Women's Mental Health Series: Menopause

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Menopause is not only the end of menstrual cycle but also of the reproductive capacity of an woman. Apart from humans, only a couple of other mammals have been shown to attain menopause (that is when they can no longer bear children). 

Menopause and Perimenopause

Menopause is the age at which the menstrual cycles come to an end and is marked by absence of menstruation for a consecutive 12 months. Most women attain menopause in their late 40s or early 50s (average age for Indian women being 45±5 years). 

A growing percentage of women are attaining earlier, below 40 years, which is called premature menopause. The causes include genetic causes, infections (mumps, TB), autoimmune diseases, smoking, drugs or following surgery to remove the ovaries which is called surgical menopause. They may experience more severe menopausal symptoms. 

Although chronic stress may bring on earlier natural menopause, more research is required to confirm the association.

However, several years preceding to menopause, a woman may experience a range of symptoms when the ovaries are gradually losing their functions and the reproductive hormones are fluctuating in levels. 

This phase called Perimenopause is defined World Health Organization (WHO) as the 2-8 years before menopause and 1 year after the final menses.

Common Symptoms

This transition phase increases women’s vulnerability and makes them more prone to mental health issues. 

Common symptoms in perimenopause and menopause include irregular menstruation, irritability and crying spells, headache, sleep disturbances, weakness, joint pains, palpitations, hot flushes, night sweats, and vaginal dryness. 

It is quite possible that depression and anxiety disorders which present with similar complaints can be missed and not evaluated properly.

The age around menopause is also the confluence of many social and personal events like adult children leaving home or aging or dying parents which may compound the risk for psychological issues.

What can be done?

Although most women attain menopause smoothly or with minor changes, many may experience debilitating symptoms impairing daily work functioning. 

Hormone therapy, medications like antidepressants, psychotherapy are available and can help adjusting to this transition phase.

-Dr. Suhasini Das, MD (Psychiatry)

Consultant Psychiatrist


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