A revolution is stirring in Africa and its being driven by women.
Sick of the stigma that surrounds menopause and frustrated by the lack of information, and the disengagement from the medical profession, they are speaking up, setting up support groups, introducing workplace training, and even raising the issue in parliament.Writing about this nascent movement in the Guardian, Zimbabwean Sue Mbaya, who hosts a menopause podcast, invites other women to add their voices to the growing calls for the menopause to be recognised and acknowledged as something with far-reaching consequences for women and for society around them.Similar discussions are happening in Asia and Latin America, where women are challenging entrenched views about their worth as they age.
Kika Lobo from Rio de Janeiro says, [Menopause] is a label that says youre old, and thats like death for a Brazilian woman, but finding an online network of influencers who are talking openly about their experiences has been a huge help.Globally, the number of post-menopausal women is growing.
In 2021, women aged 50 and over accounted for 26% of all women and girls worldwide, up from 22% 10 years earlier.
Yet few receive the advice or care they want and need.
We asked six women about their experiences and the changes they want to see.BrazilIts a label that says youre old and thats like death for a Brazilian womanKika Lobo, 59, Rio de JaneiroFor Ana Cristina Kika Lobo, menopause has been like a long tunnel, which no one tells you anything about.
Now 59, she had menopause induced at the age of 47 after being treated for endometrial cancer.
Her cancer is now in remission, but she is still suffering from menopausal symptoms.The symptoms that bother her the most are hot flushes, night sweats and chills; vaginal dryness and itchiness; and loss of libido.
But there are others, notably brain fog, irritability, tiredness and weight gain.
And you know something else no one warns you about? Facial hair! You start growing a hair here, a hair there, says Lobo.View image in fullscreenKika Lobo, a writer and influencer on womens ageing, at her home in Ipanema, Rio de Janeiro.
Photograph: Ana Ionova/the GuardianHormone replacement therapy (HRT) is available in Brazil, including through the Sistema nico de Sade public health system, but Lobo has been advised against it due to her history of cancer.
She has tried a variety of other treatments to alleviate her discomfort, including expensive vaginal laser therapy, but on a daily basis relies on regular exercise and occasionally antidepressants.Although Lobo feels that the conversation around menopause has progressed since she first entered this phase of her life, she says it remains largely taboo in Brazil.
Its a label that says youre old, and thats like death for a Brazilian woman, she says, adding that this is particularly true in Rio, a city obsessed with appearances and living life to the full.View image in fullscreenLobo talks to her two daughters, who are in their twenties, and her partner about menopause, but they are not very receptive.
Her female friends want to skirt round the subject.
Even talking to medical professionals is a challenge, in her experience.
Inside the doctors surgery, the issue of menopause isnt broached unless you raise the subject with the doctor yourself, she says.Lobo has found a support network on social media.
Online influencers play a really important role in providing information, she says.
She follows a number of influencers online, such as Smara Irum and No Pausa, and uses her own Instagram account to post openly about her experiences.
We need to make this into a big, open conversation, she says.By Constance MalleretSouth SudanWomen are supposed to have children until they dieLucia Valentino Roman, 48, JubaIn 2013, when Lucia Valentino Roman started to miss periods, she thought she might be pregnant.
I was only 38 years old, remembers the mother of five, who did not want any more children and was talking to her husband about family planning and contraceptives.A visit to the doctor revealed that she was experiencing early menopause.
The doctor said it might have been caused by a lack of sexual activity, she recalls, as her husband was away from home most of the time.
The doctor comforted me with the fact that I already had five children, and he put the blame on my husband, she says laughing.View image in fullscreenLucia Valentino Roman, a midwife and reproductive health officer, experienced menopause early at 38.
Photograph: Florence Miettaux/the GuardianNot being able to have more children did not upset Roman as she had already agreed with her husband that five was enough.
But her menopause symptoms quickly became very annoying: hot flushes (which she still experiences 10 years on), as well as weight gain.She also lost interest in her social life.
I became more isolated, she recalls.
I used to receive friends at home a lot, but after I entered into menopause, I preferred staying by myself, reading my Bible, watching TV.I told them that I cant have children any more and they left me aloneLucia Valentino RomanWorking as a reproductive health officer with South Sudans health ministry in communities across the country, Roman has learned a lot about the South Sudanese attitudes towards sexuality and menopause.
For women in many communities, not having your period any more and not being pregnant while you are still young is a great shame.Women are supposed to deliver until they die; their husbands family believe they paid cows to marry them so that they can have 10, 12 children, she says, recalling stories of husbands suspecting their wives of secretly using a contraceptive, or accusing them of being cursed.View image in fullscreenRoman with two of her five children: Saida Jimmy, 22, left, and Juliana Jimmy, 18.
Dont fear menopause, she says.
Photograph: Florence Miettaux/the GuardianPeople do not know anything about early menopause in South Sudan, says Roman.
In rural areas in particular, women tend to ignore the symptoms.
There is more awareness among women in the capital, Juba, who have better access to specialist doctors.In 2016, Romans husband, who worked as a driver for an international organisation, died in a violent incident in the north of the country.
