Menopause Treatment and HRT in Bengaluru

Key takeaways

• Menopause is confirmed after 12 months without a period; the average age in India is about 46–48 years.
• Symptoms often start years earlier, during perimenopause.
• HRT is the most effective treatment for hot flushes and also protects bones.
• The decision to use HRT is personal and depends on your age, symptoms and health history.
• Any bleeding after menopause must be checked.

What is menopause?

Menopause is the natural end of menstrual periods, when the ovaries stop releasing eggs and oestrogen levels fall. It is diagnosed after 12 consecutive months without a period, in the absence of other causes.

• Perimenopause: the transition, often lasting 4–8 years, with irregular periods and fluctuating symptoms.
• Premature ovarian insufficiency (POI): menopause before 40, which needs hormone treatment until at least the natural age of menopause.
• Surgical menopause: sudden menopause after removal of both ovaries.

Common symptoms

• Hot flushes and night sweats
• Irregular periods before they stop
• Poor sleep, tiredness, low mood, anxiety, irritability and “brain fog”
• Vaginal dryness, pain during sex and reduced libido
• Urinary urgency and repeated urine infections
• Joint aches, weight gain around the waist and thinning hair
• Longer term: bone loss (osteoporosis) and higher heart disease risk

Who needs menopause treatment?

Treatment is for any woman whose symptoms affect her quality of life, and for women with early or premature menopause, who need hormones to protect bones and heart health.

Some women have mild symptoms and need only reassurance and lifestyle advice. Others have disabling hot flushes, poor sleep or painful sex for years. Menopause is also a good time to check blood pressure, blood sugar, cholesterol, bone health and cancer screening.

What are the treatment options?

What to expect: step by step

1. Consultation: Dr. Divya discusses your symptoms, period pattern, medical and family history (including breast cancer, blood clots, heart disease and stroke) and your preferences.
2. Examination: blood pressure, weight, breast and pelvic examination as needed.
3. Tests: blood tests are usually not needed to diagnose menopause after 45, but tests such as thyroid, sugar, lipids and vitamin D may be advised. A mammogram, Pap test, pelvic ultrasound or DEXA scan may be recommended based on age and risk.
4. Shared decision: you weigh the benefits and risks of HRT and the alternatives together.
5. Starting treatment: at the lowest dose that controls symptoms, in the form that suits you.
6. Review: at about 3 months to check symptoms, bleeding and side effects, then at least once a year.

What results can you realistically expect?

HRT reduces hot flushes and night sweats by around 75% or more in most women, with improvement within a few weeks and full effect by about 3 months.

Sleep, mood and joint aches often improve too, and vaginal treatments relieve dryness within weeks. Results depend on taking the right dose and type, and on lifestyle factors such as smoking, alcohol, weight and exercise. Non-hormonal treatments are helpful but usually less effective than HRT.

What are the risks and side effects of HRT?

For most healthy women who start HRT before 60, the benefits outweigh the risks. Risks depend on the type of HRT, your age and your health.

• Early side effects: breast tenderness, bloating, headache and irregular bleeding, which usually settle within 3 months.
• Breast cancer: combined HRT is associated with a small increase in risk with longer use; oestrogen-only HRT has little or no increased risk.
• Blood clots and stroke: slightly increased with tablets; transdermal patches or gels do not appear to raise clot risk at standard doses.
• Endometrial cancer: prevented by adding a progestogen in women with a uterus.

HRT is generally not advised for women with a history of breast cancer, active liver disease, unexplained vaginal bleeding, or certain clotting disorders.

Aftercare and healthy living

Continue HRT for as long as the benefits outweigh the risks; there is no fixed time limit, but the decision should be reviewed yearly. Regular weight-bearing exercise, a diet rich in calcium and protein, adequate vitamin D, stopping smoking and limiting alcohol all protect bone and heart health. Light clothing, a cool bedroom and avoiding triggers such as spicy food and caffeine can ease hot flushes.

What does menopause treatment cost?

Costs depend on consultation and review visits, blood tests and screening (mammogram, Pap test, DEXA scan), and the type of treatment, whether tablets, patches, gels or vaginal preparations, taken over months to years.

When to see a doctor

See a gynaecologist if symptoms affect your sleep, work or relationships, if your periods stop before 40, or if you want to discuss HRT. See a doctor promptly for any bleeding after menopause, a new breast lump, or calf swelling, chest pain or breathlessness while on HRT.

Why choose Dr. Divya Venugopalan?

Dr. Divya Venugopalan is a gynaecologist with more than 14 years of experience. She holds an MBBS from KIMS, a DNB in Obstetrics and Gynaecology, an FRM and an FMAS, and offers unhurried, evidence-based menopause consultations. She can also investigate related problems such as heavy or irregular bleeding in perimenopause and fibroids, and perform a hysteroscopy if needed.

She consults at Thanisandra, Sahakar Nagar and HRBR Layout in six languages. Book a consultation.