On a rainy afternoon in July, Nisaba Godrej, Executive Chairperson, Godrej Consumer Products Limited, spoke with Dr. Sukhpreet Patel, co-founder, MenopauseWize in a public conversation at Godrej One, Mumbai. Their talk examined the science of perimenopause and menopause, its diagnosis and effects, the science behind therapies to counter its effects, and how we can offer better support at Indian workplaces.
This is a transcript of their conversation, as well as Dr. Patel’s responses to the audience questions that followed. It has been edited and condensed lightly for clarity.
Nisaba Godrej: A big welcome to you, Dr. Patel. Thank you so much for being here with us today.
I wanted to share why we invited you here and the incredible impact you've had on me. About six months ago, I think the best way to describe it was I was feeling a lack of vitality.
I went to a doctor, did some tests, and I really felt that my questions weren't answered. I wasn't supported. Through my network of friends, Dr. Patel's name came up. I went and saw her, and your advice, feedback, and support – it’s been incredible.
It's important that we are all able to flourish, and that's why we wanted to open up this conversation at Godrej, and open it up to all women – and men are always welcome, also at Godrej, so we're glad to have lots of you here.
We just saw some numbers from an internal dipstick you helped us conduct. Only 20% of people understand what perimenopause is, and 11% sort of understand the impact of hormones. So for my first question, can we just start with the basics in terms of what is perimenopause, what is menopause, and also, since most of the audience for this is in India, about the age this tends to happen in India?
Dr. Sukhpreet Patel: Firstly, thank you for inviting me and thank you for sharing your story.
Let's start with menopause. Menopause is, by definition, just one day in a woman's life, 12 months from her last and final menstrual period. So if her last period was on 1st January 2020, she achieved menopause on 1st January 2021, if she had no period during those 12 months.
Perimenopause is what precedes this stage. I like to visualise it as adolescence at the other end of the reproductive age group. You don't see a girl transform into a woman overnight, it happens over years – you see her evolve from being that little girl to becoming a woman. Menopause is similar. The ovaries don't just stop functioning one fine day. They go out – and they go out fighting.
Hormones tend to go all over the place. At times there are no hormones, at times the hormones are too high. That's what gives rise to this sort of turbulence. That’s perimenopause.
It doesn't have a very clear definition. There’s some staging criteria which goes back to 2012, and the data is still evolving. So it becomes a very hard diagnosis, because diagnosing perimenopause comes through exclusion. You've got to rule everything else out before you say, "This woman is going through perimenopause."
The Indian context: when we talk about the global average age of menopause, it's around 51. But for Indian women, it’s 46.2. That’s five years earlier. Its implications are actually pretty huge because it means we are deprived of oestrogen for longer. It also means that we are looking at egg depletion much earlier. Fertility is probably declining in the Indian population much earlier than in Western counterparts.
I think overall, if we look at data coming from all the research papers, sometimes we’re all grouped together. When I went for my bone densitometry test in Canada, there was all this information I had to slot into this form. Of course, there was white American and all of that, and then there was “Asian.” I know when they say Asian, what they mean. They mean East and Southeast Asian. They're not looking at South Asians. I don’t fit into any of their slots.
Indian data becomes important. We don’t have it, but it’s really important. Even when we go for our bone density tests, they calculate your levels - your T-scores, Z-scores. [Editor’s note: These metrics indicate the health of an individual’s bone density.] The scores they give you are all based on Western data. It doesn’t really apply to us.
All in all, when it comes to Indian data, I feel we're still collecting. We don't have enough. But we need to be aware that we do undergo menopause much earlier than that 51.
When someone says, "She’s only 38, she can’t be going through perimenopause" – that’s not true. Perimenopause can start five to 10 years earlier. If my age of menopause is 46, then that means I could be going through it at 36.
If I face premature menopause, which happens in around 3% of the population – undergoing menopause earlier than the age of 40 – then perimenopause for this woman is actually happening at 30. It could be as early as 30.
