Score a Six @Menopause

Walking into the second innings @ menopause

THE RULE OF SIX TO HELP YOU FIX

Every woman is different, issues that matter to her are different ,the outlook is different.

Some come in with a list. Typed. Printed. Three pages. Every symptom documented with dates.

I have been googling at 2 am for six months and I am terrified of what I am reading.

Some come in and say they are fine — and then, hand on the door handle, just as they are leaving, say the one thing they actually came to say...

Some come in angry. At their bodies. At the silence around this topic. At being unheard.

Please tell me I am not going mad. Please tell me this ends.

And some — and I love this — come in almost relieved. Done with periods. Done with the monthly planning, the pain, the mood swings that came every twenty-eight days like an uninvited guest. Free.

"Honestly doctor, no more periods — I could celebrate."

Between the lines — what I hear in my clinic

All of these women are right. All of their feelings are valid. And all of them deserve the same thing — clarity, without judgment, and a place to begin.

So here it is. Your place to begin.

"Menopause is every woman's story. "

First — what is normal and what is not

The confusion is real —
and it is the first thing to address

It's the  beginning of a second inning..where one has to stay on the ground ..Not OUT!

The most common thing I hear is — "but how do I know if this is menopause or something else?"

Fair question. Because the symptoms of perimenopause — irregular periods, mood changes, poor sleep, weight shifts, anxiety, brain fog — overlap with thyroid disorders, anaemia, depression, and plain old exhaustion from running a life at full speed.

This is why the first step is not googling. It is asking yourself six honest questions — and then seeing a Menopause trained specialist who will help you navigate smoothly.

The Menopause Quick 6 — MQ6

Dr Susan Goldstein, Family Physician and member of the Canadian Menopause Society, developed these six questions to help every woman — and every doctor — start the right conversation. Answer honestly. If yes to even one — you deserve proper attention.^[1]

1

Have your periods changed? — More irregular, heavier, closer together, or skipping months?

2

Are you having hot flashes or night sweats? — Even occasionally. Even just at night.

3

Any vaginal dryness, pain during intimacy, or changes in your sexual drive? — This one women skip most often. Don't skip it.

4

Any bladder leaks or urgency? — The sneeze, the laugh, the rush to the bathroom. This has a name and it has treatment.

5

How is your sleep? — Falling asleep, staying asleep, waking at 3am with your mind racing.

6

How is your mood? — Irritable, anxious, tearful, or just not yourself. You would know.

A yes to questions 1 to 4 may mean your symptoms can be helped with hormone therapy or other treatments. A yes to 5 or 6 means your sleep and mood need attention — because everything else depends on them.

Goldstein S. Can Fam Physician. 2017;63(4):295–298 · mq6.ca · Supported by the Canadian Menopause Society

Answered yes to some of these?  Now you know where you are. What's next?.

Six · Tests 

🔬

Know your numbers — these six tests tell the story

Tests that reveal the baseline health 

• PAP smear/liquid based cytology,Breast examination and an ultrasound -for the health of the reproductive system.
• Thyroid function — TSH, T3, T4 — Thyroid disorders mimic menopause almost perfectly. This must be ruled out before anything else. Many women in their 40s are hypothyroid and don't know it.
• Hemoglobin/Complete Blood Count/Vit.B12/Vit.D levels — Anaemia causes fatigue, brain fog, and mood changes. Simple, inexpensive, and missed more often than it should be.
• Fasting blood sugar and HbA1c — Insulin resistance rises after estrogen withdrawal. Early detection changes everything.
• Lipid profile — Cholesterol patterns change significantly in menopause. Estrogen was protecting her cardiovascular system — now you need to know where things stand.
• Bone density scan — DEXA — Especially if you are post menopause or have risk factors. One scan gives you a baseline. You cannot protect what you cannot measure.

Six · Foods that make it worse

🚫

Cut and eat less of these

"I eat so little and still the weight comes. What am I doing wrong?" — Often it is not the quantity. It is what and when. These six quietly make everything harder.

