When Sanjivani Patil spoke about the excruciating pain she was enduring, everyone dismissed it and said it was normal.
She started experiencing irregular periods at the age of 42, and often felt restless, suicidal and depressed. “I would get periods twice a month and bleed excessively,” said Sanjivani, a resident of Badlapur in India’s Maharashtra state.
Somehow, she kept dealing with it. Then one day, Sanjivani’s blood pressure spiked and she had to be hospitalized. Night sweats, sleepless nights, slowed metabolism and brain fog followed.
Menopause is a natural transition, typically occurring between ages 45 and 55, when hormone levels change and periods stop permanently. Many experience irregular periods, hot flashes, night sweats, sleep disturbances, brain fog and mood changes. Growing evidence suggests that these hormonal changes can also affect mental health.
An analysis of over 28,000 women in India found that nearly one in five postmenopausal women aged 50 years and older were living with clinical depression. But reliable estimates of the number of women affected by depression during menopause are scarce, partly because menopausal mental health is not routinely monitored and receives little attention, largely due to negative stigmas and the normalization of emotional and physical period pain.
The consequences of that lapse in recognition can be severe. Sanjivani went through this emotionally devastating period with no support system. “I felt sick and didn’t want to live anymore,” she told TriplePundit.
Almost on the verge of ending her life, Sanjivani found hope in a phone call from a community health worker who lived 370 kilometers away.
Building a volunteer support system
Sanjivani is an Accredited Social Health Activist (ASHA), one of over 1 million women community health workers serving people in both rural and urban India.
ASHAs were introduced under India’s National Rural Health Mission in 2005 to improve access to maternal and child healthcare and bring down infant and maternal mortality rates. They are officially considered voluntary workers, rather than government employees, and are paid largely through performance-based incentives with additional payments varying across states. Over the years, however, their responsibilities expanded far beyond maternal and child health to include immunization drives, family planning, tuberculosis care, non-communicable disease screening, and public health campaigns, leaving the majority of them overworked and underpaid.
As a result, ASHAs are unionizing to demand better pay and working conditions. During one such protest, Sanjivani met Netradipa Patil (no relation), a fellow ASHA and union leader representing 3,000 health activists, and the two exchanged phone numbers.
They chatted regularly until, one day, Netradipa noticed that Sanjivani wasn’t talking as much. Then, she stopped answering Netradipa’s calls altogether. Through fellow ASHAs, Netradipa learned that Sanjivani was diagnosed with depression.
After 15 days of unanswered calls, Sanjivani finally picked up. Based on their conversation, Netradipa suspected Sanjivani’s symptoms might be linked to menopause. “She needed psychosocial support,” Netradipa said.
Though long-distance personal support is not a typical part of an ASHA’s duties and the health activists receive no formal training in menopause care, Netradipa immediately began counseling Sanjivani over the phone and advised her to consult a doctor.
She also suggested meditation, deep-breathing exercises and other mindfulness practices. They spoke daily, and Netradipa eventually found that Sanjivani loved poetry and making rangolis — intricate, hand-drawn floor designs made with colored powders or flowers. Drawing upon her own experience, Netradipa knew that arts could be a gateway to recovery. She encouraged Sanjivani to start practicing the arts regularly, but Sanjivani didn’t feel motivated.
After two months of Netradipa sharing inspiring poems and rangoli designs on WhatsApp, Sanjivani was moved to try her hand at rangoli and document her experiences through poems. “I felt relieved,” Sanjivani said.
After seeing her rangolis, some spanning more than 6 feet across, people began inviting her to create rangolis in their homes. “This helped me regain my lost confidence,” Sanjivani said.
She was still struggling with her mental health, but she called Netradipa whenever she felt overwhelmed. Netradipa patiently listened. “It’s important that people vent,” she said.
Over time, Sanjivani began sharing small victories, too, like someone complimenting her poetry and rangoli. Netradipa encouraged her to hold on to these moments as reminders of her progress and give her something positive to draw on when she was struggling. “It’s important to keep building a bank of such positive affirmations,” Netradipa told TriplePundit.
Tackling menopause misconceptions
Menopause remains a taboo subject in many parts of India, leaving women reluctant to discuss their symptoms or seek help, especially when it is viewed as an inevitable part of aging. When Sanjivani experienced depression, she said those around her did not recognize that depression during the menopausal transition can be influenced by hormonal changes and may require a different approach to diagnosis and treatment than other forms of depression.
Menopause-related depression can also be difficult to recognize because symptoms often fluctuate over many years, said Dr. Jayashri Kulkarni, director of health education and research in the Women’s Mental Health Center at Australia’s Monash University. “Sometimes women describe that they feel completely normal, and then again, they can have a crash in their mental health,” she said.
