Menopause woes: Indian women are wired to serve—everyone else comes first

Midlife stressors like an empty nest and ageing parents hit a woman’s mental wellbeing and make menopause even tougher to handle

Puja Awasthi, TW, April 04, 2025 : (Interview with Dr Alok Kulkarni, senior consultant psychiatrist, Manas Institute of Mental Health and Neurosciences, Hubballi, Karnataka)

Q/ How does a woman recognise that her mental wellbeing is impacted by a stage of menopause, given that we live in a world where women are shamed for not keeping their hormones in check?

A/ Spotting mental health shifts during menopause is tough when society expects women to keep ‘their hormones under wraps’ as though it is a test of willpower. Research points to tell-tale signs: anxiety that feels sharper than usual, a low mood that sticks around, or trouble focusing that is new and nagging. These often sync with physical clues―hot flashes, sleepless nights―but the mental piece can stand alone.

Perimenopausal and postmenopausal depressive symptoms include persistent and pervasive sadness, anhedonia (loss of interest in activities that were previously pleasurable), fatigue, crying spells, guilt, disrupted biological functions such as sleep and appetite, concentration difficulties, hopelessness and [feeling of] worthlessness. In severe depression, suicidal ideas are apparent.

In India, where menopause talk is hushed and women are judged for these symptoms, the shame can mask these symptoms as personal flaws. A woman might notice she’s snapping more, withdrawing from loved ones, or just feeling off, beyond typical stress. If it is persistent―weeks, not days―and disrupts life, it is time to see a mental health professional.

Q/ What are the different kinds of mental wellbeing challenges that women face in this long journey of menopause?

A/ Menopause is a mental marathon with shifting obstacles. Anxiety spikes early, often in perimenopause, as oestrogen's ups and downs rattle serotonin pathways―think restless worry or sudden panic. Depression risks double especially for those with past episodes. Cognitive difficulties―brain fog―frustrate, with studies linking oestrogen drops to memory lapses that feel personal but are not permanent. Mood swings, ranging from irritability to despair, are common. Sleep loss from night sweats fuels irritability. Post menopause, some grapple with purpose―fertility’s end can hit hard in cultures tying worth to motherhood. Each stage rewires the brain differently.

Q/ How many women, in your experience, seek medical help?

A/ Hard numbers are elusive, but global estimates from The Lancet Psychiatry suggest 25-35 per cent of women seek help for menopausal symptoms―mental or physical. In India, it is likely lower. Cultural silence and family-first priorities keep many away; maybe 10-20 per cent see a doctor, often for hot flashes, but not for mood disturbances. Stigma―calling it weakness―deters them as does patchy health care access outside cities. Women with severe depression or anxiety might edge toward help, but most cope quietly. Education and urban living nudge the odds up, but it is still a minority stepping forward.

Q/ What are some self-care tips? More important, how do women change their mindsets to not be eternal caregivers to everyone but themselves?

A/ The real game-changer is mindset. Women, especially in India, are wired to serve―everyone else comes first. Studies show this self-neglect spikes stress. Therapy or support groups can reframe this unnecessary guilt as strength. However, this mindset change is easier said than done in a traditional and conservative society like ours. Self-care comprises three key elements: prioritising sleep, nutrition and exercise. For those battling insomnia, following sleep hygiene measures help. Eating fresh, locally grown seasonal food can nourish oneself. The Centre for Disease Control recommends 150 minutes of exercise per week to keep lifestyle diseases at bay. This can be a combination of strength training and aerobic exercises. Women need to dedicate at least an hour a day to themselves for self-care. If these measures are not helping, then it is worthwhile to get in touch with a mental health professional.

Q/ How can partners/families be more supportive?

A/ Support starts with understanding―partners and families need to see menopause as real. Research stresses empathy: active listening and not suggesting quick fixes. The spouse should pitch in practically―cook dinner, manage kids and so on, but this is hardly the ground reality in India, where women are burdened with the bulk of household chores. Lastly, mental health visits should become routine. Research shows that an involved partner boosts treatment uptake.

Q/ What are some myths/misconceptions?

A/ One: menopause is for “old” women―it can hit in your 40s, as per studies. Two: it is all physical―psychiatry studies scream mental health matters, too. In India, some call it a “natural end” to womanhood, sidelining vitality.

Q/ Is the cause of postmenopausal issues only hormonal changes?

A/ The heritability estimates (the extent to which symptoms can be explained by genetic factors) for anxiety disorders is 30-40 per cent. Which means the other 60 per cent is determined by environmental factors including stress, available support and substance misuse. Hormones lead the charge―oestrogen's dive tweaks serotonin and memory, sparking mood dips and fog. Progesterone’s drop stokes anxiety. Sleep wreckage from night sweats doubles the strain.

Life hits, too―midlife stressors (empty nests, ageing parents) amplify vulnerability. Past depression ups the ante. In India, cultural baggage―ageism, caregiving loads―piles on.

Nutrition, inactivity, even loneliness, tweak the mix.

It is a combination of biology and one's environment which is responsible for the complex mental landscape following menopause.