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Rising Incidence Of Early Menopause in Indian Women

Dr. Ranjit Chakraborti

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A pan-India survey conducted recently by Institute for Social and Economic Change (ISCEC) has brought an alarming new phenomenon of premature menopause amongst Indian women to light. The data for the study based on the 1998-99 National Family Health Survey-drew samples from 100000 women in the age band of 15-50 years, across 26 states. The study revealed that Indian women fare abysmally with regard to their menopausal health. The findings of the ISEC survey highlight that on an average nearly 4% of Indian women are already menopausal between ages of 29-34 years, one of the lowest thresholds for menopause in the world. The report, which was tabled in the Parliament, has said that 3.1% of the women are already in menopause by the age of 30-34 and the incidence rises to 8% for the age bracket of 35-39. This survey has once again confirmed that that womens’ health feature at the bottom of global health and wellness. According to gynaecologist Dr. Ranjit Chakraborti, the changing dynamics of the Indian family, the increased stress upon women to be financially independent and whittling down of the familial support structure have all put tremendous physical, emotional and mental strain on the women. These pressures, coupled with the lack of proper nutrition and education about health play havoc with female hormones, resulting in a skewed menstrual pattern. As explained by Dr. Chakraborti that menopause is the strongest biological transitory phase in a woman’s life accompanied by volatile physical changes. With the onset of menopause and the subsequent dip in the levels of these hormones, a woman’s overall health, including her libido, gets impacted. The plummeting estrogen levels trigger increased blood flow to the face, neck, chest and back thereby resulting in the famed hot flushes. According to Dr. Chakraborti, the cause of early menopause in women can range from genetic predisposition to autodisimmune dysfunction. Women who experience this onset earlier than normal are likely to experience some form of depression as a result of fluctuating hormone levels in the body. Women who are catapulted into this phase earlier than they had expected may experience an added sense of loss due to a premature end to child bearing years. We come across women who just dread the idea of entering into this phase of life. It is understandable that our society values youth and beauty, and the stopping of all reproductive abilities is an unmistakable sign of ageing. Early menopause can start in the early 30s or early 40s. A number of reasons can be attributed to this: " Poor nutrition " Heavy smoking " Heavy drinking " Chronic stress to the body

The most important aspect while handling a patient having early menopause is her psyche. This is most sensitive and needs to be handled very deftly. We put a lot of emphasis on patient counseling. The objectives of counseling include addressing woman’s questions and concerns, providing her updated information, facilitating informed decision making and enhancing the patients’s confidence in the decision made and in her ability to carry it out. If a therapy is chosen, the patient and the doctor should agree on goals, whether they are short-term (menopause symptom relief), long-term (primary or secondary prevention of diseases associated with aging), or both. Along with the physical changes that occur during early menopause, women may also experience changes in mood and emotional wellbeing. Emotional wellbeing during early menopause can be influenced by many factors including: " Personality " Life experiences  trauma and illness for example " Individual thinking and behaviour patterns " Earlier experiences of mood problems, like depression and anxiety " Lifestyle  health, stress, activity, substance use " Self-esteem, your roles and sense of purpose in life " Body image " Relationships, family and support networks In particular, an early menopause may also impact on emotional wellbeing depending on: " Other factors occurring in your life at the same time " The way she was diagnosed  the time it took, if it was distressing, how it came about, how it was communicated to you " Individual physical changes and symptoms " Ways of coping, your lifestyle, relationships, support etc Dr. Chakraborti says, common initial reactions to a diagnosis of early menopause may include shock, disbelief, numbness, sadness, fear, anxiety and determination. Longer term reactions may involve depression, anxiety, stress, perceived loss of control, lower self-esteem, grief, motivation to make changes, acknowledgment of life change, and lifestyle changes. Lifestyle issues are relevant to well being of women at every life stage from adolescence to midlife and beyond. As shared by Dr. Chakraborti, for a woman experiencing early menopause it is a time for personal adjustment to the necessary lifestyle changes maintain good health and wellbeing into the future. Nutritional changes may include boosting calcium intake to help prevent osteporosis and undertaking adequate physical activity for heart health and bone health benefits. Establishing a good dietary approach throughout life should provide better weight management. Early menopause could be diagnosed using a number of tests including: " Medical history, including family history. " Investigations to rule out other causes of amenorrhoea (absence of periods). Causes may include pregnancy, extreme weight loss, other hormone disturbances and some diseases of the reproductive system. " Investigations into other conditions associated with premature menopause, such as autoimmune diseases. " Genetic tests to check for the presence of genetic problems associated with premature menopause. " Blood tests at various stages of the menstrual cycle to check hormone levels. As a doctor we try to ensure the following: " Make an effort to address all the patients’s questions. " Ensure that the scientific information presented to the patient is objective. " Brief the patient about relevant health conditions such as heart disease and osteoporosis so that she appreciates how these diseases could affect her quality of life in the future " Discuss the known risks and benefits associated with each option " Discuss with the woman practical issues that she may face if medication will be part of her management plans

The complexity of early menopause involves many psychosocial factors so gaining techniques to manage these issues can be most useful. A woman may find support in family, friends, doctors, a counselor or psychologist.