Indian Write-Ups

It is customary to attribute all and sundry illness of middle-aged women to a vague term "the menopause syndrome"- a women in her fifties, got so exasperated with this diagnosis, she asked “Doctor, is there no end to this menopause? It has been troubling me for the last 15 years!”

Menopause occurring naturally or artificially (post-hysterectomy) may lead to certain changes in a women’s body, owing to deficiency of ovarian hormones, though Nature does its best, to prepare the women for it, by slowly, gradually shrinking the ovaries.

Hysterectomy with a bilateral oophorectomy leads to sudden fall in hormones and may result in the classical menopausal syndrome viz. hot flushes, palpitations, osteoporosis causing hip pain, backache etc. increase incidence of ischemic heart disease, irritability, nervousness and depression. Women may suffer from any one or a combination of these symptoms and may be helped by hormone replacement therapy (HRT) and other supportive measures.

However, there is another dimension to the depression blackening the skies of middle age. Many women in the middle age. Many women in the mid-thirties suffer from anxiety, depression and related illnesses. The spectrum of symptoms is wide enough to confuse a clinician. Both psychological as well as somatic symptoms appear, though the approach to the doctor is invariable with some physical complaints.

Characteristically many doctors of different disciplines are consulted, a hoard of investigations are ordered, a plethora of drugs are prescribed. However, no one seems to come across any positive signs indicating frank physical disease, nor do any of the tests show abnormal results. The family physician, consultant physician, gynaecologist, orthopedic surgeon, skin specialist, even neurologist, these are some of the people who get to see such a women; very rarely is a psychiatrist involved.

Pharmacotherapy at best provides only temporary relief, and leaves the patient unsatisfied and unrelieved in the long run. If the treating doctor proclaims that there is nothing wrong with her, she feels that she is accused of mailingering. This results in doctor- shopping and further investigation. Her husband or her children have to accompany her to various doctor’s clinics. This disrupts the family life. Everyone is unhappy and disgruntled and sizable amount of money is spent fruitlessly.

Finally the poor women is irrevocably stamped to have an incurable disease: ‘menopause’.

Menopause is naturally occurring phenomenon in woman's life. Generations after generations of women are going through this without any fuss. “So what’s the big deal?”, one may ask. Can all the above mentioned symptoms be explained by the ‘hormonal deficiency’ theory? When the most thorough clinical examinations as well as investigations fail to reveal anything abnormal. How does one tackle this problem and give relief to the women?

‘Hysteria’- the word has originated from ‘hysteros’ meaning ‘uterus’ or a female. It may also stem from ’histrionics’ or play-acting. Women are supposed to have a natural flair for play-acting. Women are supposed to have a natural flair for play-acting. Obviously they are making an attempt to get secondary gain -sympathy and attention. The sicker they are, the more concerned their near and dear ones may become, they hope. Why do particularly middle-aged women vie for attention? Why are they so insecure? Has anyone gone into the depth of a middle-aged women’s psyche?

“Listen to the patient- for (s)he is telling you the diagnosis”- is a well-known adage. Do the clinicians really listen?

Look at this women who has enjoyed loving parental care as a child, simulating friendship as an adolescent, a whole new world of sensuality and sexuality as a young married women, the ecstasies of motherhood and agonies of bringing up small children. She is busy living, loving, struggling, trying to achieve something.

However, as she enters the mid-thirties, the scenario changes in a subtle and imperceptible way. The children grow up, go away, become engrossed in their own world. They need maternal support less and less. The husband has risen in his job and is now in the prime of his career, and devotes less and less time to his household. In short, the other members of the family take the women of the house for granted and simply neglect to give her the ‘positive stroke’ so badly needed for happiness and contentment. She is now 35-40 years old, too old to start her own career, too young to plan for a retired life, has forgotten whatever skills she possessed in the past, has lost her looks, her stamina and vitality are at a low ebb. Is it surprising that she becomes anxious, might depressed and loses confidence and self-esteem? Slowly, subconsciously she takes refuge in the so called ‘menopausal syndrome’; ahead of her time. The mind plays tricks, the body responds, and a variety of psychosomatic disorders ensue.

Somatic Symptoms

Chronic headache: migraine, tension headaches

Hyperacidity, gastro-oesophageal reflux disease (GERD). Non-ulcer dyspepsia.

Irritable bowel syndrome: frequent sticky stools, abdominal pain.

Chronic musculo- skeletal pain especially neck, low-back, an legs. Episodic palpitations, breathlessness, sweating, tremors, cold extremities.

Giddiness, dizziness

Urinary frequency, stress incontinence.

Intractable pruritus valvae and ani.

Eating disorders: anorexia / bulaemia.