This new book is a comprehensive guide on how to deal with menopause

It would be a tiny issue something as simple as her daughter or husband refusing to do something she requested But it would bother Jasmine Lodaya sometimes even making her cry inconsolablyAbout a decade ago the Ghatkoparbased homemaker noticed she was experiencing emotional outbursts Soon hot and cold flashes followed ldquoOne week before my periods I would be very irritablerdquo says the 47yearold ldquoThere would be outbursts without any reason I would cry inconsolably even for tiny things My poor husband couldnrsquot understand why and my daughter was too young to comprehend Then my family doctor told me these are signs of perimenopauserdquoMenopause is the cessation of menses due to the depletion of oocyteseggs in the ovaries Perimenopause is the run up to menopause when ovarian function starts winding down with the fluctuations in oestrogen levels leading to various symptoms It is an overarching term used to the describe premenopause menopause and postmenopauseGynaecologist Dr Nozer Sheriar and macrobiotic nutritionist Shonali Sabherwalrsquos book Finding Your Balance looks at the various menopauserelated challenges and possible solutions PicSayyed Sameer AbediThe transition usually begins an average of four years before the last menstrual period usually sometime around mid40s but in a few cases it can begin in the 30s It is characterised by several factors including irregular menstrual cycles hormonal fluctuations hot flashes vaginal dryness mood swings among othersFor Lodaya the symptoms ebbed for a while but returned recently ldquoNow I know how to deal with them better If I notice Irsquom getting irritated I realise my periods would be near and distract my brainrdquo She turns to handembroidery or watches something light on her phone ldquoI consciously change my activitiesmdashI donrsquot participate in serious or heavy conversations or watch emotionally heavy TV showsmovies I also avoid discussing topics that could become intenserdquo She tried going for walks but couldnrsquot continue ldquoBefore your periods your body feels very heavy so you donrsquot feel like exercisingrdquo she saysThere are days when she wants to withdraw from the world ldquoThere are times I canrsquot manage my emotionsrdquo she admits ldquoI get upset and realise hours later that the incident was no big deal Sometimes just someonersquos face angers me without any rationale Other days I cry but I try not to do it in front of othersrdquoWhen Ghatkoparbased Jasmine Lodaya recognises shersquos being overtly emotional she turns to embroidery to calm herself PicPradeep DhivarThe problem thinks Lodaya is the lack of discussion around the subject ldquoIt is taboo even todayrdquo she says ldquoMy friends donrsquot discuss itrdquo Lodaya found comfort in her motherinlaw and elder sister who validated her experienceFor Neelam Sharma it began two years ago with severe pain in the lower abdomen and back during her periods She had just turned 40 a year later her menstrual cycle became irregular ranging anywhere between 10 and 45 daysldquoThere was significant fluctuation in mood around my periodsrdquo says the Powai resident Her skin started breaking out ldquoI have also started facing issues related to the thyroid gland but Irsquom not sure whether thatrsquos interconnectedrdquo A blogger by profession Sharma lives with her parents and siblings ldquoI am a very letgo kind of personrdquo she says ldquoBut now hurtful words haunt me for days I cry a lot at night I caught myself replaying negative interactions repeatedly Itrsquos as if a tragic movie is playing in my mindrdquoThe emotional turbulence affects her work ldquoI procrastinate a lotrdquo says the professional blogger ldquoA fiveminute job can take hours sometimes I canrsquot work for daysrdquo The day we spoke was one such day she had a sharp pain in the lower abdomen Sharma is glad shersquos independently employed taking mental health days off wouldnrsquot be easy in the corporate world ldquoA week before my periods it becomes really toughrdquo she says As an aid Sharma has started stretching and doing pranayama at least for 15 minutes every dayLike Lodaya and Sharma many women around the globe mostly those in their 40s are in perimenopause ldquoThe stage lasts for several years on either side of the last menstrual periodrdquo says Dr Nozer Sheriar a consulting gynaecologist at Breach Candy PD Hinduja and Holy Family hospitals ldquoThe average age of menopause in India is 47 years So perimenopause can come any time in the 40srdquoSheriar and macrobiotic nutritionist Shonali Sabherwalrsquos justlaunched bookmdashFinding your BalanceYour 360deg Guide to Perimenopause and Beyondmdashis a comprehensive guide that includes clinical and nutritional perspectivesSometimes the solution is something we already know For instance for easier periods ldquostop eating sugar refined food minimise dairy and have homecooked mealsrdquo says Sabherwal ldquoSubstitute sugar with stevia or erythritol and avoid breads as well