Keeping our eyes open and being aware: I think that is step one. We can't see what we don't know. Being open to the idea that it could happen early for a lot of women is really important.
Nisaba Godrej: You mentioned that it's actually quite hard to diagnose because it's not like one blood test or just one symptom.
I think the symptom that everyone hears about in popular culture is hot flashes. But there are 50 different things that could be happening. Could you comment a little on what the symptoms are, but also on what to watch out for – in bone density, the brain, and connections with oestrogen?
Dr. Sukhpreet Patel: The hot flash is the classic symptom. If you have a hot flash, then you probably are going through perimenopause or menopause, because there aren't too many conditions in the world that cause a hot flash. That becomes sort of diagnostic, and it's seen in 80% of women.
But we need to look beyond that. There are two parts to this: one is the consequence of the hot flash, and the other is what else is going on in the body.
If I have a hot flash at night, it's called a night sweat. If I’m having night sweats, there’s no way I’m sleeping well. And when I wake up the next morning, I don’t want to go to the gym. I’m going to work feeling blah: I have brain fog. My blood pressure could be higher because I haven’t slept well. I might crave sugar because I haven’t slept well. My cholesterol could be going all over the place.
Beyond that, women with moderate to severe hot flashes have been found to have a higher cardiovascular risk, a higher risk of stroke. They're finding links between systemic problems and hot flashes.
And hot flashes can last a decade. Around 15% to 20% of women continue to experience them, even if they become less frequent, all the way into their 70s. They just get used to it.
But what else is going on in the body? Everything. Each cell in our body has oestrogen receptors. From the brain to our bones to our blood vessels, everything has oestrogen, progesterone, and testosterone receptors.
The longer we live without oestrogen, the higher our risk of developing disease. For example, we often hear about young heart attacks. You hear about men under 50 getting heart attacks: in fact, 25% of heart attacks in Indian men happen under the age of 40, pretty young. But you don’t hear about women, like a 36-year-old or even a 45-year-old, getting a heart attack. That’s because oestrogen is cardioprotective. It protects our heart and our blood vessels.
Once we reach menopause, we suddenly lose that protection. So our risk of heart attacks becomes equal, and that says a lot. As I age, my blood vessels are not as compliant as they were. My tendency to develop hypertension goes up. My LDL – the so-called bad cholesterol – starts to go up. I start to feel uncomfortable while sleeping. I’m not sleeping well. And the consequences of poor sleep we’ve already seen.
The bones take a really big hit. When oestrogen is present, there’s a balance between bone formation and bone clearing, which keeps your bone density from declining. Once oestrogen goes away, more bone gets eaten every day. In simple terms, you’re losing more bone than is forming daily.
The result is osteopenia, a loss in density; and osteoporosis, a more severe form. Osteoporosis is diagnosed when you cross a certain threshold in bone density. The consequence is a higher risk of fractures.
We constantly look at different health parameters, but the one thing that is most important, when I think about myself and aging, is mobility. It’s my ability to take care of myself.
So if there's one takeaway from this talk, it’s to protect your bones. The activities we engage in to protect our bones are beneficial for everything else – our heart, our brain, everything. If we just protect bone density, protect muscle mass, we’ll end up doing a lot of other things right.
Nisaba Godrej: There’s this emotional aspect, which also came out in the Godrej survey – our emotional well-being. Can you talk a little bit about oestrogen and the brain, and moods? What are your thoughts on whether there’s a link to dementia, which women seem to experience more than men? Is that link real?
Dr. Sukhpreet Patel: Two out of three people with dementia are women, so women do tend to get dementia more than men. A lot of that traces back to earlier life. Dementia doesn’t happen overnight. It’s the stuff we’re doing in our 40s and 50s. The blocks start forming then, and you only start seeing the symptoms much later.
A lot of work now is pointing towards oestrogen, because the brain is very rich in oestrogen receptors. It can start with something small, like poor sleep, night after night, during perimenopause. That’s not uncommon: poor sleep is one of the early symptoms. That alone can change your mood, your way of thinking, and eventually contribute to dementia.
