Holistic care: Need of hour for menopause management

Menopause is being medicalized. This is a frequently held criticism from health care providers from diverse backgrounds as well as others having stakes in women's healthcare. What all these critics have in common is that they view menopause through the prism of biological model of disease. Others opine that menopause symptomatology is limited to western women and Indian women are happy after menopause, needing no management. Nothing can be farther away from truth.

Analyzing menopause from the biopsychosocial point of view in a culturally relevant model, we realize that postmenopausal women have special needs and thus necessitate special care and attention, which can be best provided by a menopause practitioner. Yet, menopause practitioners do not have a single unified framework in which diversity of menopause can be studied, described, and practiced. In the current review[1] by Kalra B, Aggarwal S, and Magon S, authors expound the vast spectrum of menopause medicine as they discuss the holistic management. Menopause is assessed in a much drafted framework of 6 × 4 = 24 sections (Refer table 1 of the ibid article) reminiscent of the ancient pedagogic method. All aspects of menopause management are covered, ranging from etiology to management.

In etiology, the authors discuss not only the biological (ageing) causes of menopause but also social, psychological, and cross-cultural issues. The multidisciplinary nature of the biology of nature is highlighted, but the paragraph heading “etiology” does not do justice to various concepts discussed in this section. It would require detailed analysis of all the probable causes to do more justice to etiology.

The next section describes biological issues in greater detail giving a new dimension to the term “holistic.” It helps expand the reader change his/her opinion of osteoporosis from a narrow bone centric approach to include joints and muscles, both of which are equally important for musculoskeletal health in menopause. It also helps the reader go one step further by including medical and surgical comorbidities.

In the section of holistic therapy, authors discuss conventional issues including nonpharmacological therapy. Focus on evidence-based holistic therapy such as yoga and nutraceuticals is welcome. Such supportive therapy is rightly emphasized in holistic delivery of menopause care. The authors have also utilized important concepts such as stress management, therapeutic patient education, and shared decision making, transplanting them from endocrinology to menopause science. Toward the end of this review, authors opened our minds toward concepts of eco-sensitivity encouraging menopause practitioners to widen their ambit beyond the individual menopausal woman.

The need to manage and modify the community as well as physical environment is an integral part of holistic management of menopause. The review brings into one document seemingly diverse aspects of menopause, living up to its title. However, more detailed reviews may be in order to highlight and do justice to various aspects of holistic management of menopause brought out by the authors. This article may serve to open new vistas of thinking and working on a holistic framework for managing menopause and afford better quality of life (QoL) to postmenopausal women in times to come.