Menopause is an inevitable life stage that occurs in all women but remains one of the least discussed and supported transitions in healthcare around the world.
A natural biological process, menopause is not only a major individual milestone, but also a medical, social and economic life event that marks the end of the menstrual cycle due to the natural decline of the reproductive hormones oestrogen and progesterone.
Contrary to popular belief, it is neither a disease, disease process nor an illness. The onset of menopause is diagnosed when a woman has gone 12 consecutive months without menstruating. The process of transition from pre-menopause to post-menopause is known as “perimenopause” and can start from age 40 years, as the reproductive hormones begin to decline but last until menopause is diagnosed at 12 months.
For most women, the physical changes occur during the ages of 45 to 55 years. Though some menopausal symptoms are associated with this normal decline, such as irregular periods or headaches, there are also significant changes to sleep, heart rate, weight and muscle mass, bone density and metabolism.
Symptoms of menopause and the change in oestrogen can range from a mild inconvenience to a severely debilitating condition, including hot flushes, night sweats, joint pain, vaginal dryness, urinary incontinence, anxiety, depression, and even severe sleep disturbance.
Menopause is also a risk factor for osteoporosis and cardiovascular disease, due to a drop in the hormone oestrogen, as well as thyroid dysfunction, dementia and depression in later life. The various symptoms of menopause and long-term risks can significantly affect women’s health, economic productivity and quality of life if left untreated.
The first is to recognise that menopause is a health condition that requires attention. It is not just a “natural” part of aging, but a significant transition that can affect women’s physical, mental, and emotional well-being. Women have the right to the highest attainable standard of health.
Like other health conditions like maternal or reproductive health services, menopause should be integrated into primary and secondary healthcare. Neglecting menopause and women’s health more broadly reinforces the idea that women are only valuable for their reproductive potential, not as people who deserve dignity and care at all stages of life.
Social and economic consequences
Policy too often fails to acknowledge the health impacts of menopause, and health system players do not allocate resources to meet women’s needs at this stage of life, yet menopause needs care and support. Most private health insurance plans also do not cover menopause, for hormone replacement therapy (HRT), one of the most effective treatments for menopausal symptoms. The same is true for many public or social health systems.
For many women, accessing HRT or non-hormonal medications, seeing a counsellor, or getting a bone density scan means paying out of pocket. Menopausal symptoms can interfere with a woman’s ability to work, care for others, and participate in community life. One in 10 women has left the workforce due to unmanaged or poorly managed menopause. Without the healthcare support they need, women face financial insecurity, job loss, and isolation.
Menopause is surrounded by stigma and silence. In many societies, it is seen as a sign of decline or loss of fertility, sexual attractiveness, and social value. Many women are afraid to talk about their symptoms, ask questions, or seek support. They are also often met with shame or embarrassment from friends, family members, and healthcare workers.
In many settings, even health workers are poorly trained to recognise, diagnose, or treat menopausal symptoms. Misunderstanding or misinformation can lead to misdiagnosis, unnecessary prescriptions (such as antidepressants for hot flashes), or patronising care. In other cases, shame and stigma can make women internalise their symptoms and blame themselves for their distress.
Menopause affects the body and the mind. Hormonal fluctuations influence mood, anxiety, memory, concentration, and sleep, all of which are important for mental health and overall well-being. Many women experience menopause without psychological symptoms, but for those who do, the risk is real. Depression, panic attacks, and low self-esteem can and do accompany menopause.
Menopause can also trigger or exacerbate other mental health conditions, such as generalised anxiety disorder. There is often little to no screening for depression or anxiety among women entering the menopausal transition. There is almost never any insurance coverage for therapy or counselling services.
Health systems should account for women’s needs at every stage, from adolescence to older age.
What’s missing is an effort to integrate menopause into existing health services, especially at the primary care level. This will require policy changes at the insurance level and advocacy by healthcare providers and the public. It also requires expanded training for health workers, public health messaging and community outreach to educate women about menopause and their rights, and workplace accommodations.
Menopause is a broader social issue that reflects how we value women and their contributions at every stage of life and should be integrated in health systems, in the workplace, and in society as a whole.