The fluctuating nature of the condition can make diagnosis challenging, and there is no specific laboratory test to detect menopause-related depression, Kulkarni said. Instead, doctors rely on tests commonly used to assess hormone levels that do not accurately depict what’s happening inside the brain during menopause. “Many times, doctors do blood tests to understand the hormone levels in the peripheral blood sample, which is not a good indication of what is happening with the hormonal fluctuations in the brain,” she explained.
Researchers still need to develop better ways to measure these changes in the brain, Kulkarni said.
Another common misconception in the medical community is that menopausal depression is the same as any other depression, Kulkarni added. This can lead to women being treated with standard antidepressants without sufficient consideration of the specific hormonal changes associated with menopause, and they may not be helpful.
Sanjivani faced this problem. In the first year of experiencing menopause, she said she grew frustrated with taking antidepressants while the underlying cause of her symptoms continued and went unrecognized.
One of the biggest challenges is how the medical field has long-viewed menopause in the same way it views diseases, said Martha Hickey, professor of obstetrics and gynecology at the University of Melbourne and director of the Women’s Gynecology Research Center at the Royal Women’s Hospital Australia. “That model shouldn’t apply to menopause because it’s a life event,” she added.
When menopause is framed as an illness, it can reinforce the notion that aging marks a period of decline rather than another stage of life. One way to challenge that stigma is to “talk about the value of older women rather than see [menopause] as a period of decline and decay,” Hickey said.
Rethinking menopause care
While Sanjivani rediscovered herself through poetry and rangoli, researchers were exploring the impacts of different creative expressions, as well. In Turkey, a randomized trial found that mandala coloring significantly reduced menopause related anxiety and improved quality of life.
Researchers also asked menopausal women to listen to two traditional Turkish music pieces — a calming melody in the morning and another designed to promote sleep at night — for 15 minutes twice a day over five weeks in addition to routine menopause care. They reported fewer menopausal symptoms, reduced depressive symptoms and better sleep quality than women receiving only routine care.
Another analysis found that mind-body interventions improved sleep, depression and anxiety during menopause, with mindfulness- and music-based interventions showing the strongest psychological benefits. That includes meditation, yoga, pilates, music therapy and dance therapy, among others.
And a review of 30 randomized trials including over 3,500 women found that a wide range of psychosocial interventions — from cognitive behavioral therapy and mindfulness to support groups, counseling, and coaching — improved women’s emotional wellbeing during menopause.
While menopause research traditionally focused on identifying and addressing symptoms, a review of 181 studies argues that researchers should also ask how women can flourish during this life stage. Although menopausal symptoms were consistently associated with poorer emotional and psychological wellbeing, a small body of research suggests that some women describe the transition as a period of personal growth and renewed purpose. The authors argue that these positive experiences remain underexplored.
With counseling, medications, and arts in her toolkit, Sanjivani recovered after three years. She then decided to address misconceptions about menopause in her community and help other women experiencing menopause-related depression.
Drawing on her experience as an ASHA, Sanjivani said that many women with persistent menstrual problems are quickly advised to undergo a hysterectomy — the surgical removal of the uterus — which permanently stops menstrual periods. India’s National Family Health Surveys have found that by age 50, one in 10 women have undergone a hysterectomy. “This is not how it should be,” Sanjivani said, echoing many health advocates who say the procedure is often recommended to women without adequately exploring less invasive treatments for their menopause symptoms.
Sanjivani now maintains a list of women experiencing symptoms similar to hers and helps them receive proper treatment. She aims to reach as many people as possible. “After someone heals, I ask them to share their experience with others, and that’s how this chain keeps growing,” Sanjivani said.
And while professional medical treatment is an essential, irreplaceable part of menopause care, she suggests it should be complemented with art therapy.
Netradipa is also spreading her knowledge. She has trained more than 50 ASHAs in menopause support and provides counseling for patients remotely. While ASHAs receive no formal training in menopausal mental health, many take it upon themselves to support others. Their efforts are helping fill a critical gap in mental health support. Less than 4,000 clinical psychologists serve more than 1.4 billion living in India, leaving many women with few places to turn.
Netradipa said she would like to see the government formally train ASHAs to counsel menopausal women, compensate them fairly and hire more mental health and menopause specialists. Despite success stories like Sanjivani’s, ASHAs face tremendous challenges. With limited resources and without compensation, they remain overstressed and many also work as farmers to make ends meet.
Still, they continue to help people, reaching as far as the most remote corners of the country. “Whenever I see someone recovering, I feel like I have given them a new life, which inspires me to keep going,” Sanjivani said.
