Perimenopause Symptoms in Indian Women: What No One Talks About

From brain fog and mood swings to sleep issues and weight gain, here’s how perimenopause really shows up — and what actually helps.

“I have these sudden, inexplicable urges to cry on some days. The other day I burst into tears during an argument with my son. The poor kid didn’t know what had hit him!”

“I’ve been having the worst brain fog ever. I left my handbag at my neighbourhood coffee shop and didn’t even realise it until I went back a week later.”

“I’m beginning to get scared of my own mood swings. One day I’m on top of the world and brimming with energy, the next day I’m so depressed and low on energy, just getting out of bed feels like a herculean task.”

“I’ve been having the worst acne breakouts of my life. I’ve always had clear skin, so I can’t understand what is bringing on these acne flare ups in my 40s. And my hair fall has gotten so bad, I dread hair wash days!”

“I’ve suddenly started having so many digestive problems. From bloating, IBS, gastrointestinal issues, it’s just been one thing after the other. I’m almost scared to eat anything.”

If you’re in your late 30s or 40s and just had a ‘this sounds like me!’ moment, you’re not alone. From brain fog to hot flashes, acne, hair fall, gastrointestinal issues, frequent UTI’s, insomnia, mood swings, joint pains and muscle aches, the list of perimenopausal symptoms goes on and on. And if you’re like me and thought you were done with periods and pregnancies, and may even have been looking forward to menopause (no more periods!), you wake up to the rude realization that menopause is far more complex than it seems.

What is perimenopause? (And when does it start?)

Perimenopause is the transitional phase before menopause. It’s when your hormones, especially estrogen and progesterone, begin to fluctuate. They don’t decline in a smooth, predictable way, but in waves. You may start experiencing symptoms like irregular periods, hot flashes, mood swings, and any of the whole smorgasbord of symptoms we touched upon earlier.

Team Wellthinest spoke to some renowned gynecologists across Mumbai, Delhi and Bangalore, who told us that perimenopause for most Indian women typically begins in their early 40s, though it can begin as early as the mid to late 30s for some. 

Perimenopause is followed by:

• Menopause: the stage when you no longer have menstrual periods. Your ovaries don’t release eggs and produce significantly lesser estrogen and progesterone. You have reached full menopause when 12 months have passed with no menstrual periods. A study conducted by the Indian Menopause Society shows that the average age of menopause in Indian women is 46.2 years, which is much lesser than the global average age of 51 years. What’s more, there are an increasing number of women who are experiencing menopause even earlier.
• Postmenopause: this is the stage after the last menstrual period, and also the stage you remain in for the rest of your life. Typically most symptoms of menopause ease up during this period, although you may continue to have mild menopausal symptoms for several years in the postmenopause stage as well. What’s important to know here is that due to low estrogen levels, women in the postmenopausal stage are at an increased risk for osteoporosis and heart disease.

Common perimenopause symptoms in Indian women

Perimenopause doesn’t always look dramatic. More often, it feels like something is just… off. Some of the most common perimenopause symptoms include:

Physical Symptoms

• Persistent fatigue
• Sleep disturbances
• Weight gain, especially around the midsection
• Hair thinning
• Acne breakouts
• Joint pain and muscle aches
• Digestive issues

Emotional Symptoms

• Irritability
• Anxiety
• Low mood
• Sudden emotional shifts

Cognitive Symptoms

• Brain fog
• Forgetfulness
• Difficulty focusing

Not every woman will experience all of these, and the intensity can vary widely, which is what makes this phase so confusing.

Why perimenopause is often missed in Indian Women

There is a surprising lack of awareness about perimenopause symptoms, even among urban, educated, affluent women with a wealth of resources at their disposal. This is largely due to a complex mix of social, cultural, and generational factors compounded by the fact that awareness and diagnosis are still evolving, even within parts of the medical community.

In our mothers’ generation, suffering in silence was pretty much the norm, with perimenopausal symptoms often being attributed to aging and considered something you just have to deal with. “Our mothers and grandmothers all went through this, it’s not the end of the world!” is a common refrain.

