My journey: from fertility care to midlife health

Key takeaways

• I am a Gynaecologist and Fertility Specialist (Reg. No. 2006/02/1187), and I still run my IVF and fertility practice.
• Years of fertility work meant years of reading and adjusting hormones, which is the core skill in perimenopause care.
• My own hot flashes, about two years ago, changed how I hear women describe their symptoms.
• I treat by symptoms rather than a single hormone blood test, because hormones swing through the day in perimenopause.
• The years from perimenopause onwards are neglected by women, doctors and society, and I want partners involved in care.

Where did my work begin?

My practice was built in IVF and fertility, and that work continues. Fertility medicine is, in large part, hormone medicine. As a fertility specialist I have spent years reading hormone patterns, timing treatment to them and adjusting doses as the body responds.

That experience turned out to be the bridge to my second focus. Hormones do not stop mattering when a woman's fertility years end. In many ways, they matter more.

What made me turn towards midlife health?

The first push came from my own patients. Many women I had treated for fertility in their 30s came back to me in their 40s and 50s. They were no longer asking about pregnancy. They were describing the same set of symptoms, again and again.

The words were often the same too: "I don't feel like myself anymore."

Midlife symptoms can include hot flashes and night sweats, poor sleep, low mood, irritability, brain fog (trouble thinking clearly or remembering), joint aches or bloating. Symptoms are symptoms. They do not arrive neatly labelled as "menopause", and they are very easy to put down to stress or age. It's not their fault that they don't connect the dots.

This matters in India in particular. A pan-India survey by the Indian Menopause Society reported an average age of natural menopause of about 46 years, several years earlier than the figure of around 51 often quoted for Western women. Perimenopause, the years of change before the final period, starts earlier still. Many Indian women are in the middle of it while managing work, children and ageing parents in a joint or busy household.

What changed when I had hot flashes myself?

About two years ago, I began having hot flashes. My honest reaction was: "If this is what women suffer day in and day out, I'm not ready for this."

I treated myself. And only then did I understand the gravity of what my patients had been describing. Knowing the hormones and the evidence is one thing. Living through the symptoms is another.

That is part of why my consultations are long. I want to hear every symptom, not just the one that brought you in.

Why do I treat by symptoms instead of a blood test?

See, I'll tell you. In perimenopause, hormone levels swing, sometimes within the same day. A single blood test is literally a snapshot of one moment. It can look normal on a day when you feel far from normal.

This is consistent with guidance from NICE in the UK, which says women over 45 with typical symptoms can be diagnosed with perimenopause or menopause on their symptoms, without confirmatory hormone tests. Other tests, like a blood count or thyroid check, may still be needed if something else could be causing the symptoms.

So I order only the tests that are needed: general bloods, and where indicated, DEXA bone density (a scan that measures bone strength), sonography or a Pap smear. I am not in favour of 70 or 80 test packages.

I also think about timing with a simple picture. Waiting a full year without periods to confirm menopause before treating anything is like getting down one stop after yours at the bus stop. You arrive, but later than you needed to, and then you walk back the distance.

How do I think about hormone therapy?

Carefully, and with the evidence in front of the woman.

My view is that a large study around 2002, the Women's Health Initiative, was widely misinterpreted, and that fear of hormone therapy kept many women from even discussing it. In November 2025, the US FDA announced it was initiating removal of the boxed warnings about cardiovascular disease, breast cancer and probable dementia from menopausal hormone therapy labels, and asked for updated, balanced labelling. The boxed warning on endometrial cancer (cancer of the lining of the womb) was kept for systemic estrogen-alone products.

That does not mean hormone therapy is right, or risk-free, for everyone. The FDA's labelled recommendation for systemic therapy is to start within 10 years of menopause onset or before age 60, and the decision is made between the doctor and the woman after weighing her own history. Where it is indicated, I use body-identical hormones, such as estradiol and micronised progesterone. These are prescription decisions I make after assessment.

Why do I want partners in the room?

When a woman's mood changes in perimenopause, the people around her often read it as a change in personality. I want partners in counselling so they understand that the mood changes are hormonal. That understanding can take a great deal of strain out of a home.

Daughters are welcome too. They will reach this stage themselves, and it helps to know what is coming.

What is my larger aim?

The years from perimenopause onwards make up 30 to 40 percent of a woman's life, and they are neglected by women themselves, by doctors and by society. The point is, this stretch of life deserves the same attention we gave the fertility years.

That aim became The Right Stop Programme at Cocoon × Dr Tvacha, on the 2nd Floor of Suraj Arcade, Thane West, one floor above Dr Tvacha Thane. You are seen by a woman doctor, with a female coordinator. Consult hours are Monday to Saturday, 9:30 am to 12 pm and 1:30 to 3:40 pm, with teleconsult follow-ups available.

For the wider story of the clinic, read how Dr Tvacha began, or find practical details in our guide to our centres.

How we approach this at Dr Tvacha

If you are 40 or older and you recognise yourself in "I don't feel like myself anymore", the first step is the Midlife Women's Health Check at Cocoon × Dr Tvacha. The fee is shared when you book and tests are charged at actual cost. Ongoing hormone care is Rs 4,000 to 9,000 a month. Details are on the women's health page.

Written by

Dr Anagha KarkhanisGynaecologist and Fertility Specialist · Reg. No. 2006/02/1187

Leads midlife women's health at Cocoon × Dr Tvacha, Thane.