Why it is important to talk about menopause
Indu Pal Kaur and Shringi Sharma
“MIDDLE age! I know it sounds old but I don’t feel old at all. I am, however, noticing some changes in my body. I am told it is the onset of menopause. That’s something I knew happened to all middle-aged women. But women of my mother’s generation never really talked about the accompanying biological and physiological changes in their bodies.

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Violence in the home: A flawed Bill
Leena Prasad
ALMOST every six hours, somewhere in India, a young married woman is burnt alive, beaten to death or forced to commit suicide. At least 20 per cent married women aged between 15 and 49 years have experienced domestic violence at some point in their lives, many on an almost continual basis.

Why it is important to talk about menopause
Indu Pal Kaur and Shringi Sharma

“MIDDLE age! I know it sounds old but I don’t feel old at all. I am, however, noticing some changes in my body. I am told it is the onset of menopause. That’s something I knew happened to all middle-aged women. But women of my mother’s generation never really talked about the accompanying biological and physiological changes in their bodies. Now, mercifully, women have begun to discuss menopause when they are together. And there are ads for menopause treatment everywhere — in women’s magazines, the Internet, television. It is even talked about in the evening news! I feel a lot better knowing that I am not going through this alone.”

These are the thoughts of a 42-year teacher in a private school. Archana, who had a hectic work schedule which included going to school, tending to the kids and taking tuitions in the evening, enjoyed life with her family, especially her husband. But since the past few years something had changed. “I was getting moody, volatile and anxious. In a nutshell, I think I was going crazy.” Archana had no clue to what was happening to her till she consulted a doctor and was told that she had entered perimenopause (a 4-10 year transition period prior to menopause).

The life span of a woman can basically be divided into the following phases:

Puberty
Premenopause (also known as climacteric, begins before menopause): hot flushes, night sweats, insomnia, reduced sex drive are some of the symptoms. The premenstrual syndrome (PMS) becomes more evident in some cases during this phase.

Perimenopause (continues through the 12 months following the last period): Irregular menstrual cycles or changes in bleeding are often the first sign of perimenopause.

Menopause: also known as the change” or “change of life,” occurring at a time in the reproductive life of women when the production of oestrogen and progesterone, two hormones, changes dramatically. After menopause, women are no longer able to bear children and may become more prone to certain diseases. It is a period of profound hormonal transition spanning almost 40 years of a woman’s life.

Post-menopause: refers to the complete cessation of menstruation. Problems commonly encountered in this phase are osteoporosis, cardiovascular problems, and cancers.

The baby boomers — people born between 1946 and 1964 — are getting older. Women born during this period have entered menopause and hence a large percentage of the women, world over, are into or past menopause. That is why it is all the more important to talk about menopause especially from a woman’s perspective and more or less for the ultimate welfare of the family.

Menopause is not an illness that necessitates treatment. At the same time even if the transition through menopause has been smooth and/or if one is past it, caution is still required. During menopause the production of oestrogen reduces considerably and with it all the protective effects of oestrogen are lost. Many tissues in the body are sensitive to the effect of oestrogen — breast, bone, heart and arteries, central nervous system. Changing levels of oestrogen could cause problems in some of these.

For example, as you age and go through menopause, bone loss increases significantly and osteoporosis can develop. Osteoporosis is a condition during which bone loss is so severe that the bones become weak, fragile and brittle. Loss of bone strength occurs most crucially at the spine, the hip and the wrist. Women who have a low bone mass when they reach their menopause are at the highest risk of osteoporosis. Low bone mass can be estimated by a bone density measurement at the hip and the spine, using modern scanners. A routine X-ray is no longer considered a good test of bone density.

Preserving bone density is thus an important step towards preventing osteoporosis. The same steps that helped build bone early in life will help slow its loss after menopause. To protect yourself against osteoporosis, eat plenty of foods rich in calcium and vitamin D. Vitamin D helps in the absorption of calcium. Three servings of milk, cheese and yogurt will meet the daily requirement of calcium. Oily fish (herring, tuna, salmon, sardines), fortified milk, breakfast cereals, margarine and eggs are rich sources of Vitamin D. Foods like spinach, kale, broccoli, nuts, and dry fruits like figs, prunes, raisins and dates are other sources of calcium. Calcium supplements of up to 1500 mg and 400-800 I.U. of Vitamin D a day are recommended.

Cholesterol and LDL (low-density lipoproteins) levels may go up, and HDL (high lipoproteins —to so-called “good” cholesterol) level may go down slightly during menopause. Thus, proneness to heart diseases may increase in post-menopausal women. The incidence of developing these problems can be reduced by a moderate exercise (such as brisk walking) at least 30 minutes a day, and a diet including a lot of fibre, the vitamin folate, and unsaturated fatty acids. A low intake of foods that increase blood sugar, and saturated fat also helps.