What’s more alarming is the casual, dismissive attitude among some people, that often stems from a lack of understanding about perimenopause symptoms. An aunt suffered through a whole host of what were, in retrospect, clear perimenopausal symptoms, without ever being diagnosed correctly. She was just sent from one specialist to another to treat issues ranging from a frozen shoulder, frequent UTI’s, depression, gastrointestinal issues, and abnormally heavy periods, without even once being examined by an endocrinologist to treat the root cause: hormones. When she was finally diagnosed as perimenopausal, she had already suffered for years. 

Another friend mentioned how a doctor she visited to discuss possible HRT options, casually gaslit her by saying perimenopause is largely a ‘psychological issue’ and women should just learn how to get on with their lives without making a big deal about it. 

A lot of the time women experiencing perimenopausal symptoms may not even know that what’s happening to them is related to perimenopause because we’re so caught up in the daily grind. It’s easy to attribute a persistent bad tummy, acne flare ups, or debilitating headaches to everything ranging from poor food choices, lifestyle, to stress. The fact that there is no one uniform perimenopause experience that every woman goes through, makes it even harder, because your perimenopause symptoms may be unique to you, and very different to what your best friend or even your mom might have experienced.

What helps during perimenopause

So what is a girl to do? For one, take heart, because we live in a day and age where menopause is clearly having its moment. If you’re a woman in your 40s with access to Instagram, your feed is likely already flooded with experts and influencers dispelling myths around perimenopause. While a lot of the content in the menopause space is still rooted in a Western context, Indian women have started talking about menopause too. Some public figures have started discussing their own perimenopause journeys, reducing the stigma and silence around menopause and a lot of Indian doctors are leading conversations too, with guidance on how women can navigate this phase of their lives. 

This is a brilliant sign given that Indian women experience menopause, and consequently perimenopause earlier than women in the West. Plus, this is also a phase that can last several years- years that coincide with a time when we’re at the peak of challenging careers, juggling children, managing homes, and often also caring for ageing parents. 

There are also some concrete lifestyle changes you can start making right away to navigate the journey through perimenopause:

1. Get Informed

Like I said earlier, menopause is having its moment and while this is a very good thing, what it also means is that there’s a lot of noise around perimenopause, some of which can be overwhelming. There are a lot of conflicting, contradictory views as well, and it can be tempting to adopt an ostrich approach and just tell yourself you’ll deal with it when you have to. This can be dangerous however, because a lot of the time, you may just be feeling ‘off’ and may not even realize the cause could be linked to perimenopause. 

It helps to read up about perimenopause and stay informed, so that you are aware of the changes you may have to navigate and develop a personal action plan. There’s a lot of great content out there, created by doctors and experts across platforms. Find voices that resonate with you and learn as much as you can about what is going to be a significant phase of your life.

Here are some resources we found useful, especially for perimenopause symtoms in Indian women:

1. The Indian Menopause Society has a comprehensive handbook for women which takes you through all the menopause basics, what to expect, and advice on how to navigate menopause. Put together by renowned doctors such as Dr. Duru Shah, Dr. Reena Wani and Dr. Safala Shroff, this is a great place to start.
2. Finding Your Balance: Your 360 Degree Guide to Perimenopause and Beyond– this book by Dr. Nozer Sheriar and Sonali Sabhrewal emphasizes a holistic approach towards menopause, combining modern medicine with nutrition and wellness strategies.

2. Talk About Perimenopause

Navigating the perimenopause journey is no cakewalk, but it’s not something you have to endure alone. And you definitely don’t have to suffer in silence. Sometimes just the awareness that what’s happening to you is linked to perimenopause can be a huge relief. A close friend had been having palpitations for weeks and was worried sick that she may have symptoms of cardiac disease. A chance conversation revealed that having palpitations is a perimenopause symptom and a follow up meeting with her doctor confirmed that this was indeed the case. “I was so relieved, I burst into tears,” she confessed later. “I just wish I had known this was perimenopause when it first started happening to me, instead of imagining all sorts of horrifying scenarios in my head!” 

