Sucheta Das Mohapatra
The quality of Neelanjana’s (name changed) work kept deteriorating. She wasn’t performing as per her manager’s expectation. The Human Resource (HR) Department of the company she served placed her in three Performance Improvement Plans (PIPs) in six months. There was no change. No one could make out what was happening. She was always in a low mood and had even stopped eating. Eventually, she decided to quit. Neelanjana was in her 50s, and everyone in the office thought it was fine if she wanted to take an early retirement.
Narrating this one incident from her long career as a Human Resource (HR) lead in different Mumbai-based corporates, Susanne Fernandes Gupta, now a mental health advocate based in Pune, says, “I was playing the ‘agony aunt’ to many but it never occurred to me that the changes in Neelanjana could be because of menopause. It is only now that I am realising it. She also did not mention it even once.” Menopause is still a taboo topic, and as Susanne says, discussed in hushed tones, at home and in the office, only among women going through the ordeal.
Workplaces which are slowly getting used to the new normal of a Gen Z employee asking for a day off from work because of menstrual discomfort, have still a long way to go when it comes to understanding a female employee’s emotional and physical discomfort starting from perimenopause (the years leading up to menopause) and post menopause, which can persist for several years after menopause. A working woman’s chance of navigating through the phase is better if she has a female boss and a structured work environment but as the symptoms of menopause like menstruation vary, often there is lack of empathy even among female co-workers of the same age group. Consequently, many highly talented women silently quit in the prime of their career.
Mukta SG, Vice President, SAP Labs, Bengaluru, however, has a different view. She says, “Not everyone needs to announce, but if there is a problem, one has to bring it up. In my case, I had a cold shoulder and a few visits to the physiotherapist helped. My Managing Director is a woman, and I do not see any problem if you want to take an off or want to work from home on days when you are not feeling well. We can always discuss it with the HR.” Giving the example of her 17-year-old daughter, who openly discusses menstruation, Mukta says, “Let’s start talking, let’s normalise this phase in life. Let’s start it from our homes.”
But in a country where more than 80 per cent of the female workforce is employed in the informal sector (International Labour Organisation Report, 2018), how many women have access to such benefits? Menopause is that one day in a woman’s life when she completes one year of her last period, and many Indian women do not even remember when they had their last menses unless there was a festival or celebration around the time.
When women go through sudden hormonal changes, they are twice as likely as men to develop depression because the hormones, oestrogen and progesterone, which control the menstrual cycle, influence serotonin levels in the brain, causing irritability, anxiety and sadness (https://shorturl.at/5QxTa). But in India where mental health came to be recognised as a public health concern only less than a decade back with the National Health Policy 2017, integrating it in primary healthcare, discussion on mental health of women during this significant phase of their life is yet to begin.
“It is only now that it is being seen as a problem and has also found a place in the adolescent and maternal health programmes,” says Sindhu Nambiath, Director, Impact and Customer Success, at NuSocia, a social impact advisory consulting firm, who is a M.Phil in public health from Jawaharlal Nehru University. According to her, women have many added pressures, including caregiving and running a household. She says job-related stress and personal life events are also reasons why women are at times irritable but it is often dismissed as a trivial hormonal issue.
Sandhya Gautam, Founder and Executive Director, Seher Trust that works on gender and maternal health, says as a society we have always celebrated reproduction and so the focus of our maternal health programmes ends with family planning. According to her, we need to look at the maternal health programme from a life-cycle approach, starting from menarche and ending with menopause. Sharing her own experience of menopause, Sandhya said she was very angry with the changes she saw and experienced in her body. “Your body speaks to you, and you should listen. But there was a disconnect between my body and mind and that irritated me. It took some time to accept the change.”
Sandhya’s work takes her to women who face violent behaviour from their male partners during the period and slowly become emotionally numb. “Jab aapke mann ke saare khaanche bhar jaate hain, phir rishton ki koi ehmiyat hi nahin rehti, pati ko kyon hi puchhna,” a woman in rural Haryana once told her during a meeting.
Hot flashes and mood swings apart, menopausal women’s chances of heart diseases, thyroid, decreasing bone health leading up to osteoporosis, increase during the period. But already in a period of life when you are loaded with multiple responsibilities like looking after growing up kids and elderly parents and some also concerned about increasing expenses and dwindling finances, perimenopausal women, working or non-working, visit a gynaecologist only when the symptoms are severe like heavy bleeding. The physical health problems further contribute to the psychological challenges faced by menopausal women but mostly ignored. “I get patients who complain of not being energetic, irregular periods but no one is concerned about high blood pressure, lipid profile, bone health and thyroid, which are the main concerns. The focus is more on body image and functionality and not on a better quality of life after menopause,” says Dr Deepti Jaya, an obstetrician and gynaecological consultant at Fortis Hospital, Noida.
Dr Deepti advises early treatment as five years after menopause, hormonal drugs cannot be prescribed, and the health problems may prolong and exaggerate. “I had a patient who kept having a urinary tract infection even 20 years past menopause. “There were some apprehensions with regard to HRT but studies could not establish the fears. We are again prescribing. The problem, however, is many women visit a gynaecologist and continue with the same medicines for six months without any follow-up,” she informs. While Dr Deepti prescribes hormone replacement therapy (HRT) and also anti-depressants depending on the need of the perimenopausal woman based on the guidelines of the Indian Menopause Society, she also advises yoga and food rich in Omega 3, calcium, vitamin D, probiotics, B-12 and magnesium to her patients.
According to a TeamLease report, women’s workforce participation in India is at 46 per cent in the entry level but comes down drastically to 19 per cent by the time they reach leadership positions. Nevertheless, women quitting jobs in their midlife is not restricted to India alone. It’s a global phenomenon but more prominent in India because of the pay gap, rigid work models, and inequitable career growth. Dr Lucy Ryan in her book, “Revolting Women: Why midlife women are walking out, and what to do about it” suggests measures on how to retain this talent pool with a better understanding of their challenges. But has the conversation in India even begun?
Susanne says, “No. At present we are only blindly copying western concepts and bringing in policies to appease Gen Z. Inclusivity should be embedded in a company’s culture. It should trickle from the top, with the HR serving as the key enabler. We can educate and create awareness through employee handbooks, coffee table books, orientation programmes and open conversations.”
Is anyone listening? And if no one is, listen to Sindhu, “Women, menstruating and menopausal, do whatever makes you happy: attend concerts, read books, listen to music, have girl talks and if needed take help of a therapist. Recreation is not a luxury.”