But more immediately, you’re right: mood! You hear jokes about it: “Oh my gosh, she must be going through menopause.” It is so annoying. If anyone does that, please stop right away. It’s the most annoying thing to be irritated while going through menopause, and then have someone tell you you’re going through menopause – like, really? It’s just not nice.
But it is real. Oestrogen decides the amount of serotonin your brain is producing. Now, imagine that’s not working anymore. You’re obviously going to feel depressed.
One of the things that really frightened me about menopause, when I was going through it, was this: there were a good three months where I didn’t want to get out of bed. It was scary. And it was scary because I was a half-marathoner. I was a very active mom. I looked after my parents. I had a really full life. And not wanting to get up? Who was this person?
That’s scary because no activity means nothing else is going to happen. Anhedonia is a real symptom. Anhedonia is the inability to feel joy in things that used to bring you joy. To not feel joy from anything you do – why would you get up in the morning? And especially if you have to show up for work.
I remember another very prominent symptom being anxiety. Panic attacks. At that point, I didn’t connect the dots. I keep going back to that: I had an MD in gynaecology and I didn’t know what was going on. It’s ridiculous that we are not taught about this or trained in medical school. To have a panic attack just before entering an operating room is not a good thing.
I hear this from women all the time, including women in leadership – you’re entering meetings, walking into a room and suddenly second-guessing yourself: “Am I okay to do this today? I’ve done this a gazillion times. Why am I in doubt?”
Sometimes, just letting the woman know that this is part of it, that she’s not alone: that makes all the difference. She may choose to take hormones, or not. She may seek help, or not. But validate her. Let her know that you see something is going on. She’s not losing her mind. That’s a big thing.
Nisaba Godrej: I think also the conversation with your doctor becomes difficult because you’re going with these varied symptoms, and they might be giving you anti-anxiety medication, or anti-depressants, when there’s another underlying cause.
Since we’ve talked about oestrogen, can you tell us what hormone replacement therapy is? Why are so few people on it? Maybe tell us a little of the history, what’s changed over the years, and where it’s going now.
Dr. Sukhpreet Patel: If you go back to the 1990s, hormone replacement therapy was big. I remember in 1996, when I was an MD student at KEM [hospital in Mumbai]...
Nisaba Godrej: This is the horse pee one?
Dr. Sukhpreet Patel: Yes, this is the horse pee one. When I was a student, we were prescribing it for everyone. Anyone who came with menopausal symptoms was given oestrogen and progesterone if she had a uterus. If she didn’t, she was given only oestrogen.
My own mother was prescribed this – by me. I told her, you have to get on this, everyone’s getting on it. And then suddenly, in 2002, the WHI came out.
The WHI was the Women’s Health Initiative, a massive randomized controlled trial on women who were put on hormone therapy. The news reported clearly that it causes breast cancer. The trial was prematurely discontinued. I remember calling my mother and telling her: stop it today. I wish I’d had the sense to read the paper better, but none of us did. Prescriptions dropped drastically worldwide.
But over time, more data came in, in 2002, then 2013, 2018, and 2020, following up with these women.
Let’s look at the original study, which said there was an association with breast cancer. But when they zoomed in on the age group between 50 and 59, and when hormone therapy was started early, they found an increased breast cancer risk that amounted to six women out of 10,000 per year using oral drugs.
What they failed to highlight through the media was that there were 25 fewer fractures per 10,000 women per year of use. 11 fewer cases of diabetes. 10 fewer deaths from all causes. Lower risk of colorectal cancer.
And the most interesting part: there were two arms of the study. One group had a uterus and was given oestrogen and progesterone. The other group had had hysterectomies and was given only oestrogen. In the oestrogen-only group, there was actually a reduction in breast cancer risk.
In the latest WHI data from 2020, they found no difference in mortality between those who used hormone replacement therapy and those who didn’t.
