‘I couldn’t even talk to my friends about it’: Why women in their 40s are now talking about Perimenopause

Shamita Shetty shared her experiences last year in November. “I was having palpitations, and had no clue what was happening”; Rani Kaur’s biggest supporter in her Perimenopause years is her 21-year-old son. Pic/Nishad Alam; Mini Mathur is studying women’s health in the US, as she wants to give information after she has a legitimate degree

I didn't know anything about Perimenopause. I couldn't understand what was happening. We women are driven by our hormones, and they are going crazy. I was having palpitations, and trying to make sense of it. Even most gynaecologists don't know about it, or talk about it," says actor Shamita Shetty, who spoke about her experiences in November of 2023, after her stint at Bigg Boss. Along with intense palpitations, she had put on weight, which was refusing to budge, and her mind would drift away in the middle of conversations. "I hadn't even had this conversation with my own friends. When I finally did speak about it, many of them said ‘we are going through the same!'"

Shetty, 45, is different from most women who are suffering from Perimenopause because of one reason - she finally knows what's happening to her, and is working on it. "Meditation has helped me, sitting down and hearing my thoughts, yes, that's helped me." Most women go through middle age only realising why they are feeling what they are feeling when their periods stop. Roughly speaking, the definition of Perimenopause is the time around menopause when your ovaries gradually stop working. In 2023, a study by Elda Health titled State of Menopausal Health in India said that almost 150 million women in India are suffering from Perimenopause and Menopause right now. "Figures are tentative, because most women never talk about it, or declare it," Swathi Kulkarni, co-founder and CEO of Elda Health told us. The study revealed that 98 per cent of women in menopausal age largely only visit gynaecologists for heavy bleeding or vaginal discharge issues, while period-related symptoms such as hot flashes, sexual health concerns, and mental health issues often go unaddressed. Other symptoms that women face include fatigue, sadness, hair fall, weight gain, anger, anxiety, various types of body pains, insomnia, memory loss, and skin issues. Even when we asked around for women suffering from Perimenopause, responses revealed that many didn't see it as different from Menopause. Perimenopause could start as early as your late 30s, and go on for 10 years before you hit Menopause.

Shonali Sabherwal and Nozer Sheriar

Actor and emcee Mini Mathur also realised that she needed to speak about the issue when she started feeling the brunt. "I had only heard about the most basic symptoms like hot flashes, night sweats and irregular periods… so I knew Perimenopause had begun but not even a gynaecologist could warn me that it also brings joint pain, brain fog, memory dips, mood swings, sleep disruption and utter hopelessness, depression and anxiety. That's when I started educating myself with research on it and ended up certifying myself as a health and wellness coach for women," says Mathur, who is now studying in the US. She started studying because she didn't want to spout gyaan without a legit degree, and because no medical professional had answers for her. "Did you know that perimenopause/menopause is only a four-hour class in all of MBBS gynaec studies?" Mathur feels that it's because in a society that's just getting started talking about Menopause and periods, Perimenopause is still a period of utter confusion… where a woman has to come to terms with ageing, her goals, her support system, her declining motivation and a body that seems resistant to the usual exercise. "We must sensitise men to understand and support women in this stage just like they do all their lives. Also there's just not enough emphasis on health research for women past their reproductive stage. They're almost invisible… asexual almost," says the 48-year-old, who said her first symptom was that she started feeling a bit demotivated to meet people. That was followed by disturbed sleep, low moods and hot flashes. "It makes me mad that women can actually deal with Perimenopause symptoms really well but have no idea where to begin and, more importantly, how to incorporate these major lifestyle changes into their already full routines. Weight training, following the circadian rhythm, fixing their gut issues by eating clean - no sugar, no alcohol… basically avoid all glucose spikes. And avoid stress in whatever way you can!"

Macrobiotics counsellor and instructor Shonali Sabherwal, who wrote Finding Your Balance - Your 360 guide to Perimenopause and Beyond in 2020, with gynaecologist Dr Nozer Sheriar, says that every decade decides the next, and if women work on themselves in their 40s, then Menopause and 50s could be manageable. "I am part of this group on WhatsApp, and now people are starting to walk. You can manage it better if you are healthy. There are indicators - irregular cycles, or Endometriosis - take your health in your hands," says Sabherwal. "There are emotional reasons because it's a sign of ageing. It's also about mood swings, and if you have any unresolved issues and trauma, it will come up. If you are bipolar, or suffer from depression, it's going to act up." Give up sugar, refined food, dairy and focus on your gut health, says Sabherwal. "It's hard work, but you have to do it. Discipline is key."

