Indian women invariably feature at the bottom of global health and wellness surveys. But that's not all. A recent survey now shows that they are at a phenomenally high risk of suffering from "premature menopause" with many experiencing this biological transition even before they've hit the third decade of their lives!
A pan-India survey, conducted recently by the Bangalore-based Institute for Social and Economic Change (ISEC), highlights the alarming new phenomenon of premature menopause amongst Indian women. This is increasingly becoming a source of consternation amongst the medical community.
The data for the study - based on the 1998-99 National Family Health Survey - drew samples from 100,000 women in the age band of 15-50 years, across 26 states. The study revealed that Indian women fare abysmally with regard to their menopausal health. While the percentage of young menopausal women was the highest in Andhra Pradesh at 31.4 per cent, Bihar (21.7 per cent) and Karnataka (20.2 per cent) were no better. Kerala (11.6 per cent) was a tad better while West Bengal (12.8 per cent) and Rajasthan (13.1 per cent) were just a rung lower. Overall, the percentage of women hit by premature menopause is marginally lower in urban areas (16.1 per cent) as against rural (18.3 per cent).
According to T.S. Syamala of ISEC, who conducted the pan-India research, the proportion of premature menopausal Indian women plummets remarkably with a corresponding increase in education. This establishes the fact that women from the lower economic strata are more vulnerable to premature menopause than their more privileged counterparts. Also, a higher number of illiterate women experience premature menopause as against those who are educated. Among the illiterate women, a substantive 20 per cent suffer from premature menopause as against 11.1 per cent of women who hold at least a graduate degree.
The findings of the ISEC survey, which were tabled in the Parliament recently, also highlight that on an average nearly four per cent of Indian women are already menopausal between the ages of 29-34 years, one of the lowest thresholds for menopause in the world. The natural age for menopausal onset is between 45 to 55 years with a mean age of 51 years, worldwide. Interestingly, women who marry and have children late have less reason to worry as they experience a delayed onset of menopause.
Apart from being an important socio-economic pointer, doctors feel the survey has confirmed their worst fears - that women's health is simply not a priority in our country. "The changing dynamics of the Indian family, the increased stress upon women to be financially independent and the whittling down of the familial support structure have all put tremendous physical, emotional and mental strain on our women," observes Dr. Vidhi Chowdhury, obstetrician and gynaecologist, Spring Meadows Hospital, New Delhi. "These pressures, coupled with the lack of proper nutrition and education about health play havoc with female hormones, resulting in a skewed menstrual pattern."
But what exactly is a 'skewed' menstrual pattern and how does it impact a woman's mental and physical health? "Menopause," elaborates Chowdhury, "is the strongest biological transitory phase in a woman's life accompanied by volatile physical changes. The ovaries stop producing eggs, menstrual activity ceases and the body decreases the production of the female hormones (estrogen and progesterone) which play a catalytic role in conditioning the body for uniquely female functions such as pregnancy and child-bearing."
By stimulating skeletal growth, estrogen and progesterone help maintain healthy bones, protect the heart and veins by upping the body's 'good cholesterol' (HDL or high-density lipoprotein) and lowering 'bad cholesterol' (LDL or low-density lipoprotein). But with the onset of menopause, and the subsequent dip in the levels of these hormones, a woman's overall health, including her libido, gets impacted. The plummeting estrogen levels trigger increased blood flow to the face, neck, chest and back thereby resulting in the famed 'hot flushes'. Mood swings, decreased libido and vaginal dryness are also caused by this hormone dip.
"The thinning of the vaginal wall tissues leads to vaginal dryness," adds Chowdhury. "In some cases, many physiological changes during menopause may go undetected. For instance, osteoporosis (loss of calcium in bones causing bone fragility) is often not diagnosed till a bone fracture actually occurs. So it is advisable for menopausal women to be in regular touch with their doctors."
In fact, most doctors advocate that menopausal health demands a well-defined holistic approach. "Menopause should not be misconstrued as a disease," exhorts Dr Girish Vaishnav, Head, Department of Internal Medicine, Fortis Hospital, Noida. "After all, it is a naturally occurring biological phenomenon whose transitory effects can be offset by proper medical and nutritional care."
Diet can, in fact, play a crucial role in combating the emotional, physical and mental stress of menopausal and pre-menopausal years. A high-fibre, low fat and low-carb diet incorporating herbs, minerals and vitamins in one's daily diet can work wonders. Advises Dr. Anupama Shastri, consultant dietician, Max Medicare, "One should eliminate tea, coffee, alcohol, caffeine, spicy foods and smoking during this period. This automatically eliminates food cravings often experienced by women during this period. Also, one ought to keep one's weight under check as being overweight augments these symptoms. Including soya, Vitamin E and herbal supplements in one's diet also helps."
The correct diet, according to dieticians, also helps eliminate quintessentially menopausal symptoms like depression, irritability, dizziness, hair loss and changes in body temperature, better known as hot and cold flushes. Sleep disturbances, trouble falling asleep, or if awakened, going back to sleep can also be minimised by the correct diet.
Focusing on lean proteins such as fish and chicken is a good idea, recommends Shastri. "A menopausal nutrition plan usually includes lots of vegetables, fruits, fibre and whole grains," he says. Eating five small meals per day rather than three huge ones is recommended as this helps keep blood sugar levels from fluctuating.