• Refined sugar and maida — White bread, biscuits, mithai in excess. They spike blood sugar, worsen hot flashes, and feed the belly fat that menopause is already adding.
• Alcohol — Even one drink triggers hot flashes in many women, disrupts sleep architecture, and affects liver metabolism of hormones. If you notice the connection — trust it.
• Excess chai and coffee — Caffeine worsens anxiety, disrupts sleep, and can intensify hot flashes. Two cups a day is your limit. Try switching one to green tea or tulsi chai.
• Spicy and fried food late at night — Triggers hot flashes and disrupts sleep. Your body at 50 is not processing a 10 pm samosa the way it did at 30. Eat light and early in the evening.
• Ultra-processed snacks — Packaged namkeen, instant noodles, ready meals. High in sodium which worsens bloating and blood pressure — both already under pressure from estrogen withdrawal.
• Excess red meat — Increases inflammation, worsens joint aches, and raises cardiovascular risk which is already elevated post menopause. Reduce — do not necessarily eliminate.

Six · Foods that heal her from within

🥗

Your kitchen is your first pharmacy

"My dadi never went to a doctor for this. She just ate well and got on with it." — She was onto something. These six foods have evidence behind them for Indian women in menopause.

• Ragi and sesame seeds — The richest plant sources of calcium available in every Indian kitchen. Ragi roti, til ladoo, sesame chutney — bone health on a plate.
• Flaxseeds — alsi — Rich in phytoestrogens and omega-3. One tablespoon ground daily in your dal, smoothie or roti dough. Consistently reduces hot flash frequency in research studies.
• Soy — tofu, soy milk, edamame — Phytoestrogens that gently mimic estrogen. Regular moderate consumption is associated with fewer and milder hot flashes. Safe unless your doctor has specifically advised otherwise.
• Turmeric — haldi — Curcumin is anti-inflammatory, supports joint health, and has emerging evidence for brain health. Your morning haldi doodh is not just a custom— it is science.
• Dal, paneer, eggs — protein at every meal — Muscle mass is the new estrogen in terms of metabolic protection. Without adequate protein the body cannot maintain or rebuild muscle. Start your day with protein. Don't forget the water intake with that too.
• Walnuts, almonds, pumpkin seeds — Brain food, heart food, mood food. A small handful daily provides omega-3, magnesium and zinc — three nutrients depleted by stress and hormonal change.

Six · Exercises HER body needs now

🏃‍♀️

Not less movement — different movement

"I walk every day. I have walked every day for ten years. Why is nothing working anymore?" — Because walking alone is no longer enough. .

• Strength training — twice a week — Squats, lunges, resistance bands, light weights. This is the single most important thing she can do for bone density, muscle mass and metabolic health. Start with a trainer if needed — start somewhere.
• Brisk walking — thirty minutes daily — Still essential. Weight-bearing, mood-lifting, heart-protecting. Add hills or stairs to make it weight-bearing and more effective for bones.
• Yoga — especially for balance and breathing — Hormonal change affects balance and the nervous system together. Yoga addresses both. Even twenty minutes of surya namaskar and pranayama daily makes a measurable difference to mood and sleep.
• Dance — Yes, this is exercise. And it is the one most likely to actually happen. Garba, Zumba, Bollywood dance class, or just your favourite songs in the kitchen. Joy is exercise too.
• Pelvic floor exercises — Kegels — Non-negotiable after menopause. Three sets of ten contractions daily prevents urinary leakage, improves sexual function, and takes two minutes. No equipment. No excuse.
• Stretching and cool-down — every single time — Joints and tendons are less forgiving now. Five minutes of stretching after exercise prevents the aches that make women give up entirely.

Six · Ways to fix the mood

💜

She is not difficult — she is depleted

"My family thinks I have changed. Maybe I have. But I don't know how to explain that I am trying." — She is trying. This is what helps.

• Name it out loud. Say — I am in perimenopause and this affects my mood. To your husband. Your children. Your colleague. Naming the emotions helps
• Find one woman who gets it. Not to complain — to feel heard. A friend, a group, an online community. The women who navigate this best are rarely the ones who go through it alone.
• Move your body before you try to fix your mind. A twenty minute walk changes brain chemistry faster than most things. When the mood is black — walk first, think later.
• Reduce what drains you — even temporarily. The committee you joined out of obligation. The WhatsApp group that exhausts you. The relative who always leaves you feeling worse. Menopause is permission to be selective.
• See a doctor if the low mood lasts more than two weeks. Perimenopausal depression is real, common, and very treatable. CBT, hormonal support, or medication — there are options. Suffering quietly is not one of them.
• Do one thing daily that is only for you. One cup of tea in silence. One chapter of a book. Ten minutes of your music. Reclaim yourself in small daily acts.