So that was the worst-case scenario: six more cases out of 10,000 women per year on those drugs, and that was with the older drugs. Today’s drugs are better. Now we use natural micronised progesterone. Back then, it was synthetic progesterone, called MPA – a progestin. It’s made in a factory. Everything is made in a factory, by the way. But the older drugs were synthetic molecules, not identical to what our bodies produce. Now, what we’re using is identical to what the body produces in younger years.
We also now have the option of transdermal oestrogen, through patches, gels, sprays, which avoids the excess risk of stroke seen with oral oestrogen in the old studies.
The important thing is to look at Indian statistics. We’re twice as likely to die of diabetes, five times more likely to die of a heart attack, than we are of breast cancer. Everything has risks, but it’s all about perspective: we have to weigh our risks and benefits.
What matters is: does the woman have a choice? Is she asked, are your bones bothering you? Is your vaginal health bothering you? Let her decide.
Nisaba Godrej: From what you're saying, overall, this was quite a safe modality. It was used for decades with safety. Then one piece of research comes out, nobody reads it properly, and we throw away something that’s been working – something that’s very fundamental to women’s health. At least, that’s what I take away from reading the data. We also have this idea: "Oh, we want to be natural. We don’t want to take this."
Dr. Sukhpreet Patel: I think the whole “natural” bit is taken a little too far. You have people on social media talking about being “natural.” How natural is Instagram now, really?
It’s all about putting things in perspective. We’re breathing this air – how natural is that? I love the air near these mangroves, but come on.
We have to look at things more realistically. A hundred years ago, a woman’s life expectancy was 52. She didn’t go through menopause. She just died before it. But now, we’re living beyond menopause. So we can’t say: “Our great-grandmothers did it this way, so we should too.”
I’m not saying everyone should take hormone therapy. I’ve gone down many routes myself. I was one of those people who said: “I’ll brave it.” So at 46, I decided not to take hormone therapy. I’m very grateful I went down that road because I left no stone unturned. Whether it was nutrition, exercise, stress management, I figured out a way to plateau myself out. I was doing really well, until I wasn’t.
Because while everything looked fine on the surface, I was still losing bone density. My LDL levels were going wild. And I kept thinking: “This is me. I do everything right.”
I was angry. Angry as hell, because I was doing everything right and this still happened to me.
It was right around that time that reports about hormone therapy started coming out. In 2022, the American Society released their statement. [Editor’s Note: The statement declared hormone therapy the most effective treatment for key menopause outcomes, and assessed the risk-benefit ratio to be favourable to a large population of people who experience menopause.] A whole bunch of new readings followed.
That’s when the decision was made to start hormone therapy. But I feel like everyone doesn’t need to go through all of that. It’s okay not to take it. But you do need to understand the price of not taking it.
Nisaba Godrej: You chose not to take it initially because of no outward symptoms? No issues with sleep?
Dr. Sukhpreet Patel: There were plenty of issues. I think I had every symptom in the book.
But I also had a whole history. I spent most of my life in infertility treatment and IVF. That was my world. Everything required a prescription. Then the pendulum swung to the other extreme: everything could be fixed with lifestyle.
And I think now, I’m in equilibrium. There’s a place for both.
Nisaba Godrej: I have a follow-up to this conversation on HRT. When I first came to speak with you, I thought okay, you'd just give me a small oestrogen patch and that would be it. I was really shocked, and honestly a bit upset, when you said I didn’t need it right now. That I was way ahead of needing it.
You told me we needed to look at nutrition and exercise. And I thought, how could that be? I was the healthiest person I knew. I also said I was feeling moody and didn’t want to see people – and you said, “maybe you're coming into your personality,” which was terrifying. A patch would’ve been so much easier.
But that’s why I really wanted to bring you here. I’ve never had a doctor spend so much time with me and actually coach me about what I could do differently, with food, movement, supplements. So if you could take us through what you've done with lifestyle, and what you recommend for women between 35 to 55.
