Menopause Is Not a Disease — But It’s Not Nothing Either
I have a particular frustration with two extremes in how menopause is discussed. On one end: “it’s just a natural transition, you’ll be fine.” On the other: an entire wellness industry selling supplements with dubious evidence.
The reality sits in the middle. Menopause is a significant hormonal transition that causes real symptoms for many women — symptoms that are genuinely treatable. You don’t have to just put up with it. But you also don’t need to spend a fortune on unproven remedies.
Here’s the honest picture.
What Menopause Actually Is
Menopause is defined as 12 consecutive months without a period — the point at which the ovaries have stopped producing eggs and oestrogen levels have declined permanently. In India, this happens on average between ages 46–48, a few years earlier than the global average of 51.
The years leading up to this point — perimenopause — often bring the most challenging symptoms, as oestrogen levels fluctuate erratically before declining.
The Symptoms Worth Knowing About
Hot Flashes and Night Sweats
Sudden waves of intense heat, often with sweating and flushing — sometimes several times a day, sometimes waking you at night. These are caused by the loss of oestrogen’s stabilising effect on the body’s temperature regulation. They can last for years. They’re also the most effectively treated symptom we have.
Vaginal Dryness and Discomfort
Reduced oestrogen causes thinning and drying of vaginal tissues — making intercourse uncomfortable or painful. This is extremely common and extremely undertreated, because many women don’t bring it up. It doesn’t resolve on its own and gets gradually worse without treatment.
Mood Changes, Anxiety, and Brain Fog
Oestrogen affects serotonin and dopamine pathways. The hormonal fluctuations of perimenopause are a real trigger for mood instability, anxiety, and — for some women — depression. “Brain fog” — difficulty concentrating or remembering things — is also genuinely hormonal, not just ageing.
Sleep Disruption
Often worsened by night sweats, but also directly caused by hormonal changes. Poor sleep creates a cascade of other problems — mood, weight, cardiovascular health.
Bone Density Loss
Oestrogen protects bone. After menopause, bone density declines and osteoporosis risk rises — this is a long-term health concern that many women don’t think about until a fracture happens.
What Actually Helps
Hormone Replacement Therapy (HRT)
This is the most effective treatment for menopausal symptoms. Modern HRT has a much better safety profile than older formulations, and for most women under 60 without specific contraindications, the benefits significantly outweigh the risks.
I have this conversation carefully with every patient — looking at personal health history, family history, and specific symptoms before recommending.
Local Vaginal Oestrogen
For vaginal dryness and urinary symptoms specifically — this is low-dose, localised, and considered safe for virtually all women. It works very effectively and is underused.
Lifestyle Measures That Actually Work
- Regular weight-bearing exercise — protects bones and significantly improves mood
- Avoiding triggers for hot flashes: alcohol, spicy food, caffeine, stress
- Calcium and Vitamin D — essential for bone health
You Don’t Have to Just Cope
At Punit Fertility & Women’s Center, Kandivali Mumbai, I provide personalised menopause management — looking at the full picture and recommending what actually has evidence behind it.