Beyond Reproductive Years: Addressing the Overlooked Health Needs of Menopausal Women

India was the first country to launch a National Family Planning Programme in 1952, a pioneering initiative laying the foundation for global population control measures. Over the years, female sterilization has become the most prevalent method of contraception; this heavy reliance on sterilization has significantly shaped health policies in India, which predominantly focus on women of reproductive age. These policies, in turn, emphasize maternal and child health, reflecting a concentrated effort to enhance health outcomes during this phase of life.

Government programs such as Janani Suraksha Yojana, designed to promote institutional deliveries, and Pradhan Mantri Matru Vandana Yojana, offering financial assistance to pregnant and lactating women, exemplify this approach. Furthermore, the Reproductive, Maternal, Newborn, and Child Health (RMNCH) framework reinforces the commitment to addressing health challenges during pregnancy, childbirth, and the postpartum period. Together, these initiatives have significantly improved maternal and reproductive health indicators, showcasing notable advancements in public health.

These efforts are commendable, but there is also a need to focus on the health needs of women beyond their reproductive years, particularly women transitioning into or experiencing menopause, a critical life stage that often receives insufficient attention. A pronounced data gap further compounds the issue, and – the lack of comprehensive data hampers the development of targeted policies and interventions, leaving a crucial gap in addressing women’s health holistically. Addressing this gap necessitates a shift towards a more inclusive and life-course approach to healthcare, such an approach would recognize and support women’s health needs across all stages of life, ensuring that the contributions and challenges of women beyond their childbearing years are neither overlooked nor undervalued.

Menopause is a significant biological milestone in a woman’s life, indicating the permanent end of menstruation caused by the decline in ovarian follicular function. According to the World Health Organization, natural menopause is confirmed after 12 consecutive months without menstruation¹. Typically, this transition occurs between the ages of 45 and 55, signaling the end of a woman’s reproductive phase and the beginning of a non-reproductive period. Interestingly, the age of onset of menopause varies significantly across populations, in India, women typically experience menopause at around 46.6 years ², earlier than their counterparts in western countries, for example, Europe’s average age is approximately 50.54 years ^{2 3}.  In India, approximately 8% of women between the ages of 35 and 39 report experiencing signs of menopause ⁴, which is an alarming indicator of an emerging public health concern. The country’s healthcare system, which predominantly focuses on women of reproductive age, is ill-equipped to address the challenges posed by perimenopause, early menopause, and menopause ⁵.

This transition to menopause is complex and multifaceted, significantly impacting women’s biological, emotional, and sociocultural health and well-being.

• Biologically, it is characterized by a decline in ovarian function, resulting in decreased production of hormones such as estrogen and progesterone. This hormonal shift can lead to various symptoms, including hot flashes and mood swings, while also increasing long-term health risks like osteoporosis and cardiovascular disease.
• Emotionally, this phase can trigger feelings of loss and anxiety as women grapple with societal expectations regarding aging and femininity. A lack of understanding and support from family and the community often compounds these feelings​.
• Socio-culturally, menopause may be surrounded by stigma, particularly in cultures where open discussions about it are discouraged. This can lead to isolation and a scarcity of resources for women navigating this life stage​.

For example, studies from the U.S. and Europe reveal that nearly 80% of menopausal women experience notable physical and emotional symptoms⁶ impacting daily life, with many also facing social isolation. In India, particularly rural areas, limited awareness, healthcare, and persistent stigma heighten these challenges, underscoring the need for local research to address disparities in menopausal experiences⁷.

The current framework for women’s health care needs to invest in these unique and multifaceted needs of women transitioning into menopause, resulting in underdiagnosis and insufficient treatment of symptoms that can significantly impact physical and emotional well-being over time. This limited focus on reproductive health reflects societal tendencies to prioritize fertility, overshadowing the valuable contributions women make throughout their lives. By embracing a more inclusive approach, stakeholders—including policymakers, healthcare providers, researchers and academicians—can celebrate and support women’s roles beyond reproduction, recognizing their resilience, wisdom, and ongoing contributions at every stage of life. Addressing the challenges of menopause with empathy and comprehensive care not only enhances women’s health outcomes but also affirms their intrinsic value and diverse roles within society.