A lot of the health advice we get – intermittent fasting, cold plunges – is based on research done on men. And it's often counterproductive for women our age. So I’d love for you to break it down.
Dr. Sukhpreet Patel: Sure. I usually look at lifestyle in four pillars: nutrition, movement/exercise, stress management, and sleep.
Sleep always comes first. Without it, nothing works. There’s a lot of messaging that sleep is overrated, especially when we’re young. But it’s not. Everyone needs to look closely at their sleep patterns. Are you getting deep, restorative sleep? And don’t just patch it up. Like, drinking coffee at 7 PM and then popping melatonin? That’s like cutting yourself and putting a Band-Aid on. Proper sleep isn’t just about rest. It’s your strongest insurance against things like Alzheimer’s and dementia. It’s something we need to build early.
Then comes nutrition, which is simpler than people make it out to be. I look at four things daily: protein, fibre, calcium, and antioxidants.
Most Indian diets lack enough protein. Women especially need about 1.2 grams per kg of body weight, and that’s just to prevent frailty. Not even to get strong, just to stay stable.
Then, fibre. When people start focusing on protein, especially from animal sources – meat, dairy, eggs – they forget fibre. But fibre protects your gut, lowers diabetes risk, helps with cholesterol, and prevents colon cancer. We need 25 to 30 grams daily, and most people don’t even get close.
Plants are the only source of fibre. When you choose plant-based foods for fibre, you’re automatically getting antioxidants, vitamins, and other good stuff. Think vegetables, fruits, dals, beans – they carry a lot of value. If you focus on protein and fibre together, through food, not supplements, you’re doing 80% of the work.
Next is calcium. Women need 1200 mg a day, total – not just from pills. If you’re vegan or can’t digest dairy, sure, use a supplement. But otherwise, try to get it from food. I do a mental check at the end of the day. “Did I get 800 today? Should I take my calcium tablet?” That’s my daily math.
The fourth thing is antioxidants. Once oestrogen starts dropping in perimenopause, you lose one of the body’s most powerful antioxidants. That’s why so many women start experiencing joint pain, muscle soreness. Increasing your intake of natural anti-inflammatories really helps.
People jump to supplements, but India already has amazing antioxidant-rich foods. We run after blueberries when we have amla. We ignore ginger, garlic, haldi, all packed with goodness. If you eat a diverse, colourful diet every day, you're already doing a lot.
So that’s my checklist for nutrition: protein, fibre, antioxidants, and calcium. Every morning I look at my plate and make sure those four are covered. If calcium isn’t, I take a tablet.
But most of us don’t measure. We assume we’re eating enough. That’s why journaling what you eat – even for just a week – is so helpful. You can’t change what you don’t measure. It’s like a quarterly report - you need to see the numbers.
Now, exercise, especially around muscle. Many people focus on weight or BMI - but those numbers only tell you your mass, not your composition. Two people can weigh the same, but one may have 50% fat and the other 25%. So don’t just look at weight. Look at body fat. More importantly, build muscle.
We're obsessed with “reducing fat.” But that shouldn't be the goal. Forget “thin.” Focus on getting strong, because muscle is everything. Muscle prevents falls. It helps regulate blood sugar, protecting you from diabetes. It even triggers the brain to release BDNF [brain-derived neurotrophic factor protein], which improves mood and learning.
That’s why some companies are now encouraging movement breaks in the middle of the workday. Muscle is becoming the golden organ. If you focus on building it, everything else – your food, your hormones, your mood – falls into place.
Nisaba Godrej: So weight training for both men and women is the most important.
Dr. Sukhpreet Patel: You got that right. And then, when it comes to things like sprinting and jumping, here’s how I look at it. In an ideal week, two to three sessions of weight training are great. But cardio has its own benefits. There’s slow cardio, like zone two training, where you jog and can still hold a conversation.
But what we also need is power, and power is different from strength. To get up quickly from a chair or avoid a fall, you don’t need raw strength. You need power. It’s a sudden movement, and the only way to build that is through fast, explosive motion. Sprinting, jumping: these build power by triggering fast-twitch muscle fibers.
