Pinkishe Foundation
31/10/2026
Dr. Shehla Jamal
Menopause is the time when your periods stop for good. It is confirmed once you have gone 12 months in a row without a period. It is a natural stage of life, not an illness.
Many Indian women reach menopause in their mid to late 40s, a little earlier than women in Western countries. Some reach it earlier and some later. The years leading up to it can bring hot flushes, night sweats, mood swings and irregular periods. For many women it feels like unfamiliar ground.
This guide explains each stage, what you may feel, what helps, and when to see a doctor. So make yourself a cup of chai, or something cool if a hot flush has just passed, and read on.
Premenopause is the time before any change. Your periods are regular and your hormones follow their usual monthly pattern. Most of your adult life is premenopause.
Perimenopause is the time of change leading up to menopause. It often starts in your 40s, sometimes earlier, and can last from a few months to several years. Your levels of oestrogen and progesterone rise and fall unevenly. Periods become irregular, and symptoms such as hot flushes, night sweats and mood swings often begin. For many women, this is the hardest stage.
You can still get pregnant in perimenopause, even when your periods are irregular. Use contraception until a doctor says you can stop.
Menopause is the point when your periods have stopped for 12 months. Your ovaries now make much less oestrogen and progesterone. This drop is behind many common symptoms, such as hot flushes, vaginal dryness and poor sleep.
Every year after menopause is postmenopause. Some symptoms, such as hot flushes, may carry on for a while, but most ease with time. New health needs come up now, especially for your bones, your heart and your weight.
Menopause before 45 is called early menopause. Menopause before 40 is called premature menopause, or premature ovarian insufficiency. It can happen because of family history, some medical conditions, or treatments such as chemotherapy or surgery to remove the ovaries. Often no cause is found.
The signs are the same as at any age: irregular or missed periods, hot flushes, night sweats and mood changes. If you are under 45 and think menopause is starting, please see a gynaecologist. Both early and premature menopause need a doctor, to rule out other causes and to protect your bones and heart.
Every woman is different. These are the symptoms many women notice.
Hot flushes, also called hot flashes, are the best-known symptom. One moment you are fine. The next, a wave of heat rises through your chest, neck and face. Your face may go red and you may sweat. A flush can last from a few seconds to several minutes. For many women, hot flushes come and go for several years.
Night sweats are hot flushes that come at night. You may wake up soaked in sweat. Over weeks, this can leave you short of sleep and tired.
In perimenopause, periods can become unpredictable. Some months they are heavy, some months barely there. You may skip a month, or have two periods close together. This is your body adjusting to changing hormones. But some bleeding needs a check, so please read the bleeding section below.
Changing hormones can make you irritable, anxious or tearful without a clear reason. This is real, and it is not a weakness.
Between night sweats, worry and hormone changes, many women find it hard to fall asleep or stay asleep.
Lower oestrogen can make the tissues of the vagina drier and thinner. This can cause itching, irritation, and pain during sex.
Many women put on weight around the waist during these years. Loss of muscle, poorer sleep and a shift in where the body stores fat all play a part. Good food and regular movement help.
Forgetting why you walked into a room, or losing a word in the middle of a sentence, is common. This brain fog is linked to changing hormones and poor sleep. For most women, it gets better.
Irregular periods are expected in perimenopause. But some bleeding is not part of the normal change, and a doctor must check it, even if you feel well:
Often the cause is simple, but these signs still need to be checked. Bleeding after menopause should be checked soon, even if it happens only once. Heavy bleeding over many months can also cause anaemia, which leaves you tired and breathless. Anaemia is treatable.
Menopause is natural, but you do not have to suffer in silence. There are good options.
Hormone therapy, often called HRT, is one of the most effective treatments for hot flushes, night sweats and vaginal dryness. It replaces some of the oestrogen your body no longer makes.
HRT comes as tablets, patches, gels and creams. It is safe and effective for many women, but it is not right for everyone. Some types carry risks, such as blood clots, or a small rise in the risk of breast cancer for some women. The balance depends on the type, your age and your health. Discuss the benefits and risks with a gynaecologist before you decide.
Not every woman can take hormones, and some prefer not to. A doctor can suggest non-hormonal medicines that reduce hot flushes and help with mood. Lifestyle changes help too.
Some women try black cohosh, red clover or other herbal products. The evidence that they work is weak, and black cohosh has been linked to liver problems. Please talk to your doctor before taking any herbal product.
Soy foods, such as soya chunks and tofu, are a healthy source of protein. Whether they ease hot flushes is not clear. Some women find that yoga, slow breathing or acupuncture help them feel calmer. These can be a comfort, but they do not replace medical advice.
Lower oestrogen makes bones lose strength faster. This raises the risk of osteoporosis and fractures. To protect your bones:
Oestrogen helps protect the heart. After menopause, the risk of heart disease rises. To look after your heart:
Many women worry about brain fog. To keep your mind sharp:
Menopause does not mean the end of your sex life. Dryness, discomfort and lower desire are common, and there is help:
Pain during sex is not something to put up with. Mention it to your gynaecologist.
Hormone changes can affect your mood. Anxiety, low mood and irritability are common in perimenopause and menopause. Ways to care for yourself:
If you ever feel hopeless or have thoughts of harming yourself, please talk to someone today. Call Tele-MANAS, the government's free mental health helpline, on 14416 or 1-800-891-4416, at any hour. In an emergency, call 112.
Lower oestrogen can make skin drier and less firm, and hair can thin.
Some women notice bloating, constipation or indigestion during these years. To help:
Hot flushes, mood swings and brain fog can be hard to manage at work. A few small things help:
Different cultures see menopause differently. In some, it marks a move into wisdom and respect. In others, it is hidden or seen as a loss. In many Indian homes it is simply not discussed, and women go through it quietly. Talking about it openly, with your family, your friends and your doctor, makes it easier for you and for the women who come after you.
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Prefer to work out your dates now? Open the free ovulation calculatorPerimenopause can last from a few months to several years. Hot flushes often carry on for several years around and after the last period, and for some women longer. Once you are past menopause, you stay postmenopausal for the rest of your life.
It can run in families. If your mother or sister had early menopause, you may too. Tell your doctor about your family history.
Yes. Even with irregular periods, you can still release an egg in some months. Use contraception until a doctor says you can stop.
Some types of HRT can slightly raise the risk of breast cancer for some women. The risk depends on the type of HRT, how long you take it, your age and your own health. For many women, the benefits are greater than the risks. Talk it through with a gynaecologist.
Some approved hormone medicines are 'body-identical'. Custom-mixed 'bioidentical' creams sold online or by some clinics are not tested for safety or dose. Use only medicines your doctor prescribes.
There is no single blood test that confirms perimenopause. A doctor usually goes by your age, your symptoms and your periods. Tests are mainly used to rule out other causes, such as thyroid problems or anaemia, or if you are under 45.
Menopause is confirmed after 12 months with no period, and the years around it can bring hot flushes, poor sleep, mood changes and irregular bleeding. Good food, movement, sleep and, for many women, hormone therapy can help. Any bleeding after menopause, or very heavy bleeding before it, needs a doctor.
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