Interview/ Dr Anita J. Shah, president, Indian Menopause Society
The Indian Menopause Society (IMS) is a multidisciplinary national society committed to fostering the comprehensive well-being of the mature and elderly Indian women. Excerpts from an interview with IMS president Dr Anita J. Shah, a gynaecologist in Surat since 1988.
Q/ How would you rate the understanding of menopause among the medical community?
A/ The understanding of menopause within the medical community is variable―some specialists (like gynaecologists, endocrinologists and menopause specialists) are well-versed in menopause management, but many general practitioners and even some gynaecologists may have gaps in knowledge. This can be attributed to a number of reasons:
❖ Limited medical training on menopause, as medical education focuses more on reproductive health and pregnancy, while menopause and midlife health receive less emphasis.
❖ The Women’s Health Initiative study in 2002 led to fear surrounding hormone therapy owing to concerns about breast cancer and cardiovascular risks. While later research clarified these risks, some doctors still hesitate to prescribe HT, leading to under-treatment.
❖ Lack of awareness about new therapies.
❖ Physicians usually focus on acute conditions (infections, emergencies) rather than the preventive aspect and chronic menopausal health concerns like osteoporosis and cardiovascular risk.
❖ Cultural and gender bias―symptoms like brain fog, mood swings and fatigue are often dismissed as psychological rather than physiological.
Q/ What is the Indian Midlife Registry and at what stage is it currently?
A/ The Indian Midlife Registry, an ongoing registry since 2021, is a research activity of the Indian Menopause Society. Dr Meeta Singh (past president of IMS 2012 and chair of Indian Midlife Registry) and Dr Jyoti Shah (past treasurer of IMS) conceptualised and initiated the formation of the registry. Its objectives are:
❖ To capture, maintain and analyse real-world data collected anonymously from practising members of the IMS over a period of 10 years.
❖ To develop, maintain and sustain a digital registry for Indian menopausal women while following ethical considerations.
❖ To promote and advocate the use of electronic health record capable of generating real-world data within the members of IMS.
❖ To analyse and study menopause patterns in Indian women from the registry and use it for fine-tuning the clinical guidelines for menopause in India.
❖ Promote research projects using the registry data through an impartial requisition queue system where all contributing members may submit a proposal for research.
As for progress, we have made four scientific paper presentations so far, while two are in the pipeline. It is an ongoing project, a longitudinal study.
Q/ What are the most striking aspects about menopause in the Indian context?
A/ In the Indian context, menopause has several unique aspects influenced by cultural, social and health care factors. These include:
❖ Earlier onset of menopause: Indian women experience menopause at an average age of 46-47 years, compared to 51 years in western countries. Possible reasons: Genetic factors, nutritional status and lifestyle differences.
❖ High prevalence of menopausal symptoms: Indian women experience significant symptoms, but few receive appropriate treatment due to limited awareness and stigma. Many women normalise their symptoms rather than seeking medical help. There is still hesitation about hormone therapy due to misconceptions. Many women prefer ayurveda, homeopathy, herbal and alternative therapies, yoga, meditation and lifestyle modifications over pharmacological treatments. While these can help, they are not always enough for severe symptoms.
❖ Increased risk of osteoporosis and cardiovascular disease: Indian women have lower bone mineral density, making them more prone to osteoporosis. Calcium and vitamin D deficiencies are widespread. Cardiovascular diseases are rising in postmenopausal women due to lifestyle changes, diabetes and obesity.
❖ There is a lack of specialised menopause clinics in the country.
Q/ How is the IMS working to enhance awareness about menopause, especially in rural India and among males?
A/ IMS member societies conduct free health camps to screen for osteoporosis, cardiovascular diseases and menopausal symptoms in rural areas. Local health care workers and ASHAs are trained to spread awareness about menopause and midlife health by the rural committee of IMS.
Q/ Has any worthwhile research come out of India on menopause?
A/ ‘Clinical Practice Guidelines on Menopause, 2020’ by the IMS is recognised among the top five guidelines of the world on menopause. ‘Clinical Practice Guidelines on Postmenopausal Osteoporosis, 2020’ is recognised among the top 10 guidelines of the world on osteoporosis. The Journal of Mid-life Health is the official journal of the IMS published quarterly and includes all aspects of mid-life health, preventive as well as curative.