Menopause is the point at which periods stop for good, confirmed after twelve months without a period. Indian women reach it on average in their late forties, a little earlier than women in many Western countries. The years before it, called perimenopause, can bring irregular periods and symptoms that begin well before the last period.
Menopause is natural, but its symptoms do not have to be endured in silence. Hot flushes, night sweats, broken sleep, low mood, joint aches and vaginal dryness affect most women to some degree, sometimes for many years, and all of them can be treated. Menopause is also the right moment to look ahead, at bone strength, heart health and cancer screening.
At Divine Women’s Hospital, Gota, Dr. Devang Patel offers menopause consultations that take time to understand your symptoms and priorities, and that explain the benefits and risks of hormone and non-hormonal treatment in plain terms, in Gujarati, Hindi or English.
Perimenopause, menopause and after
Perimenopause usually begins in the early to mid forties, as the ovaries release eggs less regularly and hormone levels swing up and down. Periods may come closer together, become heavier, or skip months. Symptoms are often worst in this phase, precisely because hormone levels are unpredictable.
Menopause itself is a single date, the last period, known only in hindsight. Everything after it is postmenopause. Menopause before 40 is called premature ovarian insufficiency (POI) and affects about 1 in 100 women; before 45 it is called early menopause. Surgery to remove both ovaries, or some cancer treatments, cause an abrupt menopause at any age.
Symptoms women notice
- Irregular periods, sometimes heavier or closer together before they stop
- Hot flushes and night sweats, affecting around three in four women
- Difficulty sleeping, tiredness and poor concentration or memory
- Low mood, irritability, anxiety or tearfulness
- Joint and muscle aches, often mistaken for arthritis
- Vaginal dryness, burning, discomfort during intercourse
- Urinary urgency, frequent urination or repeated urine infections
- Reduced interest in sex, dry skin and thinning hair
How menopause is assessed
In women over 45, perimenopause and menopause are diagnosed from symptoms and the pattern of periods; a blood test is usually not needed, because FSH levels fluctuate from day to day in perimenopause. FSH is helpful in women under 45, and repeated tests are used to diagnose POI under 40.
The consultation also looks for other causes of similar symptoms. Thyroid disease, anaemia, vitamin D and B12 deficiency (common in vegetarian diets) and depression can all mimic menopause and are checked where relevant.
- Blood pressure, weight and waist measurement
- Fasting sugar or HbA1c, lipid profile and thyroid function
- Haemoglobin, vitamin D and B12 where indicated
- Breast examination and mammography from the appropriate age
- Cervical screening if due, and a pelvic ultrasound if there is abnormal bleeding
- A bone density (DEXA) scan if there are risk factors for osteoporosis
Hormone replacement therapy: benefits and risks
HRT replaces the oestrogen the ovaries no longer make, and is the most effective treatment for hot flushes and night sweats, usually reducing them by around 75–90%. It also protects against bone loss and fractures. NICE and the International Menopause Society advise that, for most healthy women under 60 or within ten years of menopause, the benefits outweigh the risks.
The risks depend on the type of HRT and on you. Combined HRT is linked with a small increase in breast cancer risk, in the order of a few extra cases per 1,000 women over five years, which grows with longer use and falls after stopping. Oestrogen tablets slightly raise the risk of blood clots and stroke; oestrogen through the skin as a gel or patch does not appear to. Women who still have a uterus need a progestogen alongside oestrogen to protect the womb lining.
The type and route of HRT matter as much as the decision to take it; patches and gels avoid the clot risk of tablets.
Treatment options compared
Choice depends on whether you have a uterus, your periods, your personal and family history, and what you would like to achieve.
| Option | How it works | Suited to |
|---|---|---|
| Oestrogen-only HRT | Oestrogen as tablet, gel or patch | Women who have had a hysterectomy |
| Sequential combined HRT | Oestrogen daily with progestogen part of the month; monthly bleed | Perimenopausal women still having periods |
| Continuous combined HRT | Oestrogen and progestogen every day; no bleed | Women more than a year past their last period |
| Oestrogen with a hormonal IUD | IUD protects the lining and gives contraception | Perimenopausal women who also need contraception |
| Tibolone | A single tablet with oestrogen-like effects | Postmenopausal women who prefer one tablet |
| Vaginal oestrogen | Low-dose cream, tablet or ring acting locally | Dryness and urinary symptoms; very little absorbed |
| Non-hormonal medicines | Selected prescription medicines that reduce flushes | Women who cannot or prefer not to take HRT |
Who should avoid HRT, and non-hormonal help
HRT is generally not advised after breast cancer, with unexplained vaginal bleeding, active liver disease, or a recent clot, heart attack or stroke. A history of migraine, a past clot or high blood pressure does not always rule it out, but changes which type is chosen.
- Cognitive behavioural therapy (CBT) techniques, with good evidence for flushes, sleep and mood
- Regular exercise, including brisk walking and yoga, and weight loss if needed
- Cutting down caffeine, alcohol, very spicy food and hot drinks if they trigger flushes
- Layered cotton clothing, a fan at night and cool showers
- Vaginal moisturisers used regularly, and lubricants for intercourse
- Pelvic floor exercises for urinary leakage
Bone and heart health after menopause
Women lose bone rapidly in the first five to ten years after menopause, and Indian women tend to have lower peak bone mass, so osteoporosis and fractures are common. A DEXA T-score of -2.5 or lower confirms osteoporosis. Adult women need about 1,000–1,200 mg of calcium a day; good vegetarian sources include milk, curd, paneer, ragi, sesame (til), rajgira and green leafy vegetables.
