Vinita, 46, vice-president, sales, of a Rs500 crore FMCG company, could not understand what was happening to her. She felt that her world had suddenly changed.
The behaviour of her staff, who seemed to have suddenly lost their analytical capabilities, was most annoying. Her son, due to take the Common Aptitude Test for an MBA programme, seemed to be rarely at home. When did he ever study? She also needed to tell her secretary to fix an appointment with a neurologist for the continuous pain in her joints that was making travelling unbearable. She had actually nodded off during a vital presentation by her deputy to the CEO! Things, it seemed, could not get worse.
Before Vinita could fix a time to see her doctor, she came very close to losing her job. At a board meeting where she had an important presentation, she mixed up the CDs and gave out some old sales data. The resultant public humiliation forced her to go first on leave for a month and then in desperation to a psychiatrist and a neurologist.
The diagnosis: the dynamic corporate honcho, who was the driving force for an 80-strong team, was just an unsuspecting victim of an inevitable and inescapable force of nature—menopause. Prolonged neglect of some obvious symptoms and the irregular periods that she had blamed on too much travelling and work-tension, meant that she was also suffering from diabetes and high blood pressure. Faced with the prospect of losing her grip on a career that she had painstakingly built up over 22 years, she opted for hormone replacement therapy (HRT) for drastic results.
Vinita’s is an unfortunate example. Many urban women, senior corporates or professionals in particular, are usually aware of the sudden changes in their bodies and minds around the age of 45, which is the average age of menopause in India, compared to over 52 in the West.
But foreknowledge is only forewarned. It still means that in India, many women at the peak of their careers or housewives grappling with their husband’s high-pressure jobs, concerns relating to children’s growing-up years or leaving home, are usually neglecting issues that could actually be life and death for them.
Some of them do end up compromising their careers, battling failing relationships, or, at the very least, going through a depression.
This is where people like 60-year-old Dr Sonia Malik, gynaeocologist and fertility/IVF specialist and current president of the Delhi-based Indian Menopause Society (IMS), can and do play a vital role. Menopause is a phenomenon that affects almost every useful organ of a woman’s body, which is why the society has a variety of professionals as members, ranging from anthropologists and eye surgeons to general physicians.
“Menopause is the most misunderstood biological change in women,” says the salt-and-pepper-haired Malik, president of the society for 2007. “We have 2,100 members now after a very small beginning in 1995. Perhaps it’s not much progress in a country that has millions of doctors. But somebody had to speak out and tell women: ‘Hey, it’s not your fault’. Don’t blame yourself, it happens to the best of us!”
It did to Aarti. Troubled with an ovarian cyst at 44, this Kolkata housewife had an early onset of menopause resulting in amnesia and aggravation of an Ischaemic heart. Two years later, she found herself, curiously, shrinking, along with occasional stumbling even while walking on a level surface. Her young children initially made fun of her but were saddened to realise later that their mother was suffering from acute osteomalacia due to lack of proper hormone therapy, even developing a small hump on her upper back.
According to the World Health Organization (WHO), every young person would need to support two old people by 2050, with average life span the world over rising to 75-80 years, five years more for a woman. Says Malik: “That means 65 million Indian women over the age of 45 are victims. That apart, menopause often strikes even when the woman is as young as 30-35. A woman therefore needs to be able to support herself both physically and financially for the entire post-menopause period and tackle, apart from psychological problems, the probable onset of degenerative diseases like osteoporosis, osteomalacia, cardiovascular ailments, cancers, macular degeneration of the eye, arthritis and diabetes.”
Traditionally, discussing menopause is taboo in urban Indian families—in rural areas, women are hardly aware of the changes in their body to link whatever problems they may be suffering to it. So IMS conducts awareness camps in various cities, mostly in poorer areas, with free consultations and treatment by member-doctors. They also hold charitable screening camps and workshops offering free or heavily discounted tests like pap smears (tests that detect cervical cancer), mammograms for breast cancer and ultrasounds. And of course, they distribute pamphlets, flyers and booklets to educate women about menopause. Easy exercises that develop strength, flexibility and balance are also taught at the clinics. “Our mantra is ‘Use it or Lose it’—be it the brain, bone or muscle,” says Malik.
Nikki did benefit from use. This 48-year-old owner of a Delhi beauty parlour saw business slipping out of her hands at a time when she was all ready to expand it. She was also gaining a lot of weight, making her lethargic and ungainly and hardly the right person to enthuse customers into giving themselves a makeover. On her doctor’s advice, she opened a gym and successfully managed both business and her own health problems. Go to the parlour at 5pm, you’d never find her there. However lucrative the opportunity, Nikki would be busy lifting weights or walking the treadmill instead.
This is why IMS also focuses on collecting information and data with reference to Indian women and encourage research. Independent studies conducted by gerontologist Dr Amrita Bagga, head of the department of anthropology, Pune University, have found that rural women experience menopause much later in life than their urban counterparts because of their active life and also because they have more children—you don’t lose any ova during the nine months that the child is carried!
Tribal women from Worli in Maharashtra, for instance, experience menopause much later in life than city dwellers. Bagga also found wide variations in symptoms, behavioural and disease patterns among Western and Indian women. These things could even vary between women from different regions of the same country—women from fish-eating regions or those exposed to more sunlight could have fewer bone-related problems than the rest, says Bagga.
Malik, who received her medical degree from Rohtak Medical College, Haryana, specialized in gynaecology because there was a need for female doctors to make women patients comfortable, but had to accompany her doctor husband to Saudi Arabia early on in her career. She began her practice after returning home in 1987, and since 1995, has specialised in fertility treatment. Apart from her own IVF centre at Vasant Vihar in Delhi, she is also associated with many other clinics. But the success rate in fertility, she says, shaking her head sadly, is still only 30-40%. That means, only 30 out of every 100 patients may ultimately get to see their bundle of joy.
But older women have a rougher deal. According to Malik, there is very little data relating to older women’s health problems in India. “Women are big achievers now. Their lives are already under so much pressure because they strive for perfection in everything. It goes without saying that some of them will definitely need HRT.”
Since its inception, HRT has been mired in controversy, which has dealt a big blow to the treatment of menopause. “We have to remember that menopause is beyond HRT, it is an objective approach to age,” says Malik.
In fact, Delhi-based physician and IMS member Sushma Chawla has studied caregivers for Alzheimer’s disease, who are mostly older women and going through problems of their own. “We even educate doctors,” says Malik. “In 2002, we undertook the marathon task of bringing out ‘Practice guidelines for HRT use’ which was acclaimed both nationally and internationally. But HRT works only when given at the right time, that is two to three years after menopause, not very late in life.”
With rapid changes in food habits and lifestyles, what is technically known as socio-economic conditions, the human body undergoes many more changes and much faster than ever before.
For instance, says Bagga, general secretary of IMS, “The age for menarche (first period) has advanced by a year or so in the past decade. Girls attain puberty at 10 now.”
Malik has come across many examples of the onset of early puberty during many of her senior school camps. “With children getting mature earlier, we must change the way we look at the entire spectrum of issues relating to morality and promiscuity. We can teach children to be conservative because of the fear of AIDS but we must be mature and liberal in the way we handle their confusion and growing up.”
Early maturing has its own pitfalls too. “Did you know,” Malik asks, “that there is only one organ in the human body that dies and it is a female organ? Ovaries stop functioning and it can happen at any age, even at 25!” Malik has a 25-year-old newly married patient who’s just been diagnosed with “dead” ovaries and since then, has been calling her frequently to check for an embryo donor. God—and Dr Malik willing—she’ll find one before long.
(Some surnames have been withheld to protect individual privacy )
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