Menopause: Why It Remains One of Women's Most Overlooked Health Topics
- Sep 30, 2022
- 5 min read
Miyara Women | Sep 30, 2022 | Updated: Jun 21, 2024 Miyara's Guide to Midlife and Menopausal Transition: Part 1
Menopause is a natural part of a woman's life but is heavily stigmatized, with women often suffering their symptoms behind closed doors. No two menopause journeys are the same — and what makes it worse for many is that they are simply not prepared for it.
According to the South Asian Federation of Menopause Societies, only 33% of Indian women are aware of menopause symptoms and severity — and nearly 30 million women enter menopause in India every year, most of them without adequate information or support.
This article gives you an overview of what happens prior to and during menopause. Hope it helps!
What Defines Menopause?
The clinical definition is a missed period for 12 consecutive months. However, from surveys and research, we know that women go through a huge change — both physically and psychologically — during this transitional phase and beyond.
When we asked a group of women what menopause means to them personally, we had an array of responses (both positive and negative) during our social media interaction. There is evidently more to this phase than just the stoppage of menstruation at an individual level.
Why Is Menopause Greater Than Just the End of Menstruation?
To make sense of the array of bodily and mental changes women experience through the menopausal transition (MT), it is essential to understand the reproductive hormones.
Estrogen is the dom
inant hormone in the female body — but the idea that it is merely a reproductive hormone is, as scientists now widely agree, a gross oversimplification. Several systems in a woman's body have receptors that bind with circulating estrogen, aiding their smooth functioning. Its physiological roles are well-established and wide-ranging: energy homeostasis, cardiovascular health, fat metabolism, brain function, bone health, and even digestion. That is pretty much all the organ systems, isn't it?
A 2025 review in Frontiers in Aging Neuroscience confirms that estrogen receptors are expressed across the cardiovascular, immune, and central nervous systems — reinforcing why its decline triggers such a wide symptom spectrum.
With such broad impact, it is not surprising that estrogen's plummet during MT produces a host of symptoms:
Bone health — The risk of osteoporosis increases as estrogen modulates bone mineralization and remodeling. Importantly, a 2023 study in the Journal of Clinical Laboratory Analysis found that rising FSH levels during the transition are an independent risk factor for bone density loss — meaning bone deterioration may begin even before estrogen fully drops.
Muscles — Due to estrogen's role in energy metabolism, muscle integrity may also be affected during MT, leading to soreness and aches.
Brain and hot flashes — Hot flashes and cognitive decline (brain fog, poor memory) occur as estrogen has a huge impact on temperature regulation and brain function, increasing the risk of Alzheimer's disease.
Mood — Mood swings are mainly the result of alterations in the gut-brain axis, as the estrogen lifecycle is deeply intertwined with gut microbiome composition in a two-way relationship. A 2024 review in the Journal of Neuroinflammation found that estrogen deficiency disrupts the blood-brain barrier and suppresses BDNF (a key brain-health protein), offering a molecular explanation for the anxiety and depression many women experience at MT.
Heart — Estrogen plays a protective role against cardiovascular disease.
Reproductive and sexual health — Changes in the menstrual cycle, sexual characteristics (body hair, etc.), vaginal health, breast changes, and a decline in libido can be expected.
Skin and hair — Acne, dark spots, discolouration, wrinkles, hair thinning, and greying can occur as estrogen helps maintain skin health.
Weight — Weight gain, especially around the abdomen, is common as altered estrogen levels change the pattern of fat deposition.
Digestion — The incidence of gastrointestinal reflux has recently been associated with the drop in estrogen, which appears to regulate the passage of food through the oesophagus.
Is Estrogen the Only Hormone at Play?
Menstrual cycles are dominated by variations in estrogen and progesterone levels.
Progesterone is necessary to sustain pregnancy — cervix thickening and vaginal health depend on it. With dwindling ovarian function, progesterone undergoes a steep drop, leading to vaginal dryness and pelvic changes. The resulting higher estrogen-to-progesterone ratio causes menstrual irregularities. At a certain point, estrogen begins to fall too, though both hormones fluctuate before reaching a steady low (as the adrenal glands and fat tissues continue producing estrogen in small quantities), causing irregular, heavy, light, or painful periods.
Testosterone, produced in small quantities in the female body, is essential for bone and muscle health, libido, mood, metabolic function, cardiovascular health, and cognition. Testosterone production halves by age 40 and falls further with ovarian dysfunction, resulting in vaginal dryness, weak bones, and poor cognition post-menopause. Acne and facial hair growth can also occur.
Image credit: Front. Physiol. 9:1834. doi: 10.3389/fphys.2018.01834
FSH and LH — Follicle-stimulating hormone (FSH) stimulates ovulation monthly, while luteinizing hormone (LH) triggers egg release and progesterone production. With insufficient ovarian follicles, the feedback mechanism that shuts down FSH and LH becomes inefficient, so their levels keep rising. The landmark SWAN study (Study of Women's Health Across the Nation) found that rising FSH coincides with the most rapid rate of bone loss and the onset of visceral fat accumulation — even before estrogen fully declines — making FSH a valuable early warning signal.
How Do You Know If You Are in Perimenopause?
There is no definitive test to diagnose perimenopause. When seeking medical intervention for symptoms — which can sometimes interfere with daily life or even be debilitating — medical professionals try to rule out all other possible causes before arriving at perimenopausal status.
FSH and LH levels can serve as a guide alongside age and other gynaecological factors. Yet it is not a straightforward diagnosis: symptoms can span a vast spectrum, involving multiple organ systems and mental health. Severity largely depends on basal health status, heredity, risk factors for lifestyle diseases, and stress (both physical and mental).
Many symptoms also overlap with other health conditions or nutritional deficiencies, so it is important to rule those out before concluding your symptoms are hormone-related. The best way to know is by getting tested.
One of the other things you can do is track your symptoms with the pen and paper of the Miyara App
Commonly reported perimenopausal symptoms include:
Menstrual irregularities — heavy periods, cramping, light periods, irregular frequency
Hot flashes and night sweats — sudden heat followed by chills, flushed skin, dizziness/nausea, palpitations
Mood and cognitive changes — irritability, brain fog, poor memory, difficulty in decision-making, poor concentration
Mental health — anxiety, depression, lack of confidence/motivation
Sleep issues/fatigue — insomnia, stress, low energy
Digestive issues — irritable bowel syndrome, bloating, constipation/indigestion
Vaginal and pelvic floor issues — thinning of the vaginal walls leading to vaginal dryness, low libido, weak pelvic floor, urinary incontinence
Weight gain and change in appearance — fat around the abdomen, skin problems like acne and pigmentation, hair loss and greying
Musculoskeletal problems — loss of bone strength, joint pains, muscle stiffness/aches
Breast changes — tingling, soreness, tenderness
Migraines/periodic headaches
Neurological symptoms — burning of the tongue, tingling in the arms and legs
Please consult your physician for personalised medical advice. Always seek the advice of a physician or other qualified healthcare provider with any questions regarding a medical condition.
Written by: Dr. Ayshwarya Ravichandran — 10+ years of experience in science communication, women's health advocate.
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About the author
With 10+ years of experience in science communication, Dr. Ayshwarya Ravichandran ensures evidence and science-backed information are conveyed to women in understandable and comprehensible language and visualization. She is also a passionate women's health advocate engaging the Miyara community in different ways.
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