Talking about life after menopause

After watching the Netflix drama Bombay Begums recently, I was encouraged to see that mainstream cinema has started giving space to a female character going through menopause and experiencing hot flashes. This is probably a first in the Subcontinent's cinema.

The series did not captivate me as much as this rare portrayal of a woman during menopausal transition in a society that is so steeped in patriarchy, and an issue that even women in Nepal do not want to address. The same kind of taboos that dictate menstruation also affect menopause, the two biological events that bookend the life of women.

The general assumption is that this is not something that should be talked about openly, and the prevailing misconception is that women’s health consists only of pregnancies and contraception. Health after menopause is either ignored or dismissed. 

This is prevalent not only in the public, but also among us health workers who have limited knowledge on the matter. We need a fundamental change in how we view women’s health to understand menopause better.

Women today are living much longer than their mothers and grandmothers. Assuming most women have menopause between 45-50 years, they still have a considerable number of years left to live, which makes understanding menopause even more essential. 

Menopause is a natural biological process, and not a ‘disease’ or ‘sickness’ that some health workers and drug companies try to make it out to be. It is much like menstruation or menarche where girls experience pain only to disappear with time, with only a few needing medical treatment. 

Much of this is managed with a few simple home remedies. I used to carry a hot water bag and my mother used to make me soup with garlic and fenugreek to relieve the pain. Once in a while, I also needed a painkiller but not often. 

When I was 48, I started getting irregular menstruation and within a year, my periods stopped completely. I did not have other health problems like palpitation, dizziness, night sweats, hot flashes headaches and irritability, often described by many pre-menopausal or menopausal women. 

There is no way to predict who will and who will not experience such symptoms. But this can be avoided or reduced by adopting healthy eating habits and exercises while still in our prime.

This is explained in detail in Our Bodies, Ourselves: Menopause, a book I was gifted some time back. Given that it dealt with a matter largely untouched in this part of the world, the book's message was a pleasant surprise.

It was eye-opening in a lot of ways. I learned about various mental and physical health issues associated with menopause, and how detrimental it is not talking opening about it.

Menopause can be highly stressful for those going through it. In addition to physical discomfort, women get skin spots, gain weight and develop wrinkles. But one must accept these changes, be prepared and still strive to lead a healthy life without giving too much importance to appearances. 

Our body transforms with age, and everyone starts losing bone mass after the age of 35. Bone loss in women increases after menopause. This book has important tips on how to slow down this process: consume foods high in calcium and vitamin D, sunbathe and exercise daily. 

Whole grain, green leafy vegetables, lentils and fruits should make up a large chunk of the daily diet. Say no to junk and processed foods, carbonated drinks, extra sugar and fatty items which may give her osteoporosis later in life.

For optimum health during menopause and after, a woman should also avoid smoking which interferes with the way bones absorb calcium and weaken our bones.

Every woman has to go through menopause, but it is largely up to us to be prepared and make the experience as less painful as possible, physically as well as mentally. This book succeeds in sending the message across. 

Although written by a medical doctor, Our Bodies, Ourselves: Menopause is an easy read. The author has interviewed many women to document the myriad of experiences they have had and hence is very relatable. 

Some health workers consider menopause as a disease and have developed ways to treat it. Here in Nepal too, there is now hormone therapy for women who have undergone menopause. The book argues that it is unnecessary, and instead has negative impacts on women’s bodies. 

By emphasising that menopause is a natural process and that most women have a relatively easy time with the transition, this book tells you that the hormonal changes of menopause affect each woman differently, they just need to work out how best to manage those changes. 

And while every woman is unique, attention to diet and lifestyle can do wonders in relieving discomfort as well as help with estrogen deficiency. 

The author combines trustworthy medical information based on the best available evidence with thoughtful analysis of the social, cultural, and political forces affecting our health. 

Inspired by this read, I have decided to write a book on menopause in Nepali so that all women, young and old across the country (as well as men) are educated about this transition and are prepared with the necessary tools to tackle it. 

Aruna Uprety is a public health expert and the author of the book Khana Khanu Bho?