The Silent Transition: How Women In Rural India Cope With Early Menopause

Menopause is a natural phase in a woman's life when menstrual periods stop, usually at or beyond the age of 50. Natural menopause is said to occur after 12 consecutive months without menstruation, for which there is no obvious physiological or pathological cause and in the absence of clinical intervention. As life expectancy increases, women spend almost one-third of their lives in menopause (1). However, for some women, this transition occurs much earlier than expected. When menopause occurs before the age of 40, it is termed premature menopause and refers to the cessation of ovarian function.

Early menopause may be linked to an increased risk of cognitive decline and dementia, possibly due to the longer duration of hormone deficiency affecting brain function. For women who experience this transition earlier than expected, feelings of isolation, sadness, and anxiety can arise. The sudden loss of fertility may also cause distress for women who still wish to conceive. In addition, the fear of ageing and the potential health consequences of early menopause can contribute to mental health struggles (2).

The Story Of Seema Devi

At 41, Seema Devi, a resident of Nawagarh village in Angara Block of Ranchi, Jharkhand, and a mother of three, began noticing subtle changes in her body. Her menstrual cycles became irregular, and she often felt fatigued. Initially, she brushed it off, attributing the symptoms to stress from work and parenting. But soon, the hot flushes and night sweats started, making her feel disconnected from her once vibrant self.

Seema also had frequent episodes of vaginal infections, but she did not seek treatment due to embarrassment. Later, when she confided her symptoms to Rani, the local ASHA worker, she was advised to consult the Gynaecologist. During one of the cervical cancer screening camps, organised by the collaborative efforts of Transform Rural India (TRI) and the Community Health Centre (CHC) Angara, the Gynaecologist diagnosed her with early menopause, after taking a detailed history and conducting a few tests.

Seema had always associated menopause with ageing, something she wouldn’t have to think about for at least another decade. But here she was, searching for answers. Seema was indeed going through early menopause. The news was a shock for her. She had heard of premature menopause but didn’t imagine it would happen to her. She began to feel isolated, as none of her friends were experiencing anything similar. Most were still talking about family planning, not dealing with the end of reproductive years. Beyond the physical symptoms, the emotional toll was immense. Seema struggled with feelings of loss, not just of fertility but of her youthful energy and identity. The hormonal changes triggered mood swings, and she often found herself overwhelmed by sadness and, at times, anxiety.

When it happens between 40 and 45 years of age, it is referred to as early menopause. While early menopause is slightly more common than premature menopause, it is still considered an early transition into menopause compared to the average age of menopause. Both conditions can have significant health and emotional impacts, making awareness and understanding of these phenomena crucial. In both cases, the ovaries stop producing eggs, leading to a decline in oestrogen and other reproductive hormones.

This can result in the typical symptoms of menopause, as experienced by Seema. However, the earlier onset also introduces a range of health risks and challenges that women may not anticipate at a younger age. Women who experience early menopause are at a higher risk of developing osteoporosis, a condition where bones become brittle and more prone to fractures due to the sudden drop in oestrogen levels. Oestrogen also plays a role in protecting the heart. Women with premature or early menopause are at increased risk of heart disease and stroke due to the long-term effects of low oestrogen on blood vessels and cholesterol levels.

The Culture Of Silence Around Menopause

According to the United Nations, Department of Economic and Social Affairs (2021), globally, the population of menopausal women aged 50 years and above has increased from 22% in 2011 to 26% of all women and girls in 2021. Premature menopause was seen in about 1% of women, and early menopause in 5% of women. The Study of Women’s Health Across the Nation (SWAN) reported a 1.1% prevalence of early menopause among women.

A culture of silence around menopause, particularly among rural women, significantly affects their quality of life. Rural women facing early menopause experience unique emotional and physical challenges, often due to a lack of understanding about menopause, compounded by limited access to healthcare, education, and support systems (3). Women might face social stigma, with some being labelled as “old” before their time or considered less valuable because they no longer menstruate.

Cultural taboos around discussing reproductive health often prevent women from talking openly about their symptoms, leading to feelings of shame or confusion. Changes in sexual function, such as reduced libido and vaginal discomfort, can strain marriages. In some cases, women may feel inadequate, leading to strained relationships or even abandonment by their partners.

A lack of sexual education or counselling in rural areas makes it difficult for couples to navigate these changes together. In rural communities, women are often expected to fulfil traditional roles and often rely on their physical strength to contribute to household income, whether through farming, labour, or caregiving. Early menopause can make it physically difficult for them to meet these expectations, causing tension within the family. The fatigue, joint pain, and other physical symptoms of early menopause can reduce their ability to work, leading to financial stress.

Moreover, if they are primary caregivers, their health decline may also affect the welfare of their children and families. In many rural settings, women lack knowledge about what early menopause is, which prevents them from seeking timely medical advice or treatment. Cultural beliefs or misinformation can lead to women misunderstanding their symptoms, often attributing them to other causes or assuming it’s a natural process they must endure silently.

Unlike urban areas, where women may find support through healthcare providers or support groups, rural women often face their challenges in isolation. Family and community members may not understand the emotional and physical strain of early menopause, making it hard for women to ask for help or communicate their struggles. Due to limited access to medical care, many rural women turn to traditional remedies for symptom relief. While some remedies may provide comfort, they may not address the underlying health risks associated with early menopause, such as heart disease or bone loss.

Empowering rural women through education about early menopause, its symptoms, and treatments can help reduce stigma and promote timely healthcare access. Training healthcare workers in rural areas to recognise early menopause and provide appropriate treatment, including referrals for hormone therapy, mental health support, and bone health management, is critical. Establishing local peer support groups where women can share their experiences and coping strategies can help reduce feelings of isolation and provide emotional relief. Governments and NGOs should integrate menopausal care into rural health programmes, focusing on making affordable treatments like hormone therapy, bone health supplements, and mental health services accessible. 

Seema’s journey is ongoing, but she has learnt to embrace this new phase of life. Early menopause, she realised, didn’t mark an end, but the beginning of a different chapter, one where self-care and support were key.

References

1. M.M. Sagdeo, Dimple Arora. Menopausal Symptoms: A Comparative Study in Rural and Urban Women. 

2. Nanette Santoro, MD, a,* C. Neill Epperson, MD,b and Sarah B. Mathews, MD. Menopausal Symptoms and Their Management. 

3. Sagar A. Borker, P. P. Venugopalan1, Shruthi N. Bhat2. Study of menopausal symptoms, and perceptions about menopause among women in a rural community in Kerala. 

Authored by Dr Sarita Lakra, State Programme Officer, Health, Transform Rural India (TRI) based at Ranchi, Jharkhand.