Even short sprints – 30 seconds of running fast, resting, and repeating – can make a huge difference. Same with jumping, it’s great for bone health. That jumping stimulus helps bones rebuild.
So ideally, include weight training, sprinting, jumping, balance, and some stretching. I know it sounds like a lot, but you can keep each bit short and still benefit from it. It doesn’t have to feel overwhelming.
Nisaba Godrej: Could you also talk a little about adaptogens and supplements?
Dr. Sukhpreet Patel: Supplements should be exactly that – supplements, not replacements. The industry sells a lot because we’ve stopped eating what’s naturally available.
When I look at supplements, I ask: is this something my body used to make, but now it’s struggling to? So for example:
Vegetarians and vegans are often deficient in B12. That needs to be supplemented.
Vitamin D3 – most of us are low. Supplement it.
Calcium – again, it can be added if dietary intake is low.
Omega-3s – almost everyone is deficient. They help with mood, cognition, and more.
Magnesium – often helps with sleep, especially for women in perimenopause.
Now there's creatine. Earlier, it was seen as something only men or gym-goers take. But now we have growing evidence that it’s helpful for women too. It provides energy for the brain and muscles. There are even trials showing benefits for memory in Alzheimer’s patients. It’s completely natural. The body already has it. People confuse it with creatinine (which the kidneys excrete), but they’re not the same. Unless you already have kidney disease, 3–5 grams of creatine per day is safe.
Now, adaptogens, like ashwagandha or rhodiola. These are not made by the body. They’re herbs. Adaptogens help the body adapt to stress by restoring balance – what’s called homeostasis.
Let’s say you’re in a stressful situation. Your heart races, cortisol spikes, you’re in fight-or-flight mode. That’s fine if the stress is occasional. But in daily life, that cortisol spike never ends. We’re always in stress mode.
That’s where adaptogens step in. They help regulate that constant overstimulation. Things like ginseng, schisandra, rhodiola, they all help buffer that stress response. But here’s the thing: they’re short-term tools. There’s very little long-term data. Recent research even says not to use ashwagandha for more than two weeks at a stretch, because it can actually blunt your natural stress responses too much.
Do we want to permanently reduce cortisol? Not really. We need cortisol in the morning to wake up, to stay alert. If we keep blunting that system, it’s like fixing a leaky pipe by sealing the tap, rather than solving the underlying problem.
So yes, adaptogens can help, say, if you’re jet lagged, or in a tough phase, but not as a long-term fix for perimenopause. That phase lasts 7–10 years. You can’t stay on ashwagandha for that long.
The same goes for things like glutathione injections or very high doses of antioxidants. Our body responds to oxidative stress, and that stress helps signal repair. Like in muscle growth: you damage the muscle a little, and it repairs stronger.
If you flood your body with artificial antioxidants, you shut off those signals. Natural antioxidants in food, in small, daily amounts,are perfect. But high-dose pills can backfire. These supplements aren’t permanent solutions.
Nisaba Godrej: My last question before we open it up to the audience: what should managers, leaders, and HR do to support women through this phase? What tips would you give us in terms of organisational culture?
Dr. Sukhpreet Patel: It's quite clear now – data shows menopause is costing organisations billions. The research is out there. The question is, what do we do about it?
There are a lot of band-aid approaches. Talks are great; someone’s finally saying the words. But the follow-through is often missing. That’s what makes this conversation here different.
The first step is awareness, yes. But if you just put up resources on the website and tell women to “figure it out,” that’s really hard. Women are afraid – afraid of losing their jobs, of being seen as less capable. And organisations are also afraid, wondering if they'll be expected to offer preferential treatment.
This doesn’t have to be a trade-off. We can design systems of high care and high accountability. This isn’t forever. Perimenopause is temporary. Someone going through it just needs a hand to cross the storm, and she’ll come back stronger. We do this for pregnancy. Why not for menopause?
