Menopause is not just hot flashes: Experts explain what really happens

At the India Today Women's Summit, doctors discussed menopause symptoms, risks and treatment options. They urged women to seek timely medical advice and stop treating menopause as taboo.At the India Today Women's Summit, doctors discussed menopause symptoms, risks and treatment options. Menopause is often treated as an inevitable phase that women are simply expected to “get through.” But as awareness around women’s health grows, doctors are urging women to understand what happens to the body during menopause, identify symptoms early, and seek medical help instead of silently living with them.At the India Today Women’s Summit, a session titled 'Menopause Matters: The Silent Health Crisis' brought together Dr. Ambrish Mithal, Group Chairman and Head, Endocrinology and Diabetes, Max Healthcare; and Dr. Anita Gupta, Associate Director, Obstetrics and Gynaecology, Fortis La Femme. Moderated by Sonali Acharya, Senior Editor, India Today Magazine, the discussion addressed common myths around menopause, hormonal therapy, weight gain, bone health, mental well-being, and sexual health.MENOPAUSE HAS NOT CHANGED, BUT AWARENESS HASDr. Anita Gupta said menopause itself has not changed, but women are now far more aware of the symptoms associated with it. Earlier, many women were simply told that menopause was something everyone experiences and that they had to live with it.“So Purane zamane mein the dadis and nanis used to say to the women, 'Yeh toh sabko hota hai, kuch nahi hai, let it be,' and women just silently bared with it,” Dr. Gupta said.(“Earlier, grandmothers and older women would tell women, ‘This happens to everyone, it’s nothing, just let it be,’ and women would simply suffer through it silently,” Dr. Gupta said.) She explained that menopause is linked to the decline in hormones and should not simply be dismissed as a consequence of ageing. Urban lifestyles, meanwhile, can amplify some menopausal difficulties because of stress, professional responsibilities, family pressures, smoking, poor diet and lack of physical activity.However, lifestyle alone does not determine the age at which menopause occurs. Genetics remains a major factor, while smoking can potentially lead to an earlier menopause.MENOPAUSE IS MORE THAN HOT FLASHES AND MOOD SWINGS The panel highlighted that menopause can affect several aspects of a woman's health. While hot flashes and night sweats are among the commonly recognised symptoms, women can also experience sleep disturbances, irritability, mood changes and other physical changes.Dr Ambrish Mithal explained that menopause also coincides with an important period of metabolic change. The average age of menopause in India is around 47, although it varies across regions.During the 40s and 50s, women may face an increasing risk of diabetes, high blood pressure, fatty liver and cardiovascular disease. Menopause is also associated with a shift towards greater central and visceral fat.Importantly, Dr. Mithal said women do not necessarily gain weight because of menopause itself. Weight gain during midlife is also strongly linked to ageing and changes in lifestyle, while menopause can alter where fat is distributed in the body.“What happens at menopause is that the heart risk starts going up,” Dr Mithal said, explaining that the cardiovascular protection women have during their reproductive years declines after menopause.BONE LOSS CAN ACCELERATE AFTER MENOPAUSEBone health emerged as another major concern during the discussion.Dr Mithal explained that bone loss is a natural part of ageing and can begin well before menopause. However, the decline in estrogen around menopause can significantly accelerate bone loss.“Your bone bank is built up only till about 20, actually, and from 20 maximum 25 till about 30, 35, you maintain it, and then you lose 1% bone every year,” he said.Around menopause, this loss can accelerate, with women potentially losing around 2 to 3 per cent of bone mass annually for a period of about five years. This makes bone health an important consideration during and after the transition.With India's ageing population growing, doctors stressed the importance of prevention, adequate nutrition, physical activity and appropriate screening for women at risk of osteoporosis.HORMONE THERAPY IS NOT SOMETHING WOMEN SHOULD FEAR BLINDLYOne of the biggest concerns surrounding menopause is menopausal hormone therapy, or MHT, earlier commonly called hormone replacement therapy or HRT.Dr Mithal said the perception around hormone therapy has changed considerably over the years. Earlier studies created widespread concern about the risks associated with hormone therapy, but subsequent analyses have provided a more nuanced understanding.