Menopause | Upsurge in early menopause

Forty-three-year-old Ritika Mehra, a school administrator in Gurugram, did not know what had hit her. She would wake up in the middle of the night, gripped by anxiety, joints on fire, and struggling to grasp once familiar things. Stress was the first culprit that came to mind. It seemed to have taken a toll on her period, too, and also manifesting in falling bone density and rising cholesterol levels in recent health scans. It came as a rude shock, therefore, when she was told things were the other way round—that early menopause was the cause of all her troubles. The biological clock her body had lived with for 30-odd years was winding down. It was an eventuality Ritika expected to encounter in the future, but not this soon. It left her curiously depressed.

Ritika’s story is one a growing number of women in India are experiencing. The average age of women going through menopause in India—46–47 years—is already lower than around 51 in the West. Findings from the fifth National Family Health Survey (NFHS-5) suggest a more troubling trend: many women are experiencing early (between 40 and 44) or even premature menopause (before 40). Surgical menopause is one factor, but even if you discount it, 16.2 per cent of women in India aged 40–44 may be undergoing early natural menopause, while 2.2 per cent of women aged 15–39 may be experiencing premature menopause, according to a 2024 study in Scientific Reports. In absolute numbers, that translates to nearly 7.8 million women aged 40–44 and another 6.4 million under 40, or well over 14 million women altogether who may be affected. Doctors report the change at their clinics. Dr Lipi Sharma, obstetrics and gynaecology consultant at ShardaCare—Healthcity, notes how women in their early 40s or even late 30s are now suffering from the kind of trauma Ritika has been experiencing.

Why does this matter? For one thing, Indian women are living longer. Life expectancy has risen from 66.4 years in 2005 to around 73.6–74.5 today. “Women today are living longer than ever before,” affirms Dr Anita J. Shah, a Surat-based gynaecologist and president of the Indian Menopause Society, “and nearly one-third of their lives may be spent after menopause.” Yet neither the women themselves nor the Indian healthcare system seem prepared for it.

It matters for another reason, too: menopause is not a one-time event but a prolonged biological transition. Its symptoms begin years before the final menstrual cycle and continue long after. While commonly associated symptoms such as hot flashes, night sweats and mood swings are widely recognised, menopause also affects cardiovascular, metabolic, bone and cognitive health.Delayed diagnosis and treatment allow silent damage to accumulate.

A POCKETFUL OF CAUSES

The reasons for early or premature menopause have as much to do with biology as with lifestyle and socio-economic reasons. There is genetics, to begin with. So, when your mother menopaused could well dictate the age at which you menopause. Then, there is the age of menarche, a woman’s first period. An early onset could herald early menopause too, given the faster depletion of ovarian reserves. Reproductive history also matters. Pregnancy temporarily pauses ovulation, preserving ovarian follicles. Women who have had children—particularly at certain intervals—may menopause later, while nulliparity—or not having had children—could trigger earlier onset.

Socio-economic factors can influence menopause as well, since education, income and geography influence both awareness and nutrition. So, women from low-income, uneducated, rural backgrounds may face undernutrition, low body mass index, anaemia and metabolic stress, all of which could affect their ovarian health. Urban women may have the opposite problem: despite greater awareness, they may be prone to stress, pollution, smoking, alcohol and poor dietary habits.

To understand what early or premature menopause does to a woman’s body, a quick biology lesson may be in order. Menopause is the biological phenomenon when ovaries stop releasing eggs and producing key hormones. Clinically, it is confirmed after 12 consecutive months without a menstrual period. But the transition—perimenopause—can begin up to eight years earlier. Women begin experiencing the first symptoms, with periods starting to get irregular and the body experiencing a variety of symptoms from joint and muscular discomfort, physical and mental exhaustion to irritability and forgetfulness. Some of these symptoms persist through menopause before the body enters the post-menopausal phase for the rest of a woman’s life.

But even as the storm in a woman’s body subsides, the transition often leaves her with lasting damage, such as brittle bones or cardiovascular complications. And that is because menopause deprives a woman of one crucial life force—oestrogen. It may be known primarily as the ‘sex hormone’, but oestrogen’s job description is far wider. It regulates metabolism, supports insulin sensitivity, moderates stress responses, preserves muscle mass and helps maintain bone density. It also supports gut health, reduces systemic inflammation, and contributes to skin integrity and cognitive function.

OESTROGEN ANXIETY

As oestrogen levels fall, metabolic changes follow. Insulin fluctuations, elevated cortisol and slower metabolism cause fat to begin accumulating around the abdomen. Muscle mass declines. Inflammation rises, triggering joint pain and cognitive issues. Cholesterol levels increase, raising cardiovascular risk. Global research in the past two years draws a clear link between early ovarian decline and long-term disease risk. A 2023 study in Human Reproduction found that women who menopaused at or before 45 had a higher risk of all-cause dementia compared to those who transitioned at 46–50. Another 2023 systematic review reported increased risk of heart failure and atrial fibrillation among women with early or premature menopause. Bone health is equally affected. When bone density begins to fall early, bone turnover accelerates. International endocrine guidelines consistently warn that women with premature menopause or primary ovarian insufficiency face substantially higher lifetime fracture risk.

