, New Delhi, (WFS) - "It's a sign of the times when your roots are grey and your mem'ry's shorter; It's a sign of the times when your hourglass shape becomes a glass of water." (Menopause, The Musical, 2001)

Writer Jeanie Linders, of the famous Menopause, The Musical may have sung her way through menopause and won accolades for it. However, as the world marks World Menopause Day on October 18, millions of Indian women over 45 are finding it difficult to smile through it - thanks to the lack of information and misunderstanding among them about this rather rough phase of life.

Menopausal women have to deal with hot flushes (periods of sweating and rapid heartbeats), irritability and heightened levels of stress on a daily basis. In the long run, they become susceptible to cardiovascular diseases, osteoporosis and cancer due to falling levels of oestrogen and progesterone hormones. These hormones help maintain healthy bones and protect the heart and veins by increasing levels of 'good cholesterol' (HDL or High Density Lipoprotein) and lowering 'bad cholesterol' (LDL or Low Density Lipoprotein).

Understanding menopause

Menopause is accompanied by physical changes like the termination of periods and the capacity to bear children.

The body decreases production of oestrogen and progesterone - which are required primarily for reproductive functions - affecting a woman's overall health and leaving her vulnerable to ailments like osteoporosis.

Plummeting levels of oestrogen trigger off increased blood flow to the face, neck, chest and back, resulting in hot flushes.

Mood swings and decreased sex drive are caused by a decrease in hormone levels, hot flushes and vaginal dryness.

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In 1995, about 450 doctors - cardiologists, nutritionists, gynaecologists, orthopaedics, ultrasonologists - pooled their collective professional expertise to form the Indian Menopause Society (IMS). Based in New Delhi with affiliated clinics all over India, IMS is a pan-India platform that seeks to address menopause-related health issues and educate women about this crucial stage in their lives.

According to IMS research, there are currently 65 million Indian women over the age of 45. Not only that, according to IMS, menopause often strikes Indian women as young as 30-35 years. Despite these figures, IMS founders discovered at its inception that - like most Indian women (including the urban elite) - doctors and health professionals themselves were quite clueless about menopause-related issues.

"Menopause is the most misunderstood biological change that happens to a woman," says Delhi-based Dr Sonia Malik, IMS President-elect. An infertility and in-vitro fertilisation expert, Dr Malik comments that the changes can be traumatic and psychologically challenging for women. "Organisations like ours can play a pivotal role in creating awareness about it, not only amongst medical professionals but also among lay persons."

Through its 15 chapters in various Indian states, IMS provides a common forum for health professionals and the general public to work towards the wellbeing of menopausal women. Members raise awareness about menopause and ageing through outreach programmes and public health and education campaigns. They also hold charitable screening camps and workshops offering heavily discounted or free tests like pap smears, mammograms and ultrasounds. The outfit also distributes pamphlets, flyers and booklets to women across various economic strata to educate them about menopause.

"The idea is to promote a multi-disciplinary and comprehensive approach for the care of elderly women - both medical and non-medical. We also regularly update doctors and health professionals in the field of menopausal medicine to ensure appropriate health care for this age group," says Hyderabad-based Dr Meeta Singh, IMS secretary-general.

IMS's National Data Collection programme collects information and promotes research on menopause, with special relevance to Indian women. The organisation also offers a range of voluntary services like counselling families and underprivileged women in menopause clinics affiliated to IMS. Both doctors and people from non-medical backgrounds can volunteer at these clinics.

The aim, as Singh puts it, is to work towards women's empowerment through menopausal health. "Even though awareness about menopause is growing, most Indian women have a history of self-denial and neglect. Their family's needs take precedence over their own. So we created a public awareness teaching module for our members to reach out to older women."

Apart from a 30-minute PowerPoint presentation on menopausal health followed by an interactive session and a quiz, the public awareness teaching module consists of a National Awareness Programme - 'Fit at 40, Strong at 60'. The module was presented in 30 Indian cities and it also distributed feedback forms to gauge Indian women's perception of menopause. The responses revealed that most women are not very well informed about menopause, and myths such as menopause being a 'disease' rather than a natural phenomenon were readily believed. It was found that even educated women believed that ill-health was a part of menopause.

Apart from efforts at the national level, most IMS-affiliated doctors have a local team (comprising a voluntary medical counsellor, a nutritionist and two volunteers) at their clinics to counsel menopausal women about their health, osteoporosis and nutrition. Easy exercises that develop strength, flexibility and balance are also taught at the clinics. "We strongly endorse the mantra, 'Use it or Lose it' - be it the brain, bone or muscle," says Singh.

IMS has also formed local menopause and osteoporosis clubs that meet quarterly to help women exchange views on menopause, interact with experts in the field and explore their non-medical needs like stress and depression. These meetings help women to further de-stress.

Recently, IMS also launched a novel outreach programme for menopausal caregivers of Alzheimer's patients. "We discovered that these caregivers were so depressed themselves that it was seriously affecting their health and hence the quality of their care too," explains Malik. "So we created a venue where they could de-stress by talking about their problems and their patients, and also get counselling on menopause from various experts in the field." IMS plans similar outreach programmes for menopausal women battling with their relatives' alcoholism and cancer.

However, despite its commendable work, IMS finds itself short on funds. Its current projects are either self-funded or financed through a network of sympathetic organisations. "India is yet to fully acknowledge the true impact of menopause on women, their lives and their productivity. When women reach this stage in their lives, they are at the peak of their productivity as workers and individuals. This is why IMS is trying to create a robust, national forum that can address the psychological, biological and emotional needs of menopausal women," says Malik. (Women's Feature Service)