Menopause: The dreaded ‘M-word’

Menopause may indeed be a trying time for a woman but it does not have to be the end of life as she knows it.

“I’d call it one hell of an emotional roller coaster,” says Samreen Athar, a 42-year old mother of three when asked about menopause. “I constantly feel trapped between my full-time job and homemaking. Sometimes, I can’t even choose which cereal to eat. The temperamental ups and downs are exasperating to say the least!”

Samreen’s negative experience of menopause is enough to make anyone cringe. It seems like every woman has her own hormonal crisis to lament over and if not that, it is the terror of reaching it that gets to her. And what is worse is that none of them seek to remedy their predicament: they scream at their cooks, pick fights with their husbands and cry in secret but never try to understand just what the matter is. They regard menopause as little more than just the cessation of menstruation and are unable to cope with the impending effects, leading to family feuds, frustration and further health problems. In reality, there is a grave need to delve into the matter further and inform women about menopause and what it entails.

Biologically, menopause is defined as the absence of menstruation for 12 months or more; when the ovaries stop producing the reproductive hormones Estrogen and Progestrone, rendering the woman unable to conceive thereafter. It involves various bodily changes such as weight gain, increased facial hair, migraines and backaches, restless legs, dry skin and even hair loss. Other symptoms include random hot flashes within, sweating at night, insomnia and the much talked about mood swings. “Every woman’s experience of menopause is unique,” explains Dr Shabnam Afridi, Manager at the Reproductive Health Program at Aga Khan Health Services Pakistan. “The extent and severity of the symptoms varies significantly. Sometimes, the symptoms manifest themselves for a short time only and then come back later. Some women show no symptoms of menopause at all!”

For research purposes, Mrs Mehtab Furqan, 50, was kind enough share her story. “I have gained weight and depression is an everyday thing for me,” she admitted. “Nights are the worst as I often feel sudden bouts of heat around my neck and can’t sleep!” Others such as 59-year-old Sultana Khan* showed no symptoms except irregular menstruation.

In Pakistan, menopause is a particularly pertinent issue. With an ever-increasing population, an average female life expectancy of 67 years (and increasing) and the average age of menopause being around 49.3 years, it is important we stop shying away and bring the issue of this natural phenomenon to the table. As life expectancy gradually rises, Pakistani women now live almost one-third of their lives in post-menopausal conditions! Dr Shahida Mirza, a consultant gynaecologist at the National Institute of Blood Disease Hospital (NIBD) suggests that with “the literacy rate of Pakistani women being just 28%, most women have no inkling as to what menopause is, let alone why it occurs. “Many of my patients actually ask the most basic of questions like ‘what is menopause?’ or ‘is it very dangerous for me?’ They are so unaware, it is saddening!”



The lack of awareness breeds some myths which have a detrimental effect on women in our society. “There are many misconceptions Pakistani women hold regarding menopause, perhaps due to word of mouth or unreliable information from the internet,” says Dr Mehwish Ashfaq, a medical officer from Islamabad, currently pursuing a MPhil in Physiology. “For starters, many uneducated women link menopause to the end of their feminity and curse themselves for it.” Other incorrect notions include menopause being unnatural, a proponent of breast cancer, something only very old women undergo and that menopause signals a time in a woman’s life after which she simply cannot remain a healthy, functioning human being. One grave misconception women suffer from is that post menopause, the body ceases to produce hormones completely and that is what causes all the trouble. On the contrary, hormones like the afore-mentioned Estrogen and Progesterone decline in number, simply because they are needed less now than they were when the woman was younger. For some women, symptoms of hormonal imbalances, such as hot flashes, weight gain and urinary inconsistency may be aggravated post menopause while for others, the symptoms disappear altogether.

It is important for us to know that when it comes to our health, there is a variety of options available out there than can help us through. Some women resort to Hormone Replacement Therapy (HRT) to ward off the inevitable risks and side effects of menopause but research shows that taking the natural route is best. The most effective and lasting way to counter the symptoms of hormone imbalance is to make dietary and lifestyle changes and strengthen oneself from the inside. “Exercising, specially walking and jogging, is particularly beneficial as it not only keeps the blood circulation flowing but also controls weight gain and strengthens the bones, reducing the risk of post menopausal osteoporosis,” explains Dr Mehwish. “Food rich in protein and calcium are a must for ageing women. They must also try and keep their stress levels in check.” Milk and yogurt, for instance, are known to provide high levels of calcium which enhances bone mass and reduces skeletal fragility in post menopausal women. Foods with a high quantity of Omega-3 are equally vital as they have been proved to combat depression.

Women nearing the age of and those who have already underwent menopause need to realise that just because their menstruation cycle has come to a halt, their lives have not and even the worst of post menopausal symptoms can be dealt with effectively. Mrs Mehtab Furqan, who keeps a wet tea towel handy to control hot flashes says, “Every aging woman has to face menopause so why not be prepared for it beforehand? Women should be informed as to the health implications of menopause so that they may help themselves.” Dr Shabnam Afridi agrees. “If women are made aware of what happens during menopause, they can help reduce the negative effects it can have on their health and family life,” she says.

With a population of 185 million  — a number expected to rise to a staggering 226 million by the year 2020 — and increasing life expectancy, it is important we act to fix the lack of knowledge regarding feminine issues in Pakistan. It is high time we stop fearing menopause and welcome it as a new direction in life, wherein our priorities should change from nurturing our families and careers to caring about our health and wellbeing. Our outward appearance may have changed but it is what is inside which matters most. Remember, menopause is not the end of life. It is simply a new chapter in our story. 

*Name has been changed to protect privacy

Published in The Express Tribune, Ms T, December 22^nd, 2013.