IMS stresses that each woman needs an individualised health plan. 

1. Lifestyle Changes

For the Indian consensus experts, lifestyle takes a priority. It is recommended as the first line of treatment and is suggested as a whole of lifestyle approach, which includes exercise, calcium and fibre rich diets and low in saturated fat. Practical steps include: 

• Go for walks, swim or do yoga most days
• Do strength training to keep bones strong.
• Consume lots of vegetables, fruit, pulses and calcium products or other calcium-rich foods.
• Reduce fried foods and sweets.
• Wear light layers and keep your bedroom cool.
• Don’t smoke and reduce alcohol, caffeine and spicy food if they cause hot flushes.
• Use breathing or meditation techniques to cope with stress

Our clinical nutrition team and physiotherapists can create a plan for you.

2. Menopausal Hormone Therapy (MHT)

Estrogen is the medication for getting rid of hot flashes. It also relieves other symptoms and helps to slow down any associated bone loss. If you have not had a hysterectomy, you will also require the use of progestin in addition to estrogen.

Timing matters. According to an IMS commentary, hormone therapy is started within 10 years of menopause or before age 60. The dose and duration of menopausal hormone therapy should be individualized and reviewed periodically with a healthcare professional. It carries some potential long-term risks, such as heart disease, breast cancer, blood clots and stroke, so it is not suitable for everyone. Don’t start it without a doctor’s advice! Discuss it with your gynaecologist.

3. Vaginal Estrogen

If you’re suffering from vaginal dryness or itching and pain during sex, estrogen may be available as a vaginal cream, tablet or ring. Systemic absorption varies by the vaginal estrogen preparation and dose. It can also be used to ease some urinary symptoms. 

4. Other Vaginal Treatments

Other treatments include a hormone implant called vaginal insert or a pill called ospemifene. Ospemifene suitability and precautions should be assessed against current prescribing information and the patient’s medical history. Moisturisers and lubricants can also help relieve dryness. 

5. Non-Hormone Medicines for Hot Flashes

If you don’t want to take estrogens or can’t, you have other options:

• Antidepressants (low dose SSRIs and SNRIs)
• Gabapentin (may also be effective in reducing night sweats)
• Less frequently-used drugs such as clonidine.

Your doctor will assess the safety of doing so for you. 

6. Bone Protection

Your doctor might prescribe calcium and vitamin D, and osteoporosis-treating medications. A bone density test will be able to indicate the strength of the bone. 

7. Emotional and Mental Health Support

If you are feeling sad, worried or unable to sleep, counselling or medication may help. A healthcare professional can assess persistent mood symptoms and discuss appropriate support or treatment. 

Review your plan every year: Your requirements and the available therapies may evolve as time goes on. 

When to See a Doctor

Menopause symptoms and concerns about reproductive health may be difficult for some women to discuss. The IMS has commented that discussion about reproductive health and sexual issues are still taboo. Treatment doesn’t have to wait until symptoms are “unbearable”. 

Seek medical attention immediately if: 

• After menopause you experience vaginal bleeding. Spotting does not have to be serious, it just has to be checked. 

Book an appointment if you notice:

• Menopausal sweats or night sweats that affect sleep patterns or activities
• Changes in mood, anxiety or sadness which are not easily managed,
• Sex can cause pain or constant vagina dryness
• Micturitions are repeated, or urine leaks.
• Extremely heavy, irregular or intense bleeding in your 40s
• Amenorrhea (before age 40)
• Fears related to bone health, heart health or hormone therapy
• Family history of early menopause, osteoporosis or heart disease. 

Continue for routine well visits before, during and after menopause. The midlife preventive health check-up can find issues early. 

How to Prepare for Your Appointment

There are some things that can be done ahead of time to make the most of the visit: 

1. Track your periods: Record the dates for several months. 
2. List your symptoms: Record how it feels, how often and what makes it better or worse. 
3. Note your medical history: Include past surgeries, cancer treatment and family history. 
4. List your medicines: Include supplements and herbal products.

Common Myths About Menopause

Myth: Menopause only happens at 50.
The average age in India is about 46 years and may be less. 

Myth: Menopause means the end of your sex life.
Dryness and discomfort can be treated and many women enjoy a healthy sex life afterwards. 

Myth: Hormone therapy is dangerous for everyone.
Risks and benefits are age, timing and health related. The benefits and risks of hormone therapy vary according to age, timing, medical history and individual risk factors. 

Myth: Mood changes are “all in your head.”
They are associated with actual hormonal changes and with the quality of sleep. 

Myth: Nothing can be done, you just have to bear it.
Numerous treatments are available – ranging from lifestyle modifications to medications. 

Menopause Treatment in Gurgaon at SilverStreak Hospital

For those seeking the menopause treatment in Gurgaon, SilverStreak Multispecialty Hospital in Gurgaon. The hospital is a NABH-accredited hospital, and is home to several specialties including gynaecology, internal medicine, urology, orthopaedics, cardiology and psychiatry. The hospital offers multiple specialties that may be involved in assessing menopause-related symptoms and associated health concerns. 

Consult a Menopause Doctor

Dr. Swapnil Agrahari
Consultant – Obstetrics & Gynaecology
MBBS, MS (Obstetrics & Gynecology), F.MAS, D.MAS
8+ years of experience

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Sector 87, Opp. DLF Skycourt, Gurugram
+91-124-432-4444
care@silverstreakhospital.com

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