Hot flushes, night sweats and associated insomnia are the most characteristic symptoms of menopause and generally appear some months or years before the periods actually stop. It is a sensation of heat in the face, neck and chest, accompanied by a red flush, and followed by sweating all over. It is often brought on by company or anxiety, and therefore, tends to happen at the most inappropriate times. Hot flushes occurring at night are called “night sweats”. Avoiding white foods like polished rice, potatoes, spicy foods, alcohol and hot drinks like tea and coffee can reduce incidence of hot flushes. Further, intake of lots of water, flaxseeds, salmon and egg yolk can also help. Some of the steps which can relieve hot flushes are: sleeping in a cool room, dressing in layers which can be removed at the start of a hot flush, having a drink of cold water or juice when you feel a hot flush coming on. Vaginal dryness is another common symptom associated with menopause, which can hamper sex life.

If these symptoms cannot be helped by self-help then medical treatment is recommended. Medical treatment for the major symptoms of menopause is usually Hormone Replacement Therapy (HRT). HRT is designed to provide extra oestrogen to maintain constant levels of this hormone in the body. HRT basically includes treatment with a combination of oestrogen and progesterone. The length of the therapy varies on an individual basis but usually it is not required for a period of more than two years. Strict adherence to the medical directions given by a physician and regular monitoring along with thorough check-ups is very important during hormonal therapy. Hot flushes and night sweats are treated within two weeks of the start of the therapy followed by an alleviation of vaginal dryness within 6-8 weeks.

Oestrogen increases high-density lipoproteins, which carry cholesterol from the arteries in the heart, and disposes it, thus reducing the risk of heart disease. Further, it reduces bad part of cholesterol (low density lipoproteins) and another fatty protein (a lipoprotein), which circulates in the blood. Bone loss due to oestrogen deficiency is also curtailed by HRT. Prolonged HRT reduces the risk of bone fracture, but the benefit to bone health lasts as long as HRT is taken. The extent to which the HRT helps is different for different people because there are many other lifestyle-related factors that contribute to bone loss. Alzheimer’s disease occurs more commonly in women, and it appears from various reports that women with this disease have shown improvement on being given hormone replacement therapy. Some plants have also been found to contain an oestrogen-like substances referred to as phyto-oestrogen. This plant oestrogen works like a weak form of oestrogen. Soy is a rich source of phyto-oestrogen. Phyto-oestrogen is also found in other plant materials such as legumes, vegetables, cereals, and some herbs. Not all forms of HRT agree with all women and therapy may need to be individualised. Some very common side effects associated with HRT include: breast tenderness, nausea, unscheduled or breakthrough bleeding and PMS-like symptoms.

Some studies indicate that an increased risk of breast cancer may also be associated with the use of oestrogen. The causes of this are not known. However, since breast cancer is more likely to be diagnosed in women using HRT as they have more frequent breast examinations, the correlation may only be incidental. Further, it has been found that the risk of breast cancer does not become significant until you have used it for at least five years. The risk appears to return almost to normal when the therapy is discontinued. If hot flushes or other symptoms are not particularly bothersome, the hormone therapy should only be recommended in the sixties. This provides significant protection against osteoporosis and bone fractures, while avoiding the risks possibly associated with being on such therapy for many years.

Risks associated with using oestrogen can also be reduced, by the use of designer oestrogen (selective estrogen receptor modulators-SERMs), while retaining their benefits. Two such SERMs available in the market are tamoxifen and raloxifene. The latter has an advantage of not increasing the risk of endometrial cancer. However, these agents have been reported to increase the incidence of hot flushes, which subside by themselves after six months of continuous therapy. Another serious side effect with these agents is venous thromboembolism, which means the formation of blood clots in the veins. So, caution should be exercised while treating “at risk” patients.

Depression, anxiety and panic attacks are very frequently observed in pre- and post-menopausal women. These attacks usually occur due to stress at the workplace or at home and not because of menopause but night sweats leading to poor sleep patterns and exhaustion makes it difficult to cope with this stress. A panic attack is manifested as a sudden onset of intense fear and inability to cope with it. During menopause a woman experiences a myriad of emotions. Some have feelings of fear and uncertainty, while others sense relief that finally sex and pregnancy can fall into separate categories.

Feelings of loneliness and depression can be handled by the following suggestions:

• Express your feelings
• Talk to your partner, a close friend or family member about what you are experiencing
• Take each day at a time and remember to take time out for yourself
• Reward yourself in some way for each task done
• Take care of yourself by healthy eating. Taking regular exercise can improve the way you feel
• Talk to your doctor
• Have a positive attitude towards menopause by possessing thoughts like “I can be creative and humorous with it”, “Every time I have a hot flush, I will think of something hilarious”
• Give yourself a heart-body-mind-spirit retreat on weekends for recuperating
• Just knowing that this is normal, helps to stay sane
• Learn relaxation techniques
• Laugh
• Be proud of your age
• Think of all the things you know that you did not know when you were a teenager
• Establish a social network
• Take calcium and Vitamin D supplements
• Keep doing new things
• Alternative therapies like yoga, meditation (20 minutes, 2 times a day), acupuncture, Chinese medicine can also be practised.

Women in their 40s need to start taking their health more seriously. Ask yourself, “where do I want to be when I’m in my 60s or 70s? Do I want to go on a world tour/pilgrimage or be in a hospital?”