Heart disease becomes the main cause of death in women after menopause. Keeping blood pressure, sugar and cholesterol in range, staying active for at least 150 minutes a week, and avoiding tobacco matter more than any single tablet. Vitamin D deficiency is very common in Ahmedabad despite the sunshine, and is corrected when found.
Weight-bearing exercise such as brisk walking, climbing stairs and simple resistance work with light weights helps keep bone and muscle strong. Falls cause most fractures, so good lighting at home, sensible footwear and balance exercises are worth attention in later years. If osteoporosis is found, effective bone-strengthening medicines are available alongside or instead of HRT.
Early menopause and premature ovarian insufficiency
When periods stop before 40, or before 45, the body loses oestrogen many years earlier than usual. This raises the long-term risk of osteoporosis, heart disease and possibly memory problems. Hormone treatment is therefore advised at least until the average age of natural menopause, around 50, unless there is a specific reason not to; in this group it is replacing what is missing rather than adding risk.
Women with POI may still ovulate occasionally, so contraception is discussed if pregnancy is not wanted, and fertility options are discussed if it is.
How menopause care is organised at Divine Women’s Hospital
The first consultation is unhurried, covering your symptoms, their effect on work, sleep and relationships, and your medical and family history. Tests are chosen to suit you rather than ordered as a fixed package. Dr. Devang Patel then talks through the options so you can choose with full information, and you can change your mind at any review.
Any bleeding after menopause is investigated promptly at the same hospital in Gota, with ultrasound and, where needed, hysteroscopy and biopsy.
Your care, step by step
- Symptom reviewYour symptoms, their impact on daily life, and your personal and family medical history are discussed.
- Health checkBlood pressure, weight and relevant blood tests, with breast, cervical and bone assessment as needed.
- Treatment choiceHRT and non-hormonal options are compared in plain terms so you can decide what suits you.
- Three-month reviewSymptom relief, bleeding pattern and side effects are checked, and the dose or type is adjusted if needed.
- Yearly reviewOngoing benefits and risks are reassessed each year, along with screening and bone health.
When to book a visit
- Hot flushes, night sweats or poor sleep are affecting your daily life
- Your periods have become irregular or heavy in your forties
- Vaginal dryness, discomfort during intercourse or repeated urine infections
- Your periods stopped before the age of 45
- You have had both ovaries removed or had cancer treatment
- You are taking HRT and would like a review
Warning signs - get same-day care
- Any vaginal bleeding after menopause, especially heavy bleeding or bleeding with dizziness
- Pain or swelling in one calf, chest pain or sudden breathlessness while on HRT
- Sudden severe headache, weakness on one side, slurred speech or loss of vision
- A new breast lump, nipple discharge with blood or skin dimpling
- Severe low mood with thoughts of self-harm
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: HRT always causes breast cancer.
The increase with combined HRT is small and depends on duration. Oestrogen-only HRT carries little or no increase. Your own risk is weighed before you decide.
Myth: Menopause symptoms are only in the mind and should be tolerated.
They are caused by real hormonal change, and effective treatments exist. Suffering is not a requirement.
Myth: Once periods stop, you no longer need a gynaecologist.
Bone health, heart risk, screening and any postmenopausal bleeding all need attention after menopause.
Myth: Herbal or soy supplements are a safe natural substitute for HRT.
Evidence for most supplements is weak, quality varies, and some interact with other medicines. Mention any you take at your visit.
Frequently asked questions
At what age does menopause start in Indian women?
Studies show Indian women reach menopause on average in their late forties, though anything between 45 and 55 is considered normal. Menopause before 40 is premature and should be evaluated.
Is HRT safe?
For most healthy women who start HRT before 60 or within ten years of menopause, the benefits outweigh the risks. HRT is not suitable for everyone, for example after breast cancer or with certain clotting disorders, and your individual risks are assessed first.
How long can I take HRT?
There is no fixed cut-off. Many women take it for a few years, others longer. The decision is reviewed every year, balancing symptom relief and bone protection against your changing risks.
How long do menopause symptoms last?
Hot flushes and night sweats last around seven years on average, and some women have them for longer. Vaginal symptoms tend to persist or worsen without treatment but respond well to local therapy.
Do I need a blood test to confirm menopause?
Usually not. Over 45, menopause is diagnosed from symptoms and the period pattern. Blood tests such as FSH are mainly useful under 45, or when the picture is unclear.
Can I get pregnant during perimenopause?
Yes, pregnancy is possible while periods continue, even irregularly. Contraception is advised until two years after the last period if you are under 50, or one year after if you are over 50.
What helps hot flushes without hormones?
Keeping cool, layered clothing, regular exercise, weight loss if needed and avoiding triggers can help. Some prescription non-hormonal medicines reduce flushes, and CBT techniques have good evidence.
Does menopause cause weight gain?
Hormonal change shifts fat towards the waist, and muscle mass falls with age. Strength exercises, regular walking and smaller portions of rice, roti and sweets help counter this.
Is vaginal oestrogen safe to use long term?
For most women, yes. Low-dose vaginal oestrogen acts locally, very little reaches the bloodstream, and it does not need a progestogen. It can be used for as long as symptoms need it, with a yearly review.
Can HRT cause bleeding?
Irregular spotting is common in the first three to six months, and sequential HRT gives a planned monthly bleed. Bleeding that persists beyond six months, or starts after a long bleed-free spell, should be checked with an ultrasound.