A shift in perception

Menopause has long been a hush-hush topic even though half the world’s population will go through it or has. But how ‘the change’ is regarded is now changing as many public personalities open up about their experiences.

Popular Hollywood actress Drew Barrymore recently had a hot flash on air while filming an interview with Jennifer Aniston and Adam Sandler. She was awkward, excited like a child, and frank but she hid neither her symptoms nor her emotions. A major moment for the ‘normalise menopause’ movement.

There was a time when people spoke of it in hushed whispers. “That time of life”, “the change” and other such weak euphemisms were used to converse about what is, in reality, a life-altering shift for one-half of the world’s population. But celebrities like Drew Barrymore, Jennifer Aniston and Gwyneth Paltrow (who even has a supplement line christened ‘Madame Ovary’ for women in their 40s and above) have opened up about their experiences and thus empowered other women in their age bracket to own their menopause. In India too, celebrities like Lara Dutta and Pooja Bhatt have spoken frankly about experiencing hot flashes, insomnia and mood swings, making the topic much less taboo than it once was.

In fact, Pooja Bhatt-starrer Bombay Begums, a series on a popular OTT platform, showcases her as a woman nearing 50, fighting middle age and handling hot flashes right in the middle of a board meeting. Michelle Obama famously spoke of experiencing a hot flash in Marine One, no less. She is quoted as saying: “Literally it was like somebody put a furnace in my core and turned it on high. And then everything started melting.”

In the West, the so-called ‘menopause gold rush’ has led to a slew of companies bringing out menopause-related beauty products, supplements, clothing lines and spa treatments. While this is heartening at one level, there is also the danger of the whole conversation being reduced to just innovative marketing strategies to sell more of the same — beauty and fashion-related products and over-the-counter medications. In India though, we are still gingerly stepping past its many myths and misconceptions.

Not a part of the discourse

In recent years, initiatives undertaken by different organisations have been geared towards encouraging frankness, particularly in the context of menarche and menstrual cycles. However, menopause, which is the other significant milestone that every woman encounters, often tends to be missing from these conversations. Quoting statistics from the Indian Menopause Society (IMS), the BBC says India has more than 150 million women living with menopause. The average age of menopause is 46.2 years while globally it is 51. And yet, there is no clear understanding of the changes a woman can experience from a physical, psychological and emotional standpoint. Often, people dismiss menopause as ageing and fail to comprehend the larger transformations it leads to. This is why women find support difficult to get and they end up lonely, disappointed, sad, angry and irritable.

For many, simply having these conversations can bring forth a number of difficult emotions. There is discomfort, and there is fear of being judged. Women frequently experience complex emotions like shame and guilt when bringing up their experiences. Some feel a conversation about menopause is itself unacceptable. Others view it as a highly private experience and prefer that it be kept hushed up, while for a large majority, it is a topic best avoided. Yet others are unsure of what they are expected to say or do and would prefer to just ignore or avoid considering or discussing it.

Emotional impact

For a woman, who is going through menopause, it is possible that the physical changes can lead to changes in moods. For some, it leads to the experience of low moods and sadness. Others are seen to feel more irritability and anger, particularly around the time that their cycles occur. There is also a part of the population that experiences heightened levels of anxiousness and worry, which impedes their interactions and the work they need to do. There can be greater levels of fatigue and also some problems in being able to concentrate more fully on things, particularly when there is a disturbance in the mood states. The fluctuations in the hormonal states that are characteristic of menopause create a level of unpredictability as well. This can further contribute to the levels of distress that a woman going through menopause can experience.

It is important to understand and note that not all women would experience substantial difficulties or distress and not all would experience challenges in engaging in interactions or managing their work at home or at the workplace.

A matter of self-image

Importantly, there are numerous myths and misconceptions which surround the understanding people may have in the context of menopause. These lead to the development of stigma and prevent people from being more informed about the topic. It also predisposes women toward being misled and making wrong choices. In a day and age where people constantly come up with fallacious claims about how certain remedies can be helpful, anyone can be taken advantage of, if they do not fully understand what is happening.

Furthermore, when a woman feels that her experience is not valid or acceptable, or is seen in a negative light, she may begin to view herself negatively. It leads to a process of judgement regarding the self which can be misinformed and may be based on assumptions derived from reactions from those around. This can impact a woman’s image of her physical self, as well as her feelings of worthiness. Women, in such a scenario, can experience confusion regarding their capabilities and skills. They can end up harshly judging the ways in which they are responding, particularly if the understanding regarding the medical/biological underpinnings of what is going on is missing. Precisely why, be it talking openly about menopause or designing products and services to help cope with it are all welcome — at present, both are doing more good than harm!

Know your menopause

Women spend nearly one-third of their lives experiencing menopause and yet awareness about it is low. Furthermore, not many plan to do anything about their lack of knowledge. Here are a few tips to manage menopause better.

* Build your knowledge base: The first step toward taking care of your well-being is to become informed. This is the most critical aspect which can go a long way in ensuring that you do not feel uncertain and lost or unhappy and angry about going through the experience that you are. At the same time, it allows you to feel more confident in knowing how things are going to move forward. Ensure that this knowledge that you do acquire is from credible sources. The first and foremost person whose input you would need in this regard is a gynaecologist and discussing your experience with your gynaecologist is important. It can help you understand the process, recognise the transition, tackle your expectations, and build support around you. If what you are experiencing warrants meeting any other expert, make sure you do that in place of relying on your own or others’ thinking or the internet. Make sure you choose authenticated sources.

* Be willing to make difficult choices: Often your well-being can require you to make difficult choices, particularly if you are not accustomed to doing so or prioritising yourself. Give yourself the permission to bring in changes that facilitate your physical, emotional and mental well-being. At times this can involve support from others. In such a scenario, while you must be sensitive to others around you, it would still be important to go ahead and share what is needed by you. At each point that you have thoughts that raise emotions of self-doubt and guilt, remind yourself of the necessity to make the transitions. Reinforce the same by giving yourself reassurance. Use positive self-talk.

* Talk about what is going on: Be open to sharing and discussing what you are going through with those around you. Sharing experiences is critical to helping others to build perspective about what impacts and affects you. While it may be difficult to express and talk about emotionally or psychologically challenging situations, it is critical that you take small steps towards building this as an approach.

The author is a clinical psychologist and head of the department of mental health and behavioural sciences at a leading super speciality hospital.