Menopause at 30 for millions in poverty

from The Times Online

Jeremy Page in Delhi
# Doctors identify malnutrition link
# Problem greater in rural areas
Millions of women in India are going through the menopause as young as 30 because of chronic malnutrition and poverty, according to a study by a prominent Indian think-tank.

The research suggests that almost one in five women in the country have gone through the menopause by the age of 41.

Malnutrition is believed to be a contributory factor, particularly in rural areas, although the study did not address the causes. Yesterday doctors called for further research into the condition.

The study, by the Institute for Social and Economic Change, based in Bangalore, found that 3.1 per cent of Indian women — about 17 million — reached menopause between the ages of 30 and 34. Eight per cent ( 44 million) are in menopause by the time they are 39, the institute’s study showed, while 19 per cent have gone through “the change of life” by the age of 41.

Medical experts say that natural menopause, when the ovaries stop producing oestrogen, occurs in women between the ages of 45 and 55, with the global mean being 51. Premature menopause is defined as the cessation of menstruation before the age of 40 and affects an estimated 1 per cent of women worldwide.

“It is very clear that a significant proportion of women in India are reaching menopause prematurely,” wrote Dr T. S. Syamala and Dr M. Sivakami in the study, which has been presented to the Indian Parliament. “This is significant because most health programmes in India focus on women of reproductive age,” Dr Syamala told The Times.

“It is high time that we started to focus on post-menopausal women because of increasing life expectancy in India and because of the health risks associated with premature menopause.”

The study was based on a National Family Health Survey carried out in 1998 and 1999 and examined a sample of more than 90,000 married women aged between 15 and 49 across 26 Indian states. It did not examine the physiological reasons for the higher rates of premature menopause in India — where the average menopausal age is 44.3 years.

It found that the problem was much more common in rural areas, among agricultural workers, and among women who were illiterate and had a low body mass index. “Most of these women are malnourished and that could be one of the main reasons for premature menopause,” said Dr Syamala.

The study also found that the proportion of menopausal women aged between 30 and 49 was highest in the populous agricultural states of Andhra Pradesh and Bihar and lowest in Kerala, West Bengal and Rajasthan.

Some health experts questioned the study’s methods and conclusions and called for more focused research into the problem. “I’m not surprised, except that it’s interesting to hear figures being specified in this way,” said Urvashi Jha, founder and former president of the Indian Menopause Society. “I tend to be quite cynical about these sort of statistics, but we definitely need more research into this important field.”

Dr Jha and Dr Syamala called on Indian health authorities to devote more resources to post-menopausal women, especially in rural areas where hormone replacement therapy is unavailable.

“India’s overburdened and underfunded public healthcare system has no special programmes for older women,” the study concluded.