Every woman’s perimenopause looks different and you may find yourself navigating a set of symptoms that is unique to you. This may sometimes make you feel isolated or ‘alone’, so having a supportive partner you can talk to, or a close friend who may be going through the same phase of life definitely helps.

For a lot of women, their perimenopausal journey begins at a time when their kids may be going through their own teenage angst, making for a volatile combination. Moms who’ve found themselves locking horns with their teenage daughters (and sons) over seemingly trivial issues may relate! Again, talking helps. Have a chat with your kids about what you’re going through. Many moms I’ve spoken to about this, shared that their kids were extremely supportive and understanding and sharing the perimenopause experience with them actually helped to strengthen the relationship.

3. Find A Doctor You Can Partner With

The importance of having an understanding and supportive doctor who can partner with you in your perimenopause journey cannot be emphasized enough. This is a phase when you’re trying to make sense of the various changes your body is going through, and the last thing you need is someone who dismisses your concerns. Menopause is actually about multidisciplinary care, and needs a holistic plan involving not just your gynecologist, but also an endocrinologist, a dietitian, a cardiologist and if required, a physiotherapist, and a psychiatrist.

If you’re interested in exploring Hormone Replacement Therapy (HRT), or the relatively newer Bioidentical Hormone Replacement Therapy (BHRT), speaking to a medical professional is a must. There has been a lot of controversy around HRT because of some past research done in the West that stigmatized HRT. This research was later revealed to be flawed in its design, and many doctors debunked the findings . Many healthcare professionals in the US are now increasingly vocal about the benefits of HRT and how it can help women who suffer from debilitating perimenopausal symptoms. If you want to evaluate the pros and cons of HRT or BHRT, or even check whether it is right for you, a good doctor can guide you through the process. 

A lot of Indian women also find Ayurveda and other alternative natural therapies helpful while navigating menopause. The Ministry of Ayush has published some resources that emphasize a holistic approach to menopause and encompass Ayurvedic, dietary and yoga based strategies. You can also consider speaking with an Ayurvedic doctor or exploring other natural therapies under the right guidance.

4. Make the right lifestyle changes

The importance of sleep during perimenopause

Most women I know, including me, don’t get enough sleep. Long working hours, much needed family time, and early school runs often mean that we’re getting by on just 5-6 hours of sleep. Add Netflix and social media scrolling to the mix and our sleep schedule gets even more compromised. Healthcare professionals constantly reiterate the importance of getting your sleep basics right. Stick to the same sleep and wake times every day and get a minimum of 7 hours of good quality sleep (8 is even better!). Creating a consistent bedtime ritual that helps you wind down and reducing late night stimulation (yup, we’re looking at you, mobile phones) can make a huge difference. 

Nutrition

When it comes to nutrition, it’s the small consistent choices that matter more than any drastic changes. Choose whole foods over processed foods, minimize or eliminate alcohol, cut down on sugar, and create a sustainable diet plan for yourself. The occasional indulgence is fine, as long as you’re eating right 80 percent of the time. Also make sure you get your blood work done on a regular basis, and ask your doctor for advice on supplementation if you have any deficiencies.

Exercise

You probably already know about the benefits of strength training for women in their 40s. If you’re just starting out, find a good trainer who can work with you and invest in getting the basics right. Even 2 days of strength training a week yields immense benefits for women navigating perimenopause, because it directly combats the physiological changes caused by declining estrogen, specifically protecting our bones, muscles and metabolism. 

Make sure you get between 4 to 6 days of movement every week, and build in some cardio and flexibility into your workouts as well. And, try and get in as many steps as you can in a day, whether it’s walking around the house while taking a call (it’s amazing how this can help with your total step count!) or ditching the car for walking while running quick errands in the neighborhood.

A Quiet Closing Thought

If you’ve been feeling off lately; physically, emotionally, or mentally, it might be worth paying attention to. Not dismissing it. Not pushing it aside. Not soldiering through, because that’s what you always do. Just noticing. Because this phase deserves understanding, not confusion. And the more we talk about it, the less alone it begins to feel.

FAQs