India has around 150 million menopausal women, yet menopause and perimenopause remain largely absent from public health conversations.
Climate stress, heatwaves and air pollution can worsen symptoms such as hot flushes, fatigue, insomnia and cardiovascular risk.
Women in informal work face a sharper burden, with heat exposure, wage loss, poor clinic access and limited workplace protections compounding menopausal symptoms.
India’s health policies and surveys must look beyond reproductive age to recognise menopause as a life-stage shaped by health, work, environment and inequality.
For decades, discussions about women’s health in India have centred mainly on reproduction, menstruation, fertility and maternal care. Campaigns, policies and advertisements have slowly begun to break the silence around periods, highlighting issues such as hygiene and nutrition. Menopause, along with the preceding phase of perimenopause, remains largely ignored.
This silence is surprising, given the numbers. India has around 150 million menopausal women. For many of them, the transition happens quietly. It is misunderstood, minimised or spoken about only in fragments. Climate stress, pollution and entrenched social hierarchies all shape this experience. Menopause in contemporary India is not only a biological event. It is also shaped by the body, the environment and inequality.
Menopause is medically defined as the permanent end of menstruation, confirmed after 12 consecutive months without a period. The global average age of menopause is about 51. However, according to a nationwide survey by the Indian Menopause Society, Indian women typically experience it earlier, at around 46.2 years.
The transition begins much earlier, during perimenopause, which can start in the late 30s or early 40s. This phase can be prolonged and is marked by fluctuations in oestrogen and progesterone. Symptoms vary widely and can include hot flushes, night sweats, heart palpitations, brain fog, anxiety, mood swings, joint pain, reduced bone density, fatigue and weight changes.
While medical literature documents these symptoms well, they remain poorly understood in everyday life. Surveys by the Indian Menopause Society indicate that nearly 70 per cent of Indian women are unaware of perimenopause or its symptoms. Many regard these changes as simply “normal aging”, stress or general weakness. This misunderstanding delays diagnosis and prevents timely care.
Menopause represents a biological shift, but the environment in which it occurs is becoming more difficult. India is facing more severe heatwaves, rising average temperatures and worsening air quality. These factors affect how the body regulates temperature and hormones, increasing menopausal discomfort.
Hot flushes can become more intense when external temperatures cross 45 degrees Celsius, blurring the line between hormonal heat and environmental heat. The effects accumulate. Dehydration, fatigue and sleep disturbance worsen. High night-time temperatures hinder recovery and increase insomnia, which is already common during perimenopause.
Air pollution complicates matters further. Exposure to fine particulate matter, or PM2.5, is linked to hormone disruption, inflammation and cardiovascular risk. For women experiencing hormonal changes, polluted environments create a dual stress. The body must manage internal adjustments alongside external toxins. Urban women face congested and polluted commutes, while rural women inhale smoke from biomass fuels. The sources may differ, but the biological strain is similar.
In India, the experience of menopause varies significantly by class. However, a common expectation remains: endure quietly.
For middle-class and professional women, menopause often coincides with peak career responsibilities and caregiving roles. Workplaces typically lack clear policies or accommodations. Studies suggest that nearly one in four women consider leaving their jobs because of menopausal symptoms. This risks pushing more women out of paid work in a country where female workforce participation is already low.
For women in the informal sector, the burden is often heavier and more physically demanding. In Ahmedabad, home-based weavers associated with the Self-Employed Women’s Association report skin rashes and pelvic infections from sitting for hours in overheated one-room homes. Their symptoms worsen across the reproductive cycle, including during menopause.
Most cannot afford fans or air conditioning. The cost of travelling to a clinic may outweigh the relief it offers, leaving symptoms untreated. SEWA and other groups have begun testing heat-insurance schemes to offset wage losses during extreme heat. Menopause-specific support, however, is still largely absent.
The issue of wages is significant. A survey by the M S Swaminathan Research Foundation, involving more than 3,300 women across 15 districts in seven states, found that 97 per cent reported income losses during the peak summer months of April to June. On average, they lost more than Rs 1,500 in wages, particularly in agriculture, construction and informal service work.
For a woman dealing with perimenopausal fatigue or joint pain, this is not just another statistic. It captures the daily choice between working through heat and pain or losing wages she cannot afford to forgo.
Doctors tracking heat-related admissions note that women are more vulnerable to high temperatures. Factors such as higher body fat percentage and lower sweat production can contribute to this. Life stages such as menopause bring hormonal sensitivity that may amplify the effects of extreme heat. Limited access to restrooms at work also discourages hydration, increasing the risk.
A national analysis found that women make up 55 per cent of the population most at risk from extreme heat. Temperature-related deaths among women rose by nearly 10 per cent from 2010 to 2019, even as they declined among men, according to Significance Magazine.
Access to information shapes how menopause is experienced. Marginalised women often lack the language to describe what they feel. Symptoms such as palpitations, dizziness and anxiety may be described as ‘body heat’, ‘weakness’ or simply the cost of hard work.
A domestic worker may experience severe night sweats and sleeplessness while continuing to work across households, unaware that these could be symptoms of perimenopause. Health communication in India has historically focused on maternal and reproductive health, while ASHA workers rarely include menopause in their outreach. This leaves millions of women to navigate the transition without support.
A house-to-house study of 148 perimenopausal and postmenopausal women in rural Puducherry found that 96.6 per cent reported symptoms. Backache was the most common complaint, affecting 62.3 per cent of participants, while 93.2 per cent experienced physical symptoms overall. The authors called for local awareness-building and health education, the kind of grassroots outreach that is still missing from many frontline health programmes.
Middle-class women face a different challenge: awareness without adequate support. A study of urban women aged 40 to 45 found that 94 per cent had heard of perimenopause and menopause. But practical knowledge remained limited. Just over half knew of physiotherapeutic exercises to ease the transition, and most learned informally from family doctors or friends rather than structured sources.
Patriarchal norms shape how even this incomplete knowledge is used. Symptoms are minimised at home. Caregiving responsibilities continue regardless of health. In clinical settings, women are often told to ‘deal with it’ rather than being offered counselling, treatment options or informed advice on hormone therapy. Across classes, the burden remains individualised, and the silence continues.
India’s public health framework still offers a limited view of women’s health. Large surveys such as the National Family Health Survey mainly focus on women aged 15 to 49. This makes older women statistically invisible and slows policy attention to their needs. While menstrual hygiene has rightly gained traction in public health, menopause has not.
Addressing menopause in India means breaking this silence. Menopause education should be integrated into primary healthcare. ASHA workers should be trained to recognise symptoms and guide women towards care. Workplaces need flexible policies and accommodations. Heat Action Plans should include menopause and other gendered health vulnerabilities. National surveys must also expand beyond reproductive age groups to capture women’s health across the life course.
Menopause is not just the end of fertility. It is a physiological and social transition shaped by environmental stress, working conditions and systemic inequality. To recognise it fully is to see women not only through their reproductive years, but across their entire lives.
Trishna Sarkar, assistant professor, deptartment of economics, Dr Bhim Rao Ambedkar, University of Delhi. Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.