Most women go through their peak work years during their late 40s and early 50s. They need support, not silence. HR can play a huge role through sensitisation, flexibility in schedules, understanding about doctors’ visits, or even something as simple as ambient temperature in the office.
[At MenopauseWize] We’ve created a framework called LEAP, which addresses many different parts of this — from leading the conversation to environmental changes and having awareness, creating pods, and forming peer groups. There is a lot of strength in community. And there is a lot of strength in simply knowing that the organization recognizes it. I think that’s a big thing.
Nisaba Godrej: Thank you. Should we open it up for questions?
Dr. Sukhpreet Patel: Yes - just before that, I’d like to share a couple of slides. These might sound odd - like what does an elephant and a math formula have to do with menopause? But they’re tools that helped me get through it.
Let’s start with the elephant. Growing up, I loved problem solving - math, physics, hormones - the bigger the challenge, the more fun.
Until I hit perimenopause. Suddenly, everything felt like this huge, unsolvable elephant.
One day, a friend asked me, “Sukhpreet, how do you eat an elephant?”
And I said, “You don’t.”
He said, “You eat it one bite at a time.”
That stuck with me forever.
Today, on social media, you have 50,000 “must-dos.” We talked about so many things here - diet, supplements, exercise, hormones - it can feel like, “Oh my God, how do I do all this?”
But menopause is here till we die. You don’t need to do everything today. Change one thing every week. Add more protein slowly. Increase fiber next month. Take it bite by bite.
Now, about the formula - it's compound interest. Just like in finance, it works in health.
If you don’t have an hour, do five minutes. No five minutes? Do calf raises during Zoom calls. Every small effort compounds. And this isn’t just for women. Men too - just start somewhere.
As my mother used to say, “Mattha tek ke aa jaana.” [Just go bow your head.] Not because she wanted me to be more religious, but so I’d get up and go acknowledge something bigger.
So even if you don’t enter the gym: mattha tek ke aa jao. Start the habit. Acknowledge the journey.
This is my favourite quote, and I want to end with it:
“Do not go gentle into that good night.
Rage, rage against the dying of the light.”
Menopause can be hard. But it’s not the end - it’s just a new beginning. Thank you.
Audience Question 1: Hi, Dr. Patel. My question is generally when we talk about HRT, there's oestrogen and progesterone. But there's a lot of data now speaking about testosterone in the mix. So if you could shed some light on that, too, please?
Dr. Sukhpreet Patel: So women produce all three hormones: oestrogen, progesterone, and testosterone. And testosterone is responsible for a lot of great things, including libido. There is a lot of data that supports its use, and it is FDA approved, and approved here as well, for use for change in libido.
It is still not approved for a lot of other things.
Social media does sort of push its use generically for everyone, whether it's just mood, or it is muscle mass, or bones. So far, there haven't been enough trials to support its use for everyone. So someone who's talking about mood disturbances, let's say you have a woman who is already on oestrogen and progesterone, and then says, hey, I'm still not feeling good about it. There's a possibility you put her on testosterone, and she may get - typically, I think on social media, you'll see a few reels where they say, oh, now, you know, suddenly, instead of black and white, I now see, yeah, colour TV. So it is sometimes, for some women. There is a case for testosterone. It's probably not for everyone, but it does exist, yeah.
Audience Question 2: PCOD is another thing that's becoming very common. I want to know, does PCOD contribute to, you know, perimenopause coming earlier, or, if there's any kind of impact?
Dr. Sukhpreet Patel: Right. The terminology is now PCOS, so I just refer to it as PCOS. What has been found is that women with PCOS typically may end up having a larger stock of eggs till much later. So you may see a slight increase in them achieving menopause later.
Symptoms can be confusing, because women with PCOS will also sometimes have irregular menstrual cycles. It's hard to say whether it is because of PCOS, or perimenopause. Plus, they tend to have sometimes elevated levels of testosterone, and some symptoms which are very similar to perimenopause.
Again, it takes a one-on-one, and sometimes, dissecting the hormone levels and making women track symptoms.