Have a traditional thali Dosa rice or roti with dal and subzi and a little bit of fermented food such as buttermilk to boost gut health Ensure greens fruits and seeds are included in your diet Avoid or at least limit stimulants that push your cortisol levels such as tea coffee alcohol and cigarettes Start doing these two weeks before your period and chances of pain free periods will be highrdquoDr Sheriar admits hot flashes can be dramatic and drive a woman crazy One solution he offers is hormone therapy which shows results within weeks ldquoMenopause hormone therapy is the gold standard for relief from hot flashes and night sweats and is safe for a short durationrdquo he says in the book ldquoIt also helps vaginal dryness and mood disordersrdquo Another tip to balance oestrogen in your body is including tofu and soy ldquoHaving tofu thrice a week can help balance oestrogen where it is going up or downrdquo says Sabherwal For mild hot flashes she suggests cooling foods such as chia seeds and waterbased vegetables such as dudhi and yams ldquoAvoid garlicrdquo she advises ldquoWear lightweight loosefitting clothes made of natural fibres such as cotton and get a gel mattressrdquoldquoThere are many myths surrounding perimenopause and not everyone needs medicationrdquo says Dr Sheriar ldquobut those who do must seek helprdquo He points out that it is insensitive to ask women ldquowho wake up due to intense hot flashes are irritable due to lack of sleep dealing with osteoporosis or with vaginal dryness which makes intercourse painful and does not protect her against vaginal infections to lsquohandle it themselvesrsquordquoA recent study found that 15 per cent of Indian women endure urogenital infections itching and painful sex 32 per cent suffer vaginal dryness and urinary urgency afflicts 10 per cent Most women suffer in silence assuming these to be normal ldquoWe are talking about half the world population hererdquo says the doctor ldquoThey donrsquot need to deal with it alone They should get whatever help they canmdashwalking exercise diet calcium and Vitamin D supplementsand counsellingrdquoFitness is an important tool to negotiate perimenopause says fitness coach Pooja Pattar who only works with women in their 40s and above She herself is 44 ldquoIf someone is physically activerdquo she says ldquothey can deal with emotions better Activity retains bone density which raises quality of liferdquoPattar says strength training is especially important Every woman should consider lifting weights no matter how light or heavy It helps retain muscle mass and delays osteoporosis by strengthening bonesrdquoldquoWomen build up bones up till the age of 40rdquo adds Dr Sheriar ldquoAfter that they lose bone mass If a younger woman focuses on bone health at 40 she will be at peak bone density Her chances of getting osteoporosis are less than that of a sedentary personrdquoHe recommends a mix ldquoCardio will help lose weightrdquo he says ldquoYou need yoga for flexibility and strength If yoursquove had babies you must include pelvic exercises as the floor has been compromised and gravity isnrsquot kindrdquoSabherwal who is also a yoga and pilates instructor suggests kegel exercises that strengthen the pelvic floor muscles and also help with vaginal drynessA closely connected but often overlooked disease is cancer ldquoOver eight lakh new cases occur every yearrdquo says the book ldquoMore than 80 per cent of cancers in women occur between the ages of 35 and 65 years with the highest burden during perimenopause The leading sites of cancer among women are mainly related to four organs breast cervix body of the uterus and ovaries These account for over 60 per cent of all cancersrdquoDr Sheriar recommends regular selfexamination for breast cancer ldquoThe HPV vaccine has a significant role in reducing the risk of cervical cancerrdquo he adds ldquoGet regular Pap smears and avoid smokingrdquo Since pregnancy is a restphase for the ovaries women who havenrsquot given birth are at higher risk of ovarian cancer ldquoWomen on longterm birth control methods such as pills and those who have breastfed are at lower riskrdquo he addsA preventive tip from Sabherwal is ensuring limited exposure to endocrine disruptorsldquoChemicals such as Nonylphenol Ethoxylatein found in makeup detergents and plastic containers are endocrine disruptors and play havoc with oestrogenrdquoAre women getting menopause earlierThough women are reaching menarchy point of starting menstruation earlier the age of menopause has not pulled back Dr Sheriar says that while there is a variation it isnrsquot widespreadOestrogenbalancing recipe by Shonali SabarwalThe recipe makes a great sandwich filling can be spread on crackers or eaten by itselfMock Egg Tofu SaladIngredients250 gm tofu1 onion grated2 celery stalks cut fine2 carrots grated1 tbsp of white wine vinegarSea or rock salt to tasteMethodSteam the tofu squeeze out all the water from the block and keep aside Mix all the ingredients crumble tofu by hand and mix well Chill for 1015 minutes before serving