Swathi Kulkarni, Dr Asha Dalal and Tamanna Singh

Kulkarni, who started Elda with Dr Ameya Kanakiya and Nimish Bhonsale, says she did so because she was Perimenopausal. She adds that it was after Oprah spoke about her own experiences, women all over the world started talking. "Our initial research was done from a WhatsApp group. They were all suffering terribly, and their husbands couldn't help. Dr Ameya Kanakia, co-founder, went to study at the Indian Menopause Society as well. "Perimenopause and Menopause is like PMS on steroids, it needs good care," says Kulkarni, whose products, made of minerals and vitamins, help with symptoms. "I would also recommend going to a Menopause specialist instead of a regular gynaec."

Tamanna Singh, 46, the founder of Menoveda, an Ayurvedic brand, says their survey across 20,000 women across India revealed the stigma and lack of awareness around the subject. "In the survey, we found that 67 per cent couldn't name three stages of menopause. We also found that the average age for menopause in India is 46, five years earlier than the global average. Perimenopausal symptoms start eight to 10 years before that, so we are talking about women in their late thirties and early forties. The stage lasts from eight to 10 years. Additionally, 75 per cent of women agreed that their mental health was most affected during Perimenopause."

She added that tragically, most women think they are too young to be going through something like Perimenopause and remain in denial. "They think it's the end of their sex life and fertility life, and that's why they don't want to associate with it. But in my opinion, it's the time for self-love. Ayurveda has defined it beautifully. The menopause transition is the time for women to introspect, self-love and impart their knowledge and experiences to the next generation while finding a higher purpose in life."

Along with yoga, work out, and diet, there are other avenues a woman can opt for. Dr Asha Dalal of the obstetrics & gynaecology department at Reliance Foundation Hospital, Girgaon, discussed the benefits and considerations of Menopausal Hormonal Therapy (MHT). "MHT is good for dealing with symptoms such as hot sweats, night sweats, and vaginal dryness. But it should start early as soon as the symptoms are detected. MHT should start during perimenopause or early menopause. It should not be started late in menopause after 10 years. MHT should begin at a low dose and be increased gradually until symptoms disappear. It can have a protective effect on bones, as women's bones become weaker after menopause. It can also benefit skin and hair," she said, adding, "Whenever we prescribe it, mammography and sonography are a must because some women may be at risk of cancer. After the age of 40, one must be screened for everything - diabetes, BP, cancer - if not every year, then at least every three years."

It's a luxury few can afford. Studies have shown that women who are financially challenged, face worse symptoms, and have no access to healthcare as well. Sarika Gupta, founder of Safe & Happy, an organisation that works in the field of menstrual hygiene, highlighted the lack of awareness about pre- and perimenopause among women in lower-income groups. "They are absolutely unaware of pre- and perimenopause. Even in middle-income groups, it's not a conversation that takes place commonly. I am not aware of any NGOs in India that have been working in this field." Safe & Happy ran a few workshops for awareness about menopause. "When women hear about other women having similar experiences, it helps them in dealing with their own situation. There should be a community around this stage of life. Social media plays a small role here. Some awareness posts can help a little bit, but a proper conversation is what can truly build awareness around the topic."

In Rani Kaur's case, her 21-year-old son has been her biggest supporter. "It is believed that after you enter such a stage, women's lives are over. That is not it," says 50-year-old Kaur, who is a music event manager, often spending her evenings at gigs. "My gynaec told me nothing can be done, and to bear it. But this was too much - I was walking around without a jacket in Delhi winter, because the hot flashes were real. Now, I do weights, yoga, and have embraced it all." As Shetty told us, "It's like we have so much going on - careers, home, work, and then all this - we are truly super women to pull it all off."

With inputs from Anand Singh

‘I am making peace with my belly'

What happens when you try to lose weight, but the weighing scale doesn't budge no matter what you do? And what happens when you are trying to make the days count at a high-pace, high-performance job, but your brain fog is making it hard to even remember small details? Or what if you feel that overwhelm in your chest all day long - that feeling that you have been holding your breath?

I have been going through all of that - for the last one year, and it was only when I realised that it could be Perimenopause, I realised that it was not my fault. Because it's so easy for us to blame ourselves - "I am destined to be fat; I am not good enough for this position; I am letting life win if I get too stressed".

But I have come to a decision that this is the time that I need me most - and hence, this negative talk that we subject ourselves to every time something goes wrong, needs to stop. I went to a gynaecologist, and I got lucky, because she told me - "this is natural, and nothing to be scared of. Let's get ready for it?"

So yes, it means giving up sugar, and forcing myself to get up every day and pick up weights (I hate working out), and not drinking as much (what ya), and not eating any of the crap that makes us feel good, but it also means to now, love yourself more. See a therapist who listens to you, as not many in your life will have time to listen. Make gratitude lists, and listen to affirmations - no matter how corny that sounds. But most of all, be okay with who you are - actually, fiercely love who you are, and the shape of you. My shape is round, and my belly is one you could put your head on and sleep. But it's okay. It's mine, and I am now in love with it. And Perimenopause can't take that away from me.