So to answer your question – it can be very confusing. In fact, in every sort of textbook of menopause, there's a separate section on PCOS saying, it's nuanced. One needs to sit down with the symptoms, track them, and then try and figure it out. We don't have a lot of answers for a lot of menopause. If I don't know something, I just say we don't have the data.
Audience Question 3: Hi, doctor. My name is Jamini. I'm a trans woman. And the symptoms of menopause we spoke about, like hot flashes, you know, they start around the early 40s or late 30s for cis women, maybe. But when I started my HRT one year back, I started getting these symptoms from the age of 24, which is, you know, pretty young.
So how do you tackle the additional health risks that come with it for trans people? Because there's very little information or data available. How do you recommend we deal with it?
Dr. Sukhpreet Patel: The thing is, we have very little data on menopause itself, and then, for a smaller section of trans women, it's even less. But there's one thing in common, that is, the deprivation of oestrogen which starts triggering the symptoms.
So whether you are a trans woman, or a trans man who has not had his ovaries removed, but will at some point undergo menopause, the symptoms start off because – a hot flash typically happens because of that withdrawal, that oestrogen level being taken away. If you put that oestrogen back, that hot flash will go away. That's the easiest symptom to treat. Just some oestrogen, and the hot flash is gone. The question becomes, should there be more, or is it not yet time to withdraw that oestrogen?
There are other drugs, too, but they haven't been successfully used or tested in the trans community. They've basically been tested for hot flashes in only cisgender women. I'm talking about non-hormonal alternatives. But at any time, you can undergo withdrawal. Today, if I am taking hormone replacement, and I decide to get off it, whenever I get off it, I will go through a hot flash again.
Audience Question 4: [When introducing your talk] Parmesh [Shahani, head, Godrej DEI Lab] jokingly used the term “man-o-pause.” Is that a reality at all? If it is, what are the kind of symptoms?
Dr. Sukhpreet Patel: Well, it’s called andropause. But it also is something which is understudied. So it is just the one area that men are understudied.
It's just because it doesn't happen suddenly. It's a very slow decline. For women, it's just those few years, and you just see those changes all clustered in those three to five years. For men, it's this slow decline of testosterone. It happens so gradually that you don't realise that it's happening, till it's happening.
Now, testosterone is a very powerful hormone. It is the go-getter, right? The drive, the motivation. And that slow decline, at some point, will become a symptom, where that threshold is gone. I don't feel like going to work today. I don't feel like going for my run. And I feel those are like early symptoms, that testosterone is declining.
Testosterone supplementation is coming in a big way for women. There's more and more data coming in. There's already more data for men than there is for women, so it's a fact.
The side effect of testosterone is testicular atrophy. And that is something that holds men back. So it depends on whether you want to go to the office, or… [laughter]
Audience Question 5: Hi. With my experience, I have understood that when you're going through menopause or perimenopause, you feel very down and depressed. But there is also a side where you suddenly also snap at things, in your mood. I feel that to emotionally support [women], educating people around is - I don't know if it's more, but it's equally important. So, in your work, do you also take that into consideration? Because I have done it, and I have seen a big difference in the way the family deals with it.
Dr. Sukhpreet Patel: I couldn't agree more. I couldn't agree more. I think the family is so important in understanding her situation. There are a few husbands who show up, or partners who show up for appointments, and I think it's great. More and more have started to.
More than anything, I feel it's time to educate our children about it. Because a woman is, in those early 40s, mid-40s, she is a mother, she is a daughter, she is so many things. And she's constantly filling everyone else's cup, and nobody's filling hers. Even she isn't filling her own.
You're absolutely right, I feel family needs to be involved. And – you know, we can't change the 50-year-old men today, anywhere. But we can change our 20-year-old boys. That's why I keep saying, okay, maybe you missed the boat with men showing up for us, but I definitely want my son to be someone who shows up for his partner.
So, whether you educate the man in your life or not, I feel like, definitely, your children.