Groundbreaking research from Kozhikode reveals the prevalence, influencing factors, and protective interventions for menopausal women in rural India
For the women in the lush, tranquil villages of Kozhikode, a silent health transition often unfolds behind closed doors. Menopause, a natural biological process marking the end of menstrual cycles, affects every woman who reaches midlife, yet remains one of the most misunderstood and underdiscussed aspects of women's health. In rural India, where healthcare access may be limited and cultural taboos persist, this transition can be particularly challenging.
Menopause is defined as the permanent cessation of menstruation after a woman has gone 12 consecutive months without a period 1 . But this clinical definition barely scratches the surface of what women actually experience.
Contrary to popular belief, menopause isn't a sudden switch but a gradual transition called perimenopause that can begin up to ten years before the final period 9 .
During this phase, the ovaries gradually produce less estrogen and progesterone, but this decline isn't steady. A woman's hormones can fluctuate unpredictably from day to day 9 .
The hormones produced by the ovaries promote health throughout the female body, influencing everything from bone density and cardiovascular health to cognitive function and sleep quality 9 . When these hormones decline, the effects ripple through virtually every system in the body.
To better understand the menopausal experience in rural Kerala, researchers conducted a comprehensive cross-sectional study in Nanminda panchayat, a rural area in Kozhikode district 1 .
245 postmenopausal women aged 40–55 years 1
One year (June 2015 to June 2016) 1
Nanminda panchayat, Kozhikode district 1
The study employed rigorous scientific methods to ensure accurate results. Researchers used cluster sampling, selecting 6 out of 17 wards in Nanminda panchayat through random sampling 1 .
Each participant underwent a comprehensive assessment using a pretested semi-structured questionnaire based on established checklists of menopausal symptoms 1 .
The findings from Kozhikode painted a clear picture of the menopausal experience in rural Kerala. The average age of menopause among participants was 46.7 years, with most women attaining menopause after age 47 1 .
The Kozhikode study revealed several significant factors associated with the presence and severity of postmenopausal symptoms 1 . Understanding these factors is crucial for developing targeted interventions.
The research revealed that women who experienced early menopause faced greater health challenges. Those who reached menopause at a younger age and those with less time since their final period had a higher risk of experiencing postmenopausal symptoms 1 .
This connection between menopausal timing and long-term health is supported by newer research from 2025, which found that women with later-onset menopause have healthier blood vessels and are less likely to experience heart attacks and strokes in their postmenopausal years 7 .
The Kozhikode study found that educational status was significantly associated with postmenopausal symptoms 1 . This connection likely operates through multiple pathways: education often leads to better health literacy, enabling women to recognize symptoms and seek appropriate care.
Similarly, marital status showed a significant association with menopausal symptoms 1 . Married women may have better social support systems, which can buffer against some challenges of this transition.
One of the most promising findings from the Kozhikode research was that calcium supplementation had a protective effect against menopausal symptoms 1 . Binary logistic regression analysis confirmed that dietary intake of calcium supplements was significantly associated with reduced symptom prevalence 1 .
The protective role of calcium may be particularly relevant for preventing osteoporosis, a significant concern for postmenopausal women. As estrogen levels decline, bone loss accelerates, increasing fracture risk.
A 2025 analysis revealed encouraging news: osteoporosis-related mortality among postmenopausal women in the U.S. declined significantly from 1999 to 2023, with age-adjusted mortality rates dropping from 29.35 to 12.00 per 100,000 women 6 .
This finding takes on additional significance in light of recent large-scale studies. The Women's Health Initiative, a landmark study of postmenopausal women, found that calcium and vitamin D supplements appear to lower the risk of dying from cancer by 7%, though they may slightly increase the risk of dying from heart disease by 6% 2 .
The findings from rural Kozhikode contribute to a growing global recognition of menopause as a significant public health issue that deserves greater attention and resources. Despite progress, substantial gaps remain in both healthcare provider knowledge and public understanding.
A startling survey revealed that over 90% of obstetrics and gynecology residency program directors in the U.S. believe residents should have access to standardized menopause training, yet less than a third of programs actually offer one 9 .
The consequences of this educational gap are significant. A 2025 survey found that 24% of women aged 40-49 had a healthcare provider incorrectly attribute their perimenopause symptoms to anxiety 5 .
A 2025 prospective cohort study found that intentional weight loss was associated with lower subsequent mortality rates in postmenopausal women 3 . Specifically, intentional weight loss was linked with:
The growing recognition of menopause as a critical health issue is reflected in new initiatives, such as the Menopause Society's announcement that it will invest $10 million into a training program specifically designed to equip healthcare providers with the knowledge and tools necessary to treat menopause 5 .
The research from rural Kozhikode provides valuable insights that extend far beyond its specific geographic context. By revealing that nearly two-thirds of postmenopausal women experience significant symptoms, and identifying key factors that either protect or predispose women to these challenges, the study points toward concrete strategies for improving midlife women's health.
"If a woman understands her physiology, she'll do much better in the long run" 9 . The same principle applies to healthcare systems and societies broadly—the better we understand menopause, the more effectively we can support women through this transition.
The findings underscore that menopause is not merely a reproductive event but a comprehensive health transition with implications for multiple body systems. The protective effect of calcium supplementation, the impact of socioeconomic factors, and the significance of menopausal timing all represent potential intervention points for enhancing women's health and quality of life during this transition.
Women expected to be in menopause globally by 2030 9
Projected menopause market by 2033 9
Research like the Kozhikode study provides the essential foundation for building a future where every woman can navigate menopause with support, understanding, and appropriate care.
References will be listed here in the final version.