Indian Women are Reaching Menopause Earlier than Expected

Growing evidence suggests that more Indian women are reaching menopause earlier than expected. Agra-based gynaecologist Dr Jaideep Malhotra sheds light on the possible causes behind this concerning shift. Dr Malhotra currently holds the position of director at Ujala Cygnus Rainbow hospital and Rainbow IVF Agra. She was also former president of Indian Menopause Society and South Asian Federation of Menopause Societies

Q. Why are more Indian women experiencing menopause earlier than expected?

A. While the natural menopausal age globally is 45–55 years (WHO), studies show the average age of menopause in India is around 46.5 years—significantly earlier than in Western populations. This trend is influenced by a combination of genetic predisposition, high stress levels, and fast-paced urban lifestyles. Exposure to environmental toxins such as plastics, pesticides, and endocrine-disrupting chemicals also plays a major role. Unhealthy habits—smoking, alcohol consumption, and poor sleep—combined with nutritional deficiencies (especially Vitamin D, B12, and iron) contribute further. Conditions like PCOS, endometriosis, ovarian surgeries, chemotherapy, and a higher prevalence of autoimmune disorders are also linked to early menopause and ovarian decline.

Q. Common symptoms of perimenopause and menopause

A. Perimenopause and menopause bring a wide range of symptoms, which may vary from mild to significantly disruptive. Many women experience vasomotor issues like hot flashes and night sweats, along with irregular or heavy periods. Psychological symptoms such as mood swings, anxiety, irritability, and depression are also common, as are sleep disturbances. Cognitive issues—including brain fog and memory lapses—often accompany hormonal shifts. Vaginal dryness, painful intercourse, reduced libido, weight gain (especially abdominal fat), hair fall, skin dryness, joint pains, and overall fatigue are other frequent concerns. Without proper management, these symptoms can impact daily functioning, job performance, relationships, and mental health.

Q. Rise in premature menopause — patterns and risk factors

A. There is a clear rise in early and premature menopause in India, including cases of premature ovarian insufficiency (POI), which affects around 3% of Indian women—higher than Western figures. This trend is more visible among women in metro cities and is often linked to autoimmune thyroid disorders, a higher incidence of endometriosis, or a history of ovarian surgeries. More women undergoing IVF or facing declining ovarian reserve are also reporting earlier menopause. Post-COVID stress, lifestyle disruptions, and chronic inflammation have additionally contributed to this pattern.

Q. Is menopause often mistaken for stress or ageing?

A. Yes, menopause is often misinterpreted as stress or simply ageing, particularly when women present with irregular cycles, depression, or vasomotor symptoms. Because the signs often mimic thyroid disorders or mental health issues, misdiagnosis is common. Many women also tend to prioritise family over their own health, and routine reproductive screening is often neglected after childbirth. This lack of visibility leads to delayed diagnosis, making awareness essential for timely identification and care.

Q. Is there a lack of awareness?

A. There is a significant lack of awareness about menopause in India. Although menopause is a natural biological process, understanding of the associated symptoms, risks, and preventive strategies remains very limited. Many women believe menopause is something they must “tolerate,” leading them to suffer silently due to stigma and lack of support. Workplace environments rarely acknowledge menopause-related challenges, and open discussions are limited. Better education around hormonal changes, early prevention, and long-term consequences can substantially improve women’s quality of life.

Q. Diagnostic tests for women with irregular cycles in their 30s–40s

A. Women experiencing irregular cycles in their 30s or 40s should undergo a detailed evaluation that includes hormone testing—FSH, LH, estradiol, AMH to assess ovarian reserve, thyroid profile, and prolactin levels. Pelvic ultrasound helps assess ovarian and uterine health, while bone density scans may be needed if estrogen decline is suspected. Testing Vitamin D and B12 levels is also essential. In this age group, routine health screenings such as mammography, Pap smear, lipid profile, liver function tests, and kidney function tests are recommended. Diagnosis is always made based on both clinical history and symptoms.

Q. USFDA-approved Elinzanetant — should India get it?

A. Elinzanetant is a newly approved non-hormonal drug for hot flashes, offering relief without the side effects associated with hormone therapy. Although it was expected to launch in India this summer, it is still not available, likely due to regulatory, pricing, or local trial requirements. Given its safety profile and suitability for women who cannot take hormones, India would benefit from its introduction once local safety data and approvals are complete, especially since treatment options for menopausal symptoms remain limited and often unaffordable.

Q. Treatment options for severe symptoms

A. Management of severe menopausal symptoms must be individualised, depending on age, time since menopause, comorbidities, and specific complaints. Lifestyle modifications—including regular exercise, good sleep hygiene, stress reduction, and a calcium- and Vitamin D–rich diet—form the foundation. Probiotics also help with gut and hormonal balance. Pharmacological options include hormone therapy (the gold standard for vasomotor symptoms), SSRIs/SNRIs for mood disturbances and hot flashes, vaginal estrogen for urogenital symptoms, and calcium or Vitamin D supplements. Bisphosphonates may be prescribed for osteoporosis. Non-pharmacological approaches such as counselling, yoga, cognitive behavioural therapy (CBT), pelvic physiotherapy, and appropriate cosmetic care also support overall wellbeing.

Q. Does menopause require the same medical attention as pregnancy?

A. Yes, menopause deserves attention comparable to pregnancy, as women spend nearly half their lives in the post-menopausal phase. The hormonal shifts that occur during this period can quietly progress into full-blown metabolic syndrome, severe osteoporosis, cardiovascular disease, and various mental health challenges. These changes can significantly impact not just the woman but her entire family.

Q. How does early menopause impact long-term wellbeing?

A. Early menopause raises several long-term health risks due to the premature decline in estrogen. Infertility is inevitable because reproductive capacity ends earlier. The risk of osteoporosis increases significantly—studies show around an 83% higher risk.

Cardiovascular disease risk rises by nearly 30%, and there is a documented 22% increase in the likelihood of cognitive decline or dementia. Urogenital ageing becomes more pronounced, leading to dryness, recurrent infections, painful intercourse, urinary incontinence, and pelvic organ prolapse. Women with early menopause should prioritise regular bone density tests, cardiovascular monitoring, and timely initiation of hormone replacement therapy (HRT) when medically indicated to reduce these risks.