Inheriting a wife is a common practice in South Sudan, including in her late husbands ethnic group.
Roman could therefore have become the wife of a brother or other male relative of her husband after his death.
Being menopausal helped avert this.
I told them that I cant have children any more, she says, and they left me alone.She urges South Sudanese women to see a doctor as soon as they see a change in their period, and not to feel shy to tell their husbands about it.Dont fear menopause, dont be disappointed, says Roman.
Its better to accept it.By Florence MiettauxEcuadorHot flushes are referred to as bochornos, meaning embarrassment in SpanishAlbeley Rodrguez Bencomo, 51, QuitoHer menopause symptoms are under control, at least for now.
After friends told her it would help, the new year resolution for Albeley Rodrguez Bencomo, 51, was to eat better and be more active.
She gave up sweets and goes to yoga four times a week.
It seems to be working.But not long ago, she says, her hot flushes were out of control.
Id be talking to you and all of a sudden Id get really red, and Id be sweating really heavily, she says.View image in fullscreenThe nights were the worst.
She would wake up soaked in sweat and have to throw her blankets off, then wake up cold and have to put them back on again, several times a night.
Thankfully, those symptoms have subsided.Rodrguez, a humanities professor and single mother of a 13-year-old girl, has slight memory loss, moments of not being able to focus and finds it hard to control her weight.She feels lucky to have a few friends who are also going through menopause.
Its a relief to have other people around who are going through something similar, she says.
We have a few laughs about it.Women also use it as a way to insult other women who may be in a bad mood, saying: Youre being menopausalAlbeley Rodrguez BencomoBut she is not this open with everyone.
Menopause, and all that it implies, is taboo in this society, just as old age is a bit of a taboo, she says, adding that both Ecuador and her native Venezuela are societies that prize youth and beauty.This is reflected in the language, she says.
Hot flushes are referred to as bochornos embarrassment.
Women also use it as a way to insult other women who may be in a bad mood, saying: Youre being menopausal.Rodrguezssymptoms began two years ago, immediately after her hysterectomy.
She had been suffering for years with a uterine fibroid, which she now believes was a precursor to menopause and the change in hormone levels.
However, no doctors told her that at the time, nor did her gynaecologist warn her, that she may become perimenopausal after the operation.She has not been back to the hospital or gynaecologist since, saying nothing she has experienced so far has been as painful as the fibroid.By Kimberley BrownIndiaDoctors told me to grin and bear itPayal Talreja, 57, DelhiGrowing up, Payal Talreja was expected to be a strong woman who could take everything in her stride.
So when menopausal symptoms arrived in her mid-50s, she tried to cope with the physical and mental fatigue, hot flushes, brain fog, loss of libido, and sense of joylessness that made her feel only half alive.View image in fullscreenI think he initially felt unnerved and helpless, Payal Talreja says of her husband, Sunil, adding that she shared everything with him and he had been very supportive and patient.
Photograph: Elke Scholiers/the GuardianShe eventually consulted doctors but found them dismissive.
The fatigue hit me like a brick every morning but they told me my symptoms werent so bad.
I was shocked at doctors lack of empathy and they were women doctors.
Basically, they told me to grin and bear it, says Talreja.If I tell you, then youll start having those symptoms, one doctor told her, as though women were merely suggestible and hysterical.HRT is available in Indian cities but was ruled out in Talrejas case because her symptoms were not serious enough.
Her husband, Sunil, was upset by her mood swings and listlessness, particularly as she had previously been outgoing, sociable and upbeat.The sympathy she showed me was a vast improvement on my experience with the medical professionPayal TalrejaBut their marriage had always been characterised by frank discussion of their feelings.
Like a lot of husbands, I think he initially felt unnerved and helpless, thinking if the doctors dont have any treatment or solutions, then who do we turn to?, she says, but adds: I shared everything with him and he was very supportive and patient.Her husband urged Talreja to start exercising more and joined her on walks and practising yoga.It definitely helped; it made me feel much less sluggish.
But I still suffered from emotional exhaustion, she says.
I just wasnt interested in anything, least of all in socialising.
she says.View image in fullscreenFor her diabetes, Talreja consults an ayurvedic practitioner, who told her that, according to that alternative medicine, menopause was a dimming of the life force within her and recommended a diet with more protein, clarified butter, nuts and seeds to reactivate the life force.I have no idea if these dietary changes made a difference, but what I can say is that the sympathy she showed me was a vast improvement on my experience with the medical profession, says Talreja.She had started therapy for unrelated reasons and found that it helped too, by encouraging her to make time for herself and focus on her own needs without feeling guilty.The therapy taught me I had to give up this notion that I can cope with everything.
It allowed me to admit I wasnt coping.
That alone can be a breakthrough for many women, she says.Talreja, who says she now feels 80% better, believes her husbands role was vital.
Partners need to be 20 times more patient and understanding, and luckily Sunil understood this and helped me through it.ByAmrit DhillonKenyaWe should normalise talking about itNaijeria Toweett, 49, NairobiAfter experiencing sudden flare-ups of body heat and night sweats, bouts of insomnia and lower sex drive, Naijeria Toweett felt some trepidation.
