Life Paused at Thirty

 

 

Israti Devi’s last meeting with her doctor brought her life to a sudden standstill. She was told she has hit early menopause and cannot conceive anymore. The thought that she will not be able to bear a male child has come as a big blow to this mother of three young girls who feels she’s failed in her responsibility to bear a son to carry forward her husband’s family name. Though still in her mid-thirties, she stopped menstruating 10 months ago. “What do I tell my family now? I don’t know what’s wrong with me, though doctors tell me this is not a disease, it happens to women sometimes,” wonders a teary-eyed Israti who lives with her husband and in-laws in a slum area.

Israti’s is not an isolated case. Indian women are at a phenomenally high risk of suffering from premature menopause, says a study conducted by the Bangalore-based agency, Institute for Social and Economic Change. In fact, the study – based on the National Family Health Survey-2 (NFHS-2) data collected during 1998-99 – reveals that 3.1 per cent of the Indian women in the age group of 30 to 34 (about 17 million) have reached menopausal stage. Eight per cent (44 million) hit menopause by the time they are 39, while 19 per cent experienced this physical change by the age of 41. A disturbing figure which – when compared to the current NFHS-3 data – is increasing. The ISEC research suggests that almost one in five women in the country experience menopause by the time they turn 41.

Menopause is the permanent physiological or natural cessation of menstrual cycles where a women’s life undergoes a transition from the reproductive to non-reproductive stage. During the menopausal transition, the woman experiences body ache, irritability, sleeping problems, loss of libido, lack of energy, weight changes, problems in concentration, etc. Medical experts say that natural menopause occurs in women between the age of 45 and 55. However, in case of premature menopause, the aftereffects are startling for women with existing health disorders, such as increased risk of ischaemic heart disease and osteoporosis, gynaecological cancer. Some of the main reasons for the onset of premature menopause in lower socio-economic groups of society are intake of lower nutritional diet, lesser use of contraceptives, lesser body mass index, early marriage and early child bearing, or bearing too many children, and illiteracy, point out Dr TS Syamala and M Sivakami in the study report. Interestingly, the government has done precious little to address this problem.

“The public health system in India is concentrated on women of childbearing age and they receive little attention when they move out of this bracket. Hence, we wanted to draw some attention of the policy makers towards this problem,” Dr Syamala told TSI. The NFHS-2 data were collected from a sample of more than 90,000 married women aged 15-49, that covers 99 per cent of India’s population living in 26 states. The cases of early menopause is highest in Andhra Pradesh (31.4 per cent), followed by Bihar (21.7 per cent) and Karnataka (20.2 per cent). Kerala (11.6 per cent), West Bengal (12.8 per cent) and Rajasthan (13.1 per cent) are comparatively in a better position.

“Premature menopause is not a normal case and we get many such cases. Hence, we refer patients to senior specialists. Besides, we do not have proper facilities for check up and further treatment,” says Dr Sandhya Mansiya, Medical Officer, Maternity and Child Welfare Centre, Babarpur, East Delhi. Early menopause, she adds, causes emotional disturbances in women. “They are extremely stressed.”

The social aspect of the problem can not be ignored either. “Often the stressed induced conditions are the cause of early menopause,” says Sanghamitra Acharya, Associate Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi. “Hence, the woman needs help in accepting the condition and seeking care. In this, the support of her spouse and family is extremely essential. Studies suggest that in most infertility related problems, women do not get the required treatment because husbands refuse to cooperate. There is a need for husbands to understand both the physiological and psychological stresses that are experienced by the women.”

She further emphasises, “Early menopause is reported by women from lower socioeconomic groups largely as postpartum amenorrhoea. It is attributable to poor nutritional intake and to poor health care access. Provisioning of health care services is often mistaken as a solution for improving the health conditions. There are other factors which impede care access propensity, physical accessibility due to distance and location, and social associability due to choices available, decision making and social disparities. Therefore, the state has to design mechanisms to minimise these impeding factors.”

Dr Duru Shah, President, Indian Menopause Society (IMS), Pune – despite holding some reservations regarding the study report – does confirm the non-existence of services for menopausal women. Though IMS, she says, is doing its best to create awareness on this subject, it hasn’t been able to reach larger sections of the society. Till the time this awareness regarding the causes and effects of premature menopause are widely known in all stratas of the society, many women like Israti will continue to suffer in silence – emotionally, mentally and physically.