Menopausal women are left behind

I just returned to Islamabad from the second global dialogue commemorating the 30^th anniversary of the International Conference on Population and Development (ICPD30). This global dialogue, held in Bangladesh and co-sponsored by Japan and Bulgaria, focused on demographic diversity and sustainable development. This was the second of a series of three landmark events — the first was ICPD30 global youth dialogue held in Benin and the third will be held in New York to discuss technology and the population issue.

The debate in Bangladesh brought to light a wide array of critical issues including demographic polarisation, climate change, and rapid technological advancements in data generated by AI and machine learning. The participants also discussed population decline, migration, aging, youth, sexual and reproductive health, reproductive rights, and the principle of leaving no one behind. However, amidst these discussions by delegates and experts from 48 countries, I felt a pang of guilt recognising that the vulnerabilities of women in post-reproductive age, who suffer silently and invisibly, were largely absent from the conversation.

Menopause is a significant reproductive health concern for women. The global population of menopausal women is expected to include 1.2 billion by 2030 due to increased life expectancy. Throughout my service at the UN, I rarely witnessed an active discussion on women in post-reproductive age. This neglect is a disservice to women whose concerns regarding their bodily experiences, desires, and needs during this transformative phase deserve to be discussed and understood. As an experienced gynecologist shared with me that many women report that menopausal symptoms significantly interfere with their daily lives. Women patients in their 40s or 50s are often asked about common menopausal symptoms such as hot flashes, mood swings, and memory problems. It is crucial to recognise that menopause is not solely a biological transition from reproductive to post-reproductive age; it has a profound medical, emotional, social, and economic significance.

While menopause is a natural part of the aging process, it can also be triggered by factors other than aging such as genetics, surgery, or cancer treatments. Medically, it is a hormonal shift that affects almost every organ in the body, including the skin, the bones, and the brain. While estrogen therapy has been widely used to alleviate the symptoms, however, it may not be sufficient because menopause also involves a decrease in testosterone, a doctor explained to me. Premenopausal women have been shown to benefit from testosterone in terms of bone density, heart health, metabolism, cognition, and the health of their ovaries and bladder. While research on testosterone’s benefits for women over 65 may be limited, treating menopausal symptoms solely through treatment is not enough as it neglects a fundamental aspect of women’s well-being: their sexual health. The emotional changes may include anxiety, low mood, and even depression and distress due to the decreased sex drive.

From a socioeconomic perspective, research reveals a significant negative impact of menopause symptoms on work outcomes. Thus, there is a need to improve medical treatment for these women and to make the workplace environment more inclusive and supportive. The impact is substantial; with the aging megatrend worldwide, women in many developed countries spend up to one-third of their lives postmenopausal. Diminished concentration, mood swings and impaired recall during menopause can negatively impact work. Employers who acknowledge the onset of menopausal symptoms can make adjustments to help women continue working without exacerbating their symptoms or needing time off from the job or leaving their jobs entirely.

Menopause impacts social dynamics, labour market outcomes, and healthcare demand. Some researchers have estimated the effect of menopause diagnosis on employment and earnings, reliance on social safety net programmes, and demand for medical care. Menopause affects a broad swath of women’s lives — from a temporary increase in doctor visits to a persistent decline in full-time employment and earnings, as well as an increased reliance on social transfers. The earnings losses can make up to 20% of the pre-menopause levels. Significant savings could be achieved with proper investments in the services for menopausal women.

Some researchers concluded that menopause negatively affects the psychological well-being of women, the severity of the effects increases by years since the onset of menopause. Vulnerable rural women described a need to understand fully the intensity of menopause-related symptoms, including changes to their physical and mental well-being. They described menopause as having a significant impact on their relationships and identified social support and humour as their primary coping strategies.

There are social determinants for the health of women in menopause. These include cultural factors, lifestyle choices (nutrition, exercise, smoking, etc.), family support, educational level, employment, marital status, and the number of pregnancies and childbirths. Raising awareness about menopause particularly to dismantle the stigma surrounding it, creating emotional, family, and social support, as well as good planning for lifestyle enhancement improves women’s well-being during this life stage.

Research revealed that the younger generation often stereotypes menopausal women as unstable and mature, depicting them as fragmenting their families with emotional instability.

Menopausal experiences vary widely among women, influenced by diverse factors. Recognising and responding to this diversity is crucial for improving the quality of life for all menopausal women. Therefore, we need to address the needs of women in menopause from a multidisciplinary angle to ensure a healthy and inclusive environment in this post-reproduction age. This includes providing high-quality comprehensive health service, counseling, psychosocial support, inclusive work environments, and educating families as the guardians and custodians for social solidarity to provide the needed support for women during and post-menopause. We also need to improve health services and awareness among women in the reproductive stage to help them plan for menopause through healthy lifestyle, nutrition, and understanding the needs of their bodies.

Comprehensive management of postmenopausal women’s health should address various interconnected aspects of well-being including cancer screening, regular mammograms and breast examinations, colon cancer screening, dementia prevention, cognitive stimulation, social engagements, and regular physical exercises. It should also include sleep and pain management and regular annual checkups.

Published in The Express Tribune, June 4^th, 2024.

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