Then her periods stopped and she realised she was going through menopause.At first, she did not dwell on it much.
Then her symptoms got worse.
Usually organised to a fault, Toweett began to be increasingly disconcerted by small things.
The mother of three would forget to salt her chapatis, constantly misplaced her glasses or returned from shopping without the groceries she needed.
Her anxiety increased and she started to have sudden mood shifts.Id be laughing one minute and the next Id just want to crawl into bed and cry.
I dont know why, says Toweett, 49, who went from being an extrovert to a recluse, turning off her phone for weeks at a time.View image in fullscreenNaijeria Toweett, a software engineer, says being able to work remotely was a lifeline in helping to cope with symptoms.
Photograph: Kang-Chun Cheng/the GuardianAt home, minor annoyances could ignite outbursts that left her husband flummoxed.
At work, little peeves morphed into unbearable annoyances.
Toweett, who is a software engineer and works remotely, says flexible work arrangements were a lifeline, enabling her to keep the difficulties she was facing from her colleagues.Jokes of the personal summer and menopause bellies among her friends made her feel understood, but it also troubled her how much they all had to navigate without support or advice.
Toweett, who has worked in the reproductive health field for nearly two decades, says that unlike periods, sex and sexually transmitted diseases, there is very little public information on menopause.Information is readily available to women of childbearing age, but when youre in your 40s and 50s, people assume that because youre older, you know these things, she says.There is also stigma, perhaps due to it being an end to a womans reproductive years a central part of female identity for many women.
Toweet has no recollection of her 72-year-old mother navigating it or telling her what to expect, as she had with other reproductive health issues.View image in fullscreenNaijeria Toweett and her husband, Matthew Ondiege, at home in the Donholm suburb of Nairobi.
We should normalise talking about it, she says.
Photograph: Kang-Chun Cheng/the GuardianToweett found information online and was helped by a former colleague, who was training to become a certified menopause coach and advised her on symptoms, medical treatments and lifestyle adjustments.She also joined online support groups with global memberships, but wishes there were more Kenyan communities where she could find more tailored advice on dietary plans and the accessibility of medical treatments such as HRT in the country.
Some hospitals offer treatment, but it is too expensive for many.
She is sharing the information, and her experiences, with her two daughters, in the hope that they will be better equipped for the experience than she was.We should normalise talking about it both for those of us going through it and those close to us, says Toweett.By Caroline KimeuBangladeshMost of my male colleagues have no idea what menopause isFarhana Jahan, 47, DhakaIt was in July last year that Farhana Jahan first felt something was wrong.
The 47-year-old artist had been having irregular periods but then her symptoms got worse fatigue, hot flushes and general discomfort.
By October, her periods had stopped completely.At first I thought it might be a cyst.
Then I wondered if I was pregnant, says Jahan.
It didnt occur to me that it might be the menopause.View image in fullscreenFarhana Jahan, an artist, at her home in Dhaka, Bangladesh.
Photograph: Farzana Hossen/the GuardianAfter discussing it with friends, she made an appointment with the doctor.
I was told it was perfectly normal and natural for a woman my age, but I couldnt help but feel sad about it, recalls Jahan, who thought to herself: It all goes downhill from here.The past few months have been difficult for her.
Hot flushes have become more frequent and she breaks out in sweats when she least expects it.
I have trouble sleeping at night and then feel irritable throughout the day.
Ive become forgetful, too, says Jahan, who also experiences migraines and joint pain.It helps that she has someone she can talk to.
I speak to my husband about everything and he has been very supportive, says Jahan, who has two teenage children.She says: My children have noticed that Ive become short-tempered, so weve explained that Im going through some changes and need space from time to time.Awareness is key to reducing stigma and encouraging people to talk more openlyDr Zinnat NasreenIt is harder for Jahan to explain what she is going through at work particularly to male colleagues.
Most of them have no idea what the menopause is and speaking about it would only make them uncomfortable.But also, why should it be up to me to explain? she says.
Jahan thinks workplaces should take the initiative to educate staff and create menopause-friendly environments.Jahan has tried to make lifestyle changes, eating more healthily and exercising more.
She has also been using her art as therapy; there are striking handpainted pieces scattered around her Dhaka apartment.
It helps me to be more mindful and better manage my anxiety, she says.View image in fullscreenWomen going through menopause should have access to counselling, Jahan believes.
There is no proper support system in place, she says.
Theres hardly any information available from the health sector, so were left to seek it out for ourselves.If women and girls were more aware of the impacts physically, mentally and emotionally they could better prepare for it.
Or at least see it coming.It is something that others in Bangladesh are trying to address.
Dr Zinnat Nasreen, at the Bangladesh Menopause Society, has been trying to raise awareness of menopause and the support available for women.
The female team holds events and seminars for perimenopausal women and the medical professionals tasked with helping them.The menopause is a major milestone in a womans life but far too many feel forced to suffer in silence, says Nasreen.
Awareness is key to reducing stigma and encouraging people to talk more openly.By Thaslima Begum.
This article first appeared/also appeared in theguardian.com