Reaching out: IMS president Urvashi Jha; Photo: Rajesh Kumar

At 12, when the world was opening up for her, Urvashi Jha didn?t even try to understand what was wrong with her 38-year-old mother. It was only years later that she realised why her mother had looked so ill and behaved so unlike her old self.

It was when Urvashi Prasad Jha started studying medicine at the Lady Hardinge Medical College in Delhi that she realised her mother had suffered from premature menopause six years ago.

?She had gone through such a terrible time, and we didn?t even understand,? she rues. But Jha, now a practising gynaecologist, has more than made amends for that. She is the president and one of the founders of the Indian Menopause Society (IMS), which, as the name suggests, is committed to doing its bit to extend medical help to middle-aged women going through this difficult period in their lives.

The Indian Menopause Society is more visible now than ever before. It has 12 chapters in as many cities ? the latest, in Surat, having opened a couple of months ago. The IMS, which started in 1995 with a small group of 17 doctors from various fields of medicine and surgery, has over 750 members. ?For a specialised field, that?s a huge number of committed people,? says Jha with a hint of satisfaction.

Getting women to address menopause as a health condition, though, remains as difficult as ever. Just like Jha?s own mother, most women in India won?t even mention the word menopause. ?It?s usually dismissed as ?is umar mein hota hai? (it happens at this age),? she says. On the other hand, it is imperative that they talk about it because, according to Jha, Indian women are different from their European counterparts in matters related to menopause.

For one, it sets in earlier than with the Caucasians. While the average age in Western countries for the onset of menopause is 51.7, in Indian and most of Asian women, it is between 48 and 49. Also, the effects of menopause are not the same. While Europeans are more prone to hot flushes and night sweats, Indian women have a greater tendency to develop aches and pains. They get tired very easily, and depression and anxiety are common symptoms of menopause.

?Unlike the West, where comprehensive studies have been done on menopause, we Indian medicos are ill-equipped in dealing with it. But we have drawn these conclusions on the small amount of research that has been done here,? says Jha. The IMS is trying its best to educate doctors and women on these differences. In fact, Jha stresses, the first priority the IMS has is educating doctors, as Indian physicians tend to know very little of and pay even less attention to the condition.

It was when Jha was pursuing her fellowship in obstetrics and gynaecology in England in the Eighties that she came across special clinics set up to provide medical support to menopausal women. It struck her why India couldn?t have similar centres. However, it wasn?t until 1995, when she was working as head of the department of gynaecology at the Hinduja hospital in Mumbai, that she called up a senior doctor, the Mumbai-based renowned reproductive endocrinologist Rama Vaidya, and laid her plans out.

Seventeen other doctors, mostly from the Hinduja hospital and including cardiologists and cancer specialists, extended their support. Even now, specialists from all disciplines are members of the IMS chapters.

The IMS is also trying to address the problems of ovarian and breast cancer and old age in women. Jha reveals that talks are on with the Delhi administration for setting up free clinics and ambulance services in the city.

?We already have a free clinic once a week at the All India Women?s Conference headquarters in Delhi. It gives underprivileged women an opportunity to come and get a free pap smear (a test for cervical infection, abnormal cells or cancer) done,? says Jha, who is now with the Indraprastha Apollo Hospital in Delhi. The clinic also helps women understand the changes that they go through during menopause.

The IMS is focussing not just on menopause, but on the impact of post-menopausal conditions on women?s health as well. While depression and anxiety are just some psychological changes that women have to deal with during menopause, genital and vaginal infections, cancer and loss of libido are some post-menopausal risks that they stand to encounter.

Of these, cancer is the greatest risk. But in this case, one of the setbacks the IMS faces in countering the risk of ovarian cancer is the tendency in women to dismiss abnormal discharges during menopause as natural. ?For one, Indian women are not complainers. Second, they are embarrassed to come out in the open about it. And then, we have to deal with ignorance, both on the doctor?s part and that of the patient?s,? says Jha.

She explains that heavier and more frequent periods, considered normal by women before menopause sets in, is actually the first sign of the possibility of cancer. ?Ideally, periods should get lighter and further apart,? Jha informs.

The IMS has been holding workshops for doctors and camps for women to dispel such misconceptions. It also brings out a newsletter to address the issue of menopause periodically.

World Menopause Day has just passed round the corner (it is celebrated worldwide on October 18) and the IMS is proud to have made a mark in India. The Indian medical journal Obs & Gynae Today has dedicated two back-to-back issues to menopause this year. Related issues, like the controversy surrounding hormone replacement therapy (HRT) have been addressed.

HRT is a tricky subject that IMS is addressing right now. During menopause, a woman?s body runs dry of the hormones, estrogens and progestogens. Most doctors have been prescribing HRT for menopausal women, to make up for the loss in hormones. However, a study by Women?s Health Initiative, a US-based programme, over two years ago had sent shockwaves around the word, claiming that HRT could increase the risks of breast cancer, thrombosis and stroke.

Though the study was done in older women (average age 63 years), a majority of menopausal women have started to question HRT, with many choosing to suffer rather than be treated. The IMS is trying to help women understand that it doesn?t have to be so, that in certain cases like premature menopause, HRT makes life a lot better.

Even in regular cases, for women under 60, it is sometimes a lot more beneficial than otherwise. ?For women who start HRT early, instead of 10 to 15 years past menopause, the therapy can help,? says Jha. To help doctors have a clearer picture about HRT prescription, IMS has compiled a manual called Practice Guidelines For HRT Use. Jha herself, like her mother, suffered premature menopause at 38, and has been on HRT since.

Despite its work and its success, IMS is still short on funds, and mostly dependent on pharmaceutical companies to sponsor its seminars and workshops. ?But they?re not that eager. Health in middle-aged and old women is one of the most neglected areas, and we?re lucky if we can get their help,? she says.

But that hasn?t stopped them from holding awareness programmes. While the chapters at their local levels do their bit, the members meet once a year to compare notes and chart out better programmes. With the help of women?s groups all over the country, the IMS has held radio and television programmes on menopause. This year, on Mother?s Day, it held a cancer screening camp where 250 women were given free mammography and ultrasound scans. Next year, IMS plans to spread its wings further with its thrust on cardio- vascular diseases for mature women.

Jha is a satisfied woman. After almost 10 years from its inception, Jha will step down as the president of a very successful body in February 2005. ?But I will continue to be indirectly involved with the society,? she says. At 51, Jha can finally lay the ghosts of her indifference at 12 to rest.