IGNORANCE IS NO BLISS

Unlike menarche, which is celebrated in many societies—from India, Africa, Latin America to even Japan—menopause is an unsung retreat into oblivion. It remained invisible because healthcare systems traditionally focused on fertility rather than midlife health. Dr Gayatri Muthukrishnan, co-founder of menopause support platform Miyara Health, says menopause was long normalised as ageing. “Millions of women experience symptoms but lack diagnosis or support because menopause has been treated as something women must simply endure,” she says.

Social stigma, too, has hindered conversation on the subject, with menstruation taboos in conservative households extending into menopause. Most often, though, women lack plain understanding of why their bodies start behaving strangely. “Many women mistake early symptoms for stress or ageing and often rely on advice from friends or the internet instead of seeking medical guidance,” says Dr Anita Gupta, senior director, obstetrics and gynaecology, at Fortis La Femme, Delhi. Reethi Rai, content and community head at Miror, another menopause-dedicated support platform, says the same: “As symptom patterns vary widely, many women initially are not sure that what they are experiencing is menopause-related.”

For many women, this phase also often coincides with their peak career years and they fear being perceived as less capable if they exhibit any signs of vulnerability. Others are weighed down by caregiving duties for elderly parents or other family responsibilities, and so delay their own care until their symptoms become severe.

WAKING UP TO THE WORRY

Until recently, menopause care meant treating symptoms like sleep loss, mood changes or joint pain individually. That is beginning to change. Several large hospital groups are launching dedicated comprehensive menopause services. Fortis Memorial Research Institute in Gurugram introduced its Maitri Menopause Clinic in 2024, offering multidisciplinary consultations along with hormone evaluation, bone density screening and metabolic risk assessment. Hospitals such as Max Super Speciality Hospital in Delhi and Fernandez Hospital in Hyderabad have expanded structured menopause consultations within women’s health departments. States like Maharashtra and Kerala are taking menopause care to India’s villages, with some hospitals setting up menopause clinics.

Doctors say these programmes work better because menopause affects multiple systems at once. Dr Yashica Gudesar, director and unit head of obstetrics and gynaecology at Max Super Speciality Hospital, Dwarka, New Delhi, says that good menopause care must be continuous and personalised rather than limited to one consultation. Evaluating bone health, heart risk, metabolic changes and mental well-being alongside symptom management helps prevent complications that often appear years later.

The Indian Menopause Society works through more than 64 societies across India and over 6,500 members to conduct medical education programmes, webinars and public awareness initiatives on menopausal health. “Our guiding idea is simple: women should be fit at 40, strong at 60, and independent at 80,” says Dr Shah.

Digital platforms are also emerging as important entry points for women unsure whether symptoms are menopause-related. Femtech companies now offer symptom tracking, teleconsultations and expert-led education. Miror operates menopause-focused communities where women exchange experiences and attend sessions on sleep and hormonal health. Other startups are building structured clinical pathways. Miyara Health offers a digital companion helping women over 35 track hormonal health across sleep, mood and metabolism while connecting them to expert-led solutions. Companies such as Elda Health combine consultations with peer support networks and lifestyle programmes addressing sleep and mental health, while Proactive For Her now offers menopause consultations alongside preventive screenings. Nutrition-focused platforms such as Earthful provide dietary and supplement guidance tailored to hormonal transitions and metabolic shifts.

Integrative medicine is also entering mainstream discussion. In late 2025, VMMC–Safdarjung Hospital partnered with the Central Council for Research in Ayurvedic Sciences to develop evidence-based integrative menopause protocols, combining lifestyle approaches such as yoga and dietary guidance with modern screening for heart, bone and metabolic health.

Most importantly, women are beginning to talk about menopause. Bollywood celebrities like Soha Ali Khan, Twinkle Khanna and Lisa Ray are lending their names to the cause. And if Akshay mainstreamed menstruation in the film Pad Man, Bollywood explored menopause with the heartwarming Me No Pause Me Play, a film about three women not letting their menopausal travails come in the way of running a marathon. Gujarati cinema, too, gave audiences Jalebi Rocks last year, where the film’s protagonist rediscovers her worth even as she navigates menopause and a busy life.

MENOPAUSE CARE FOR ALL

While these developments together signal the emergence of a menopause care ecosystem India long lacked, access remains uneven. Services are still concentrated in large cities, leaving women in smaller towns dependent on doctors who may lack menopause-specific training, while specialised consultations and diagnostic tests remain costly and often uninsured.

This gap often leads to self-medication. Many women, says Dr Gupta, begin taking over-the-counter supplements marketed for menopause relief, including calcium, vitamin D, herbal formulations or phytoestrogen products, or even start hormone replacement therapies based on advice from friends or online forums. And unsupervised menopause management, she warns, can do more harm than good. “Improper or unsupervised use can worsen existing risks such as blood pressure, metabolic issues or clotting tendencies, and sometimes mask underlying problems that need treatment,” she explains.

But awareness, and support, are growing. For women, it will mean the difference between years lost to confusion and years lived in good health.