Major national surveys, such as the National Family Health Survey (NFHS)⁸ and the Longitudinal Ageing Study in India (LASI)⁹, touch on menopause only tangentially, with a handful of indirect questions, this leaves a gap in fully understanding the physical, emotional, and social needs of women during this critical life stage. Therefore, expanding the scope of research to include targeted inquiries into menopause can provide valuable insights, enabling the development of policies and resources that better support women’s health and well-being. Furthermore, by prioritizing comprehensive research and integrating the experiences of menopausal women, stakeholders can create a more inclusive and responsive healthcare framework that empowers women to navigate this transition with confidence and access to necessary care.

What is urgently needed is a shift towards a life-course approach to women’s healthcare, one that recognizes and celebrates their diverse roles and contributions at every stage of life. This perspective is particularly important when addressing the health concerns of menopausal women within national policy frameworks as the population of women in this age group continues to grow, they encounter unique health challenges that necessitate specialized attention and care. Moreover, research indicates that 50% to 75% of women experience menopausal symptoms such as hot flashes, palpitations, urinary incontinence, and brain fog ^{10 11}, which can disrupt their daily lives, reduce productivity at work, and limit social engagement. Therefore, integrating the health needs of menopausal women into national policies is not only a step toward improving health outcomes but also a means to empower them to continue contributing meaningfully to the workforce, families, and communities, ultimately, this approach fosters a more inclusive and thriving society that values women’s contributions across all life stages.

Furthermore, it is essential to incorporate menopausal health into national discourse including within policy and research to dismantle the stigma and misconceptions associated with this life stage. Openly discussing menopause in policy frameworks can help normalize conversations surrounding women’s health issues and encourage women to seek the necessary support and resources. This change empowers women and fosters a more informed society that understands the significance of comprehensive healthcare across all life stages. While recent policy shifts reflect a commendable acknowledgment of the health needs of women and girls- such as the increasing focus on adolescent health—it is crucial to expand this focus to include the health and well-being of menopausal women. It is also important to build more evidence on the health needs of menopausal women. By integrating menopausal health into national policy and research work, we can address the specific challenges this demographic faces and promote better health outcomes for all women.

NOTES

1. World Health Organization. 2024. “
2. Prasad, Jang Bahadur, Naresh K. Tyagi, and Pradyuman Verma. “Age at Menopause in India: A Systematic Review.” Diabetes & Metabolic Syndrome: Clinical Research & Reviews, January 2021. https://www.researchgate.net/publication/348635760_Age_at_menopause_in_India_A_systematic_review.
3. GMatH (Global Maternal Health) Model. “Menopause.” 2022. http://gmath-model.org/1_2_9_Menopause.html.
4. Pallikadavat, Saseendran, Reuben Ogollah, Abhishek Singh, Tara Dean, Ann Dewey, and William Stones. “Natural Menopause Among Women Below 50 Years in India: A Population-Based Study.” PubMed Central, 2016. https://pmc.ncbi.nlm.nih.gov/articles/PMC5320842/.
5. Kundu, Sampurna, and Sanghmitra Sheel Acharya. “Exploring the Triggers of Premature and Early Menopause in India: A Comprehensive Analysis Based on National Family Health Survey, 2019–2021.” Scientific Reports, 2024. https://www.nature.com/articles/s41598-024-53536-9.
6. Avis, Nancy E., Sybil L. Crawford, and Robin Green. “Vasomotor Symptoms Across the Menopause Transition: Differences Among Women.” PubMed Central, 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6226273/.
7. Poomalar, G. K., and Bupathy Arounassalame. “The Quality of Life During and After Menopause Among Rural Women.” PubMed Central, 2013. https://pmc.ncbi.nlm.nih.gov/articles/PMC3576769/.
8. (NFHS-5), 2019-21, India Report.
9. International Institute for Population Sciences (IIPS). “The Longitudinal Ageing Study in India (LASI).” 2017.November 7, 2024.
10. Whiteley, Jennifer, Marco daCosta DiBonaventura, Jan-Samuel Wagner, Jose Alvin, and Sonali Shah. “The Impact of Menopausal Symptoms on Quality of Life, Productivity, and Economic Outcomes.” PubMed Central, 2013.
11. Johns Hopkins Medicine. “Introduction to Menopause.” Accessed November 7, 2024.