Violence in the home: A flawed Bill
Leena Prasad

ALMOST every six hours, somewhere in India, a young married woman is burnt alive, beaten to death or forced to commit suicide. At least 20 per cent married women aged between 15 and 49 years have experienced domestic violence at some point in their lives, many on an almost continual basis.

These alarming statistics from government sources like the National Family Health Survey and the National Crimes Records Bureau identify the home as a major site of violence against women and girl children. This violence takes a variety of forms — mental, physical, sexual and economic — and occurs for a range of reasons. Not only does domestic violence have serious consequences for the health and well-being of the individual woman, it serves to maintain the subjugation of women as a class.

While the Government of India has recognised the seriousness of the problem and the need for legislation, it has completely failed to understand the true dimensions of a law on domestic violence. In the Domestic Violence Bill, which is proposed to be introduced in the current Budget session of Parliament, it is stated: “If a man beats his wife to protect his property, it is NOT domestic violence, this will be taken as part of his right to defend himself.” (This and other emphases are the author’s).

Further, while defining domestic violence, the proposed Bill totally fails to capture a woman’s experience of abuse and daily violence in the home and also does not clearly state that mental, economic and sexual violence is domestic violence. It is unfortunate that the lack of political will prevent the government from adopting the broad definition of domestic violence as delineated in the UN Model law code and thus stops short of protecting women from being abused and exploited.

This Bill further defines domestic violence in vague terms as conduct which includes “habitually” assaulting or making the life of the aggrieved person “miserable”. Ironically, while not defining terms such as “habitual” and “miserable”, the Bill makes counselling of the victim of domestic violence mandatory, thus negating the inputs and understanding of women’s groups over the last few decades.

In fact, the experience of the women’s movement in dealing with the issue of domestic violence has been reflected in a draft Bill prepared by Lawyers Collective, a group of lawyers working on women’s rights, which has been shared with the government on several occasions.

Lawmakers need to understand that a law on domestic violence has a different role to play as compared with a law dealing with marriage or property. A law on domestic violence is in the nature of an emergency legislation with the singular aim of stopping the violence at once.

Hence, the underlying theme of a domestic violence law should be that no one has a right to be violent against any other person, especially when statistics show that women are most vulnerable in their own homes. One fails to understand then, the reasons that prevent the government from legislating in a manner that clearly communicates this message rather than creating self-defence pleas to protect the abuser or his property.

On another crucial front, the Government Bill also fails to declare that women have the right to reside in the “shared household”. This is the most important right for women who are subjected to domestic violence. Lawmakers need to understand that by granting the right of residence, one does not decide on the ownership patterns of the property. A woman who marries should have the right to stay in the matrimonial home for as long as she desires. The mandate of a law on domestic violence is not to decide the ownership of property but to end violence in all its forms.

The most common form of domestic violence is driving the victim out of her home, or forcing her to leave it. Women ejected from their homes in these circumstances often have nowhere to go. It is because of the threat of being thrown out and without viable options that millions of women today continue to silently tolerate extreme violence — sometimes till the point of death — at the hands of their relatives. Without granting this crucial right to residence, a law on domestic violence will have no meaning at all.

In contrast to the Government Bill, the Domestic Violence Bill drafted by the Lawyers Collective is a civil law remedy that seeks to address emergency situations. It is meant for a temporary purpose with a singular aim — to stop the violence. This Bill is designed to help a woman during the most intense phase of abuse and the availability of protection orders or residence orders will succeed in stopping the violence for that period. A domestic violence bill should not only provide a support mechanism; such relief will also be a tool of a woman to negotiate her rights from a position of equality.

The Government Bill also fails to empower judges to grant residence orders, orders restraining dispossession and mandatory reposession of the matrimonial home, which is perhaps the most important reason of having a new law on domestic violence. A law on domestic violence without emergency monetary relief or custody orders for the abused woman’s children will serve no purpose.

Another common form of domestic violence is the taking of a second wife. Unsuspecting victims of bigamous marriages have no remedies under the existing laws. Any law proposed on domestic violence must take cognisance of this reality.

Even though the Government Bill envisages the setting up of a new institution of protection officers, there is no mention of any fund allocation. Such a law is then bound to fail right from its inception.

In a travesty of justice, the Government Bill recommends mandatory counselling for victims of domestic violence, rather than the universally accepted convention that mandatory counselling is a method of correcting the behaviour of a violent person. Read carefully, the law states that the abuser may get away with the abuse while the complainant is forced to undergo mandatory counselling. We all know that this is another way of forcing a woman to reconcile to her fate in order to preserve the ‘sanctity’ of the marriage.

The need is to shift from the accepted social context that is characterised by an emphasis on the ‘sanctity’ of the marriage, the economic dependence of the woman, the dowry system and an understanding that it is the duty of a woman to “adjust” to the violent conditions. Lawmakers need to realise that in these circumstances, there is little support for a woman in distress.

In short, the Government Bill requires serious reconsideration, since a badly drafted law with underlying patriarchal values can work to the disadvantage of half the population of the country.

Let us all wait for the day when lawmakers understand completely the right ways of combating domestic violence against women, rather than allow the Government to pass a law that will undo decades of hard work and take us centuries back in the struggle for women’s rights.