E-Paper
Menopause in India: Health crisis hiding in plain sight
This article is authored by Abhishek Gautam, director, Gender and Health, International Center for Research on Women, Asia office.
Prefer HTon Google
India has over 100 million women currently in perimenopause or post-menopause, a figure projected to reach 130 million by 2030 (World Economic Forum, 2025).
India’s health system has long prioritised attending to women during their reproductive years. What happens after has been largely invisible. Public health programmes have done a great deal: 89% of births now take place in institutions, maternal mortality has declined significantly, and contraceptive access has expanded (IIPS and ICF, 2022). However, this near-exclusive focus on women's reproductive years leaves a significant gap. The years that follow, as a woman moves through perimenopause into post-menopause, receive negligible attention in policy, in the health system, and in health research. Women aged 45 to 60 remain largely invisible across all three.
This is not a small gap. These women are in their 40s and 50s, often at the peak of their economic participation, with many in senior level positions and leadership roles, while navigating caregiving responsibilities. And yet there is no dedicated clinical pathway for them, no training for health service providers on menopause, and no national data that directly captures what they are experiencing in terms of symptoms, health seeking, and impact of menopause on their daily lives.
Dr Sampurna Kundu, post-doctoral research fellow in epidemiology at University of Exeter says, “Even if menopause starts to be talked about, it is still only about reproduction. Women's health is not the focus.”
Conversations with women about their experiences further reveal a lack of adequate public health information which recognises clinical and physiological symptoms of menopause as deserving of medical attention.
“I suffered during menopause for 2 years. It was heavy and painful bleeding which kept me awake. I used to feel very hot, couldn’t sleep, had frequent headaches, was feeling depressed. During that time my husband died. It was a tough time.”-- Rajni, 52, urban resident, Haryana (Singh C Sivakami, 2020)
“The weight gain was sudden and stubborn, hair loss noticeable, and insomnia relentless. My appetite vanished and mood swings hit without warning, making it difficult to complete even routine tasks. Doctors need better training to recognise the interconnected nature of health challenges. Many women don’t seek help until their symptoms become unbearable.”-- Eima Azim, co-founder, Khushtaar Initiative (YourStory, 2024)
These are not isolated experiences. Research across Indian settings consistently documents heavy and painful bleeding, sleepless nights, mood swings, joint pain, and profound fatigue
as the most commonly reported menopausal symptoms. Yet most women go through this alone, with no clinical support. Beyond diagnosis and medication, there is also a need for establishing a holistic care protocol which includes mental health counselling. A study from Haryana found that women’s dominant desire during menopause was “to be understood rather than to be treated” (Singh C Sivakami, 2020). The health system, where it engages at all, has not been meeting even that basic ask.
Research has estimated the average age at menopause in India at around 46 to 48 years (Pallikadavath et al., 2016; Ghosh C Syamala, 2024), three to five years earlier than in high-income countries. An analysis of pooled data from NFHS 3, 4, and 5 (2005 to 2021), covering over 1.5 million women, confirms this and adds something important.
The overall trend is encouraging: The proportion of women aged 40 to 49 classified as menopausal has declined over 15 years. But this improvement has not been shared equally. Women with greater education and economic resources have benefited most.
Women with the least education, lowest incomes, and poorest nutritional status continue to reach menopause earlier. And in one area where the situation for the most vulnerable women has actively worsened rather than improved: the rising burden of hysterectomy amongst those least equipped to question or refuse it.
Among women aged 40 to 49, hysterectomy prevalence rose from 7.6% in NFHS 4 to 8.1% in NFHS 5. In this age group, surgical menopause is now comparable in scale to all categories of natural menopause combined. What makes this alarming is the pattern underneath.
Hysterectomy is rising among women least equipped to question clinical recommendations. Among women with no education, hysterectomy rose from 8.1% to 9.7% between 2015–16 and 2019–21. Among women with higher education, it fell from 5.0% to 3.7%. Among rural women it rose; among urban women it fell. The gap is widening, not closing. This points to a clinical governance problem, particularly in private facilities, where women with limited ability to seek second opinions are most affected (Desai et al., 2019; Prusty et al., 2018).
Beyond hysterectomy, the analysis shows that the age at which a woman reaches menopause is shaped by conditions accumulating across her life. Women with no education are substantially more likely to reach menopause earlier than the most educated. Women in the poorest wealth quintile reach menopause earlier than the wealthiest. Underweight women reach menopause earlier than women with normal BMI. Each factor has an independent effect, meaning they are not simply proxies for each other.
These findings do not mean that investing in education or nutrition is a menopause intervention in any simple sense. The pathways are complex and need more research. What they do suggest is that the structural conditions shaping women’s lives from childhood also shape their midlife health in ways the health system is not equipped to respond to.
“The distress in the lives of poor women from Haryana seems to stem from the complex interaction of patriarchy, gender, and poverty”-- Singh C Sivakami (2020), Palgrave Handbook of Critical Menstruation Studies.
First, menopause must enter the health system. Health and Wellness Centres, now rebranded as Ayushman Arogya Mandir under Ayushman Bharat, which serve as touchpoints for primary health care in India, do not currently include menopause services in their package. A minimum package covering awareness, screening, counselling, and referral pathways should be added, alongside capacity-building and sensitisation of service providers and orientation of frontline health workers like ASHAs and ANMs on how to support and guide women as they enter menopause.
A recent and welcome step in this direction has been the establishment of India's first dedicated menopause clinics in Maharashtra, introduced in the public health system on January 14, 2026, offering counselling, screening, and medical consultation to women across district and rural hospitals in the state. This is a model other states should look to replicate.
Second, we need to listen to women. National surveys do not ask women directly about menopause. Menopausal status must be inferred from proxy variables. Symptom burden, care-seeking, and the impact on daily life are almost entirely undocumented at a national scale. A study from West Bengal found that women did not seek healthcare during menopause due to a knowledge gap, dissatisfaction from previous visits, cost issues, and unavailability of resources in the healthcare delivery system (Sarkar et al., 2023). Investing in a dedicated menopause module in a national survey, and qualitative research giving women space to name their experiences, is as important as any quantitative data effort.
Further analysis using the Longitudinal Ageing Study of India (LASI) data can help examine health impacts of menopause in later life, including cardiovascular, metabolic, cognitive, and functional outcomes for women who reached menopause earlier. This will connect the determinants story from NFHS to downstream health consequences.
Menopause is a public health issue of significant scale in India, and the health system has been looking away for too long. The burden is unequally distributed, as women who reach menopause earliest are those who have had the fewest opportunities across their lives. The evidence, however, does not offer a quick fix. It highlights the intersecting gap in evidence, health policy and systems, and calls for the prioritisation and valuation of women’s health beyond their reproductive years.The age at which a woman reaches menopause is shaped by the society she was born into. Menopause has been invisible in clinics and in policy for too long. That invisibility has a cost, and it is paid by the women who can least afford it.
(The views expressed are personal)
This article is authored by Abhishek Gautam, director, Gender and Health, International Center for Research on Women, Asia office.
