Understanding Menopause, Andropause

Male and female bodies undergo certain life cycle processes related to their reproductive organs. While girls and women deal with menstrual cycles throughout their reproductive years, men do not experience menstrual cycles since they lack ovaries, where fertilised eggs grow into a foetus after fusion with sperm. In various countries, girls refer to their menstrual cycle as "chums," meaning friends, as it occurs monthly, typically in a 28-day cycle.

Hormonal functions in both males and females cause the body to go through different phases during puberty, the active reproductive years, and the decline of reproductive functions. While the physical changes in women associated with the menstrual cycle are often known among family members, the physical changes in boys and men are rarely discussed. Understanding the phase both men and women undergo as their reproductive age ends, and the changes that occur in their bodies, is crucial for maintaining a good quality of life in the aging community. While menopause is a familiar term, andropause is not commonly known in Nepali households.

Andropause

“Menopause happens when women have gone 12 months without a menstrual cycle. This is a normal process and typically occurs between the ages of 45-55,” said Dr. Laxmi Gautam during a recent community interaction. Men were also invited to this community event but arrived late and were less open to learning about changes in their bodies. Men, too, undergo a phase called andropause, also known as male menopause. It is characterised by a steady reduction in testosterone levels, commonly seen in middle-aged or older men.

In Nepal, openly discussing reproductive activities and the “private parts” of boys and girls remains taboo. Although the physical relationship between males and females, leading to pregnancy and childbirth, is a beautiful phenomenon, it is often associated with shame to avoid pregnancy outside wedlock. Despite restrictions on sexual desire, relationships before or after marriage cannot be stopped. Unfortunately, the taboo around reproduction has created an atmosphere where these issues are not discussed, leading to gender-based violence against girls, boys, and women who are taught not to expose their experiences, whether against their will or related to their desires during different life phases.

Not all women have the same menopausal experience. Some experience continuous bleeding before menopause, while others may stop having menstrual cycles and then restart. One woman shared that she had continuous bleeding and needed an operation to remove her uterus, leading to early menopause. Dr Gautam explained that due to various medical conditions, some women must undergo operations to remove their uterus, leading to menopausal symptoms. Many women shared that they experienced months of heavy blood flow, pain, and exhaustion, along with hot flashes, anger, irritation, and, in some cases, depression.

Perimenopause refers to the time when the body naturally transitions to menopause, lasting between 7-14 years. Hormones like oestrogen and progesterone fluctuate, causing irregular menstrual cycles that eventually stop. Symptoms of perimenopause include hot flashes, mood swings, trouble sleeping, discomfort or disinterest in physical relationships, weight gain, and decreasing bone density. Dr. Gautam cautioned that these symptoms could also result from other physical conditions, so consulting a medical expert is essential to rule out diseases like diabetes.

Andropause involves a progressive hormonal transition in men, with symptoms such as exhaustion, mood fluctuations, decreased libido, and changes in body composition. Both menopause and andropause are natural parts of the aging process, but understanding these changes can improve the quality of life. Men experiencing andropause can seek medical help, which may involve hormone replacement therapy or lifestyle adjustments to enhance general health and well-being. Long-term medication for illnesses like diabetes and high blood pressure can also impact health.

Women often discuss their menstrual and menopausal experiences among themselves. A few years ago, my friends and this writer, including Dr. Aruna Uprety, shared our menopause experiences and found that those who exercised regularly, practiced yoga, ate healthily, and avoided junk food fared better. Research confirms that lifestyle significantly impacts reproductive health. Dietician Hillary Wright, co-author of The Menopause Diet Plan: A Natural Guide to Managing Hormones, Health, and Happiness, emphasises regular exercise and a diet rich in fruits, vegetables, whole grains, nuts, seeds, legumes, more seafood, less red and processed meats, and limited alcohol as effective ways to manage menopausal symptoms.

Dr Laxmi also stressed the importance of healthy eating habits for a safe and less stressful menopausal and andropause phase. Medical help may be necessary in some cases, as determined by experts. However, a healthy eating habit can be much better than taking supplements. She mentioned that the Nepali habit of eating roasted corn and soya bean for snacks are very healthy eating habit. Both these have nutrients which help in various health conditions including tiding over menopause. 

Strategies

Nepal government health department should develop strategies to educate the aging Nepali population about menopause and andropause. While some efforts have been made to create awareness of menstrual and menopausal phases in women’s lives, there is almost negligible awareness regarding andropause. Traditional and cultural norms and values observed while raising children often discourage women from speaking up about any discomfort, they may experience due to hormonal changes, as it is associated with shame. Similarly, men are discouraged from sharing their discomfort due to the male ego fostered by similar child-rearing practices.

 The Nepali community should continue to adopt good eating habits passed down by our ancestors but change the cultural and traditional practices that strengthens wrong gender-based value system which hampers in fostering a more conducive and happy life. Removing the stigma associated with these life phases is crucial for improving the quality of life for the aging population. There should be forms where the elderly can talk about these issues together and support each other. 

(Sharma is a senior journalist and women's rights advocate. namrata1964@yahoo.com. Twitter handle: @NamrataSharmaP)