‘I was always exhausted’: Things about menopause that no one prepares you for

For Priyanka (name changed), a Mumbai-based retired government employee, the period of her mid-40s was daunting. Apart from hot flashes, constant exhaustion and cranky mood, she also faced physical complications after menopause, a phase she reached at the age of 45. Coping with work, home and family became difficult. "Around menopause, there was a time when I had heavy bleeding, which lasted for the entire month. I had to get a D&C procedure done. During that time, I also got typhoid and malaria, which led to a massive weight loss," she shares.

The definition of menopause seems fairly simple - a phase when a woman's menstrual cycle ends and she is no longer able to reproduce. However, this nine-letter word holds implications and complications that far exceed the scope of this definition.

World Menopause Day is marked on October 18 every year to raise awareness about the condition and various support options available to help navigate the challenges, not limited to physical complications. Women also have to battle mental and emotional difficulties during this period.

After 53-year-old Veena (name changed) reached menopause at the age of 48, she started experiencing things she didn't before. "Since menopause, I start sweating easily which is often accompanied by a sense of unease and anxiousness. Additionally, I have frequent mood swings. I have also observed that after menopause, I get emotionally hurt even by little or insignificant things," she reveals.

Another often-ignored aspect of menopause is the effect it has on one's intimate relationships and sex life.

As the taboo around menopause slowly starts fading, and conversations start seeing the light of day, mid-day.com speaks to medical experts who highlight what people need to know about menopause and life after it.

When does one reach menopause?

"When one does not have periods consistently for 12 months, menopause is considered final," informs Dr Nirmala Chandrashekar, Sr. Consultant Obstetrics and Gynecology, Gleneagles BGS Hospital, Bangalore. However, before reaching there, women may also start experiencing irregular periods. This phase is called perimenopause, which comes with its own set of challenges.

Physical changes and complications during menopause

As one reaches menopause, several physical changes might occur in the body. A major one is the reduction in skin elasticity, says Dr. Chandrashekhar. "As skin elasticity decreases, wrinkles start appearing," she states.

Menopause also has an impact on other organs of the body, which can either give birth to new health complications or worsen existing ones. Dr. Chandrashekhar informs:

• The ovaries and uterus atrophy after menopause.
• Reduced estrogen levels may also lead to vaginal dryness.
• Bones tend to weaken, which might cause susceptibility to fractures.
• The heart may also get affected, increasing the risk of coronary artery disease or cardiovascular complications.
• There are chances that vision might also get affected.
• Urinary infections and other problems are also common after menopause.

Mental and emotional challenges after menopause

While physical challenges are often talked about, most women are not prepared for the mental and emotional changes that accompany menopause.

This phase can cause various neurological changes, according to Dr. Chandrashekhar. "This can cause various mental health issues and also lead to episodes of migraine," she explains.

She continues, "Anxiety episodes are common in women after menopause. They often experience hot flashes i.e., they start sweating profusely, which may be accompanied by panic or anxiety."

Relationship counsellor Ruchi Ruuh believes that menopause is a significant transition that can bring about complex mental and emotional challenges. "The decline of essential hormones leads to mood fluctuations, increased irritability and even heightened anxiety or depression," she states.

"Women may find themselves feeling overwhelmed by changes in their sense of identity and body. They may struggle with a sense of loss of fertility and youth that can create a negative outlook towards their own body. Additionally, cognitive changes such as memory retention or difficulty concentrating can be unsettling. Each woman's experience is unique and while some may breeze through this phase, some may experience it more severely," she adds.

Intimacy and sex after menopause

These physical and emotional challenges can also impact intimacy. Ruuh explains, "The reduction in estrogen can lead to vaginal dryness, thinning tissues and discomfort during sex, which can decrease sexual desire. Emotional intimacy can also be impacted - hormonal fluctuations may cause mood swings, emotional distancing or even a dip in self-esteem, making it harder to feel connected or confident around their partner."

Challenges in both physical and emotional intimacy can impact sex after menopause. According to Dr. Rajan Bhonsle, Hon Professor & HOD, Department of Sexual Medicine, KEM Hospital & G.S. Medical College, one's sex life can change for the better or worse.

"I have seen two things happening. One is that the sex life gets better due to many factors. There's no fear of pregnancy anymore. By the time menopause occurs, couples are quite well-experienced in terms of each other's preferences in sex. At this point, their children are also usually well-settled and living their own lives, so there are no privacy obstacles. So, I have seen many couples saying that this is the best time of their lives," Dr. Bhonsle informs.

He continues, "There are other people who believe that their sex life is over just because the woman has reached menopause. Women might also have self-esteem issues, feeling things like they don't look as attractive anymore. The partner may also comment on her saying things like ‘I don't get aroused by you anymore' or ‘you've put on too much weight after menopause'. These are things that negatively impact the sex life."

Physical changes in the body may also cause complications in sex. Dr. Bhonsle explains, "Due to lack of oxygen, the vagina can start remaining dry. There's also a thinning of the vaginal lining which makes it prone to abrasions and injuries, if there's no proper lubrication. So, many people complain about pain while having sex, or remaining dry."

While physical issues can be treated with medications prescribed by qualified experts, psychological or relationship issues pose a risk to healthy sex life.

How to navigate menopausal challenges

Priyanka navigated this difficult phase of life by taking leaves from work, resting and focusing on her health. She also engaged in yoga and meditation which significantly helped her symptoms.

Every woman's journey with menopause is different, posing diverse challenges. However, experts suggest some important ways to navigate these.

Dr. Chandrashekar believes regular health check-ups are significant. "Through regular scans, bone density can be tested and necessary steps can be taken to improve it such as calcium supplements. Additionally, check-ups are essential to rule out issues of the ovaries, uterus or risk of cervical cancer," she says.

Physical challenges while having sex can also be navigated with proper medical processes, as Dr. Bhonsle informs. "If the couple is passionate, has had a healthy relationship and sex life, physical issues can be navigated without affecting sex," he states.

To navigate intimacy, Ruuh suggests, "Instead of seeing physical and emotional changes as an end of intimacy, it can be an opportunity to rediscover new forms of closeness with cuddling and exploring non-penetrative forms of sex."

She suggests the following tips:

• Discuss the changes you're experiencing, both physically and emotionally, with your partner. Being open about discomfort or shifting desires can prevent feelings of rejection for both partners.
• If emotional distress or physical discomfort becomes overwhelming, seeking help from a therapist or healthcare provider can be a game-changer. Having a supportive group of friends can also make this phase less daunting by talking about the journey and experiences.
• Physical touch and closeness can evolve to include more massages, cuddling or intimate conversations rather than solely on sex. The use of sexual aids such as toys, lubricants, etc., can help couples enjoy moments of intimacy together.
• Prioritising your well-being through regular exercise, mindfulness and self-compassion can boost your mood and reduce anxiety. Instead of seeing menopause as an end, embrace it as an opportunity to redefine your relationship with yourself and your partner.

Disclaimer: This does not replace professional medical advice. Consult a qualified medical expert for personalised guidance.

Also Read: Why contraceptives are still essential after 40 until menopause is confirmed