Six · Ways to sleep well again

🌙

Sleep is not a luxury — it is medicine

"I fall asleep fine. But 3 am — I am wide awake. Mind racing. Heart racing. By morning I feel worse than when I went to bed." — The 3 am wake is one of the most common and most underreported menopause symptoms. Here is what actually helps

• Keep the bedroom cool —  Night sweats are triggered and worsened by a warm room. A fan, lighter blankets, cotton nightwear. Simple but transformative.
• No screens one hour before bed. Blue light suppresses melatonin — the sleep hormone. Replace the phone with a book, light stretching, or the ten minutes of breathing you have been meaning to try.Just a cool shower helps.
• Same sleep and wake time every day — including weekends. The body clock in menopause is fragile. Consistency is the single most effective non-drug intervention for sleep quality.
• Magnesium at night. Magnesium glycinate or magnesium-rich foods — banana, pumpkin seeds, dark chocolate — support sleep onset and reduce night waking. Ask your doctor if supplementation is right for you.
• If hot flashes are waking you — treat the hot flashes. Sleep disruption from night sweats is a medical symptom, not a lifestyle problem. MHT or non-hormonal alternatives can restore sleep when nothing else can.
• Write the 3 am thoughts down — then put the notebook away. The racing mind at 3 am is often anxiety looking for an outlet. Keep a notepad beside the bed. Write what is worrying you. Tell yourself it will wait until morning. Often — it does.

Six · Ways to feel on top of the world

✨

Because this is the beginning of something entirely hers

"I know some women who seem to absolutely bloom after menopause. Like they found something. How do I get there?" — You get there by deciding that you deserve to.

• Celebrate the freedom. No more periods. No more monthly planning around pain and mood. No more contraception anxiety. This is a freedom most women spent thirty years waiting for — and then felt guilty claiming. Claim it.
• Redefine what beautiful means — for you, at this age. The grey hair is not failure. The changed body is not defeat. The lines on the face are not something to hide. They are the map of a life fully lived. She earned every one of them.
• Do the thing you postponed. The trip. The course. The hobby. The friendship you let go quiet. The version of yourself that got shelved somewhere around forty. This is the decade to find her.
• Invest in your health like you invest in your children's futures. The DEXA scan. The annual review. The therapist. The gym membership. You would not think twice about spending on your child's health. You are worth exactly the same.
• Find your voice — and use it. Many women describe a new confidence after menopause. A willingness to say no. To disagree. To take up space. This is not aggression — it is decades of wisdom finally speaking without apology.
• Know that the storm was not the story. It was the chapter before the one where she finally, fully, becomes herself.

INNINGS abhi baaki haI — the GAME is not over

She has only just reached the interval

Just like in a Bollywood film,the interval comes with excitement.The audience leans forward. And then — the second half begins. And so it is with Her 

The periods are done.

The woman is not.

The children are grown.

She is still is exploring 

The storm has passed.

She is still sailing.

Her mother told her to be careful.

Her daughters are watching her be brave.

Navigate gracefully!

References

This post is for general educational purposes and does not replace individual medical advice. Please see your doctor for personalised assessment and care.

[1]Goldstein S. An efficient tool for the primary care management of menopause — the Menopause Quick 6 (MQ6). Canadian Family Physician. 2017;63(4):295–298. Available at mq6.ca · Supported by the Canadian Menopause Society

[2]Panay N, et al., on behalf of the International Menopause Society Board. Menopause and MHT in 2024: addressing the key controversies — an IMS White Paper. Climacteric. 2024;27(5):441–457. doi:10.1080/13697137.2024.2394950

[3]De Villiers TJ, Goldstein SR, on behalf of the IMS. Update on bone health: the IMS White Paper 2021. Climacteric. 2021;24(5):498–504. doi:10.1080/13697137.2021.1950967

[4]International Menopause Society. State of the art in menopause: IMS World Congress 2024, Melbourne. Climacteric. 2025. doi:10.1080/13697137.2025.2457993 

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