“For the first five to 10 years after your menopause, and if your age is say typically below 55 and all, you are pretty safe,” Dr Mithal said, while stressing that women still need appropriate screening and individual medical assessment before starting treatment.For women who are suitable candidates, particularly those experiencing significant menopausal symptoms and who are within the early years of menopause, MHT can provide substantial relief.HRT NEEDS TO BE PERSONALISEDThe panel stressed that hormone therapy has potential benefits as well as risks, meaning the decision has to be individualised.Doctors need to consider factors including age, how long it has been since menopause, family history of breast cancer, clotting history and unexplained uterine bleeding before recommending therapy.Dr Mithal also pointed out that newer preparations, including transdermal options, have changed the way doctors approach hormone therapy and may have a lower clotting risk than some older preparations.He said treatment duration also needs to be decided according to individual circumstances rather than following a one-size-fits-all approach.LOCAL VAGINAL TREATMENTS CAN HELP SEXUAL AND URINARY SYMPTOMSMenopause can also affect intimate health, but this remains a subject many women hesitate to discuss.Dr Gupta explained that declining estrogen can lead to vaginal dryness, discomfort and painful sex. Urinary and vaginal symptoms can also affect a woman's quality of life.“The vaginal issues actually bother the woman a lot,” Dr Gupta said, adding that local vaginal gels and tablets can help address such symptoms when prescribed appropriately.The doctors also highlighted that sexual health should not be treated as a taboo topic during menopause.MENOPAUSE CAN AFFECT SEXUAL HEALTHThe discussion also addressed whether menopause can affect a woman's sex life.Dr Gupta said menopause can lead to vaginal dryness, which can make sex painful, while hormonal changes may also affect sexual desire.Dr Mithal added that testosterone also plays a role in female libido and said low-dose testosterone is increasingly being considered in some cases, although doctors in India remain cautious about its use.The key message was that changes in sexual health are medical concerns that women can discuss with their doctors, irrespective of their relationship or marital status.WEIGHT GAIN IS NOT NECESSARILY CAUSED BY HORMONE THERAPYAnother common fear is that hormone therapy or devices such as Mirena automatically cause significant weight gain.The doctors challenged this belief.Dr Mithal said there is no strong evidence that estrogen and progesterone therapy, particularly estrogen alone, directly causes significant weight gain. Changes in body weight during midlife are often related to ageing and other lifestyle factors.“That's just our midlife, not our menopause,” Dr Mithal said while addressing the belief that hormone therapy itself inevitably causes weight gain.Dr Gupta added that Mirena may cause some water retention in certain women, but it should not automatically be blamed for significant weight gain.WHEN SHOULD WOMEN SEE A DOCTOR?Dr Gupta advised women to become more proactive about their health as they approach midlife.She recommended that women above 45 undergo regular health check-ups rather than simply ordering a set of blood tests on their own.Depending on an individual's age and risk profile, comprehensive health checks may include gynaecological evaluation, breast screening, cervical screening and assessments for cardiovascular and other health risks.She also cautioned women against relying solely on information found online, particularly when trying to self-diagnose symptoms.EARLY MENOPAUSE NEEDS MEDICAL ATTENTIONThe panel also discussed women who experience menopause earlier than expected.While menopause is largely influenced by genetics, certain factors can affect its timing. Dr Gupta noted that some studies suggest pregnancy history may have an association with the age of menopause, but this is not a fixed rule.Women experiencing symptoms suggestive of early or premature menopause should consult a doctor rather than assuming that every symptom is related to menopause.HYSTERECTOMY CAN LEAD TO SURGICAL MENOPAUSEThe doctors also explained the difference between natural menopause and menopause following surgery.If a woman undergoes a hysterectomy but her ovaries remain intact, the situation is different from one in which both the uterus and ovaries are removed.When the ovaries are removed, estrogen production drops suddenly and can result in surgical menopause. Dr Gupta said women in such situations may experience menopausal symptoms much earlier and may be candidates for menopausal hormone therapy, depending on their individual medical circumstances.MENOPAUSE SHOULD NOT BE A SILENT EXPERIENCEThe central message from the session was simple: menopause is a natural biological transition, but that does not mean women have to suffer through severe symptoms without help.Better awareness can help women distinguish normal menopausal changes from symptoms that require medical evaluation. From cardiovascular and metabolic health to bones, mental well-being and sexual health, menopause can influence several areas of a woman's life.The doctors urged women to ask questions, seek appropriate medical advice and stop treating menopause as a taboo subject.As the session concluded, the message was clear: women do not have to suffer silently through menopause. Talk about the symptoms, seek help and take charge of health during midlife.- EndsPublished By: Chaitanya DhawanPublished On: Aug 22, 2026 15:47 IST