Until a few years ago, menopause was not even discussed among women in Nepal. It was assumed that there was nothing to discuss and women’s health was associated more with pregnancy, contraception, and reproductive health. Even health workers held such beliefs. But times have changed and many women now live longer than their grandmothers and mothers did. Nepali women on average live up to 68 years of age (though differences between rich and poor, urban and rural, and between castes still exist). Women generally undergo menopause between 45 to 50 years of age, and at this time, they need counselling and information on how to remain healthy.

A natural process

About 10 years ago, I received a book on menopause, Our Bodies, Ourselves: Menopause, from a friend in the US. I was surprised to see such a large book on menopause and by the time I finished it, I learned the mental and physical health issues associated with menopause, many of which exist among Nepali women but no one really talks about it. I learned that we are all overwhelmed by the issue of reproduction, but once reproduction becomes impossible, no one seems to take note of what happens to women’s bodies. 

The inception of menstruation is a natural process and a few adolescents feel pain and discomfort. Among them, only a few need medical treatment. In the same way, menopause is a natural process and a few women feel some discomfort and among them, very few need medical treatment. But if care is not taken at this stage, women can invite many health problems.

The information in this book is useful for women who are still 25-30 years of age, as it teaches you how to take care of your health from an early age, so that you can lead healthy lives after menopause. The onset of menopause is usually between 48 and 50 years of age, though some women may have it by 40 or 45, and others at 55.

Natural symptoms

Our Bodies, Ourselves: Menopause also provides information that some women may not have. There is often discomfort during menopause but some women may experience palpitations, dizziness, night sweats, hot flashes, headaches, and irritability. There is no way to predict who will undergo these symptoms. However, the book argues that women who keep up healthy lifestyles by eating healthy and exercising regularly experience fewer symptoms during menopause than those who lead unhealthy lifestyles.

It should be noted menopause is a period of changes and for some women, it can be highly stressful. The book emphasises that women need to help themselves when it comes to uncomfortable symptoms by accepting that they are part of the experiences, rather than trying to reject or deny them. As menopause happens to all women, it is better to be prepared for it. Changes that occur with age and after menopause are changes in the skin, including wrinkles and spots, changes in the hair, and changes in the breasts. Women who value their physical appearance might feel depressed when such changes start to take place but these changes are natural and women need to come to terms with them. After all, as the book argues, it is important not to place too much emphasis on appearances.

Furthermore, everyone starts losing bone mass after the age of 35 and bone mass loss in women increases after menopause. The book suggests that to minimise the loss, women need to keep up with regular exercise and get enough calcium and vitamin D through food and exposure to the sun. Women must eat whole grains, green leafy vegetables, lentils, and seasonal fruits while avoiding junk food, carbonated drinks, sugar, processed foods, and fatty foods. For optimum health during menopause and after, woman should also avoid smoking as it interferes with the way bones absorb calcium and is responsible for weak bones.

Lessons learnt from this book made me think that since all us women go through this period, it is important for all of us to know about menopause and what should be done to remain healthy, not only physically but also mentally. Though written by a medical doctor, the book is very easy to read and does not contain difficult jargon. To make the subject more relatable, the authors have conducted interviews with many women, who have shared their own experiences on menopause.  

Not a disease

I also realised that menopause is considered a ‘disease’ by some health workers in the US, but the author of the book takes a stand and rejects “the medicalization of women’s natural life transitions” while providing an “even-handed consideration of all treatment options, whether ‘conventional’ or ‘alternative’; and a focus on understanding individual women’s health in social and political contexts.” Even in Nepal, some health workers have started to provide hormone therapy for women after menopause. But this book provides evidence to why hormone therapy is not only unnecessary but also has many negative impacts on woman’s bodies.  

Emphasising that menopause is a natural process and that most women have a relatively easy time with the transition, this book provides message that hormonal changes during menopause affect all woman differently and each one of us needs to work out how best to manage these changes. While every woman is unique, attention to diet and lifestyle at this stage is important for all, since the later effects of menopause and oestrogen deficiency can be alleviated by adopting as healthy a lifestyle as possible.

The book also combines trustworthy medical information, based on the best available evidence and thoughtful analysis of the social, cultural, and political forces that affect our health. I would recommend this book to all young adult women so that they can understand adequately the effects of menopause and how best to ameliorate the discomfort that can arrive alongside.

Dr Uprety writes on nutrition and health