Bleeding, fear, and no answers
By Kelvin Tembo & Wezi Nyirongo Chamanza
When the heavy bleeding began at the age of 45 followed by dry flow of blood in some months, hot flashes, and mood changes, this Malawian woman, who chose to remain anonymous, was certain something was fatally wrong.
The flow in particular, was so intense and so unfamiliar, leaving her confused.
“I thought it was cervical cancer when I first started experiencing the heavy flow, and I cried and cried for days,” she says, remembering the fear that consumed her.
Her diagnosis came almost by coincidence. She had gone to the hospital for an injury she thought was a fracture.
During the consultation, she mentioned the strange nights she had been experiencing, which included unbearable heat followed by chills within minutes.
The doctor informed her she was entering menopause. That was the end of the conversation. No explanation, guidance, and support.
Back home, confusion turned into shame and emotional chaos. Sweat poured from her in public spaces, prompting friends to conclude that something was wrong with her blood pressure.
At home, her unpredictable moods frightened her children. Her marriage, too, became strained as intimacy felt uncomfortable and overwhelming.
“Sometimes, I didn’t want to be touched by my husband, it irritated me. Sometimes, I got angry without any cause, shouting at my three children. My husband and children were afraid of me due to my mood, it was a bad experience,” she says.
Only after joining a menopause forum did she begin to understand her symptoms.
She now believes that if she had been educated earlier, she would not have faced the terror she endured.
“Women need to know this happens so that they are not taken by surprise when they reach the stage. We need open conversations to break the silence,” she says.
“No one told us what to expect.’
This woman’s story reflects the confusion many Malawian women encounter.
At 57, Manyanani Munthali remembers discovering she had reached menopause at 47 after experiencing short episodes of sudden heat.
Her symptoms were mostly manageable, but one lingers painfully.
“The worst thing was memory loss,” Munthali says.
Like many others, Munthali received no support from the health system. She figured out her coping mechanisms on her own such as drinking warm water and adjusting her lifestyle. But she believes women deserve more formalized assistance. She wants national menopause guidelines that include screening, diagnosis, counselling, mental health support, and treatment options.
“Primary healthcare workers must be trained to recognize and manage menopause symptoms sensitively and effectively,” Munthali says.
Another woman, who entered menopause at just 37, and opted for anonymity felt her entire life slow down.
Hot flashes, mood swings, exhaustion, brain fog, and changes in weight left her overwhelmed.
“I had to hold a meeting with myself just to get in gear and prepare mentally for some tasks. Even my relationship with others suffered. I became less tolerant, especially with my stepdaughter.
Hospitals offered little help, often nothing more than Panadol and dismissal. I prayed to God for strength to go back to the old me,” she explains.
She adds; “The worst thing about this has been not knowing how to handle myself. I am now managing my symptoms by taking it one day at a time.”
For this woman, who discovered she was entering menopause at the age of 50, the most difficult part was the emotional upheaval.
Anxiety, irritability, and heavy bleeding disrupted her routine and affected her sleep.
“I wish I had known earlier what to expect but information in this area is lacking. I now manage my symptoms through taking supplements and hydration but I believe that women should talk openly about menopause without shame,” she says.
We cannot keep dismissing women
Despite these widespread experiences, the Ministry of Health remains reluctant to prioritize menopause, viewing it as a natural process that does not warrant focused attention.
This position frustrates advocates who believe such neglect is harmful.
Mercy Nwachukwu, Youth Coordinator for Menopause issues at the Malawi SRHR Alliance says the health system’s attitude is both outdated and dangerous.
For her, menopause belongs squarely within the framework of sexual and reproductive health rights.
She emphasizes that menopause is not simply a biological milestone but a phase that reshapes a woman’s physical, emotional, and social wellbeing.
“When women are dismissed, their quality of life drops. And when a system repeatedly tells women ‘there is nothing wrong with you,’ they begin to doubt their own experiences,” Nwachukwu says.
She argues that menopause must be integrated into Malawi’s SRHR policies with the same seriousness as other reproductive health stages. That includes training for healthcare workers so they can identify symptoms instead of mislabeling or minimizing them.
She believes the lack of information on menopause in Malawi reflects a broader societal reluctance to acknowledge women’s midlife health needs.
But her advocacy extends far beyond hospitals. She says community-level awareness is crucial, beginning with conversations led by traditional authorities, faith leaders, and local influencers who can break cultural myths. She adds that the media should normalize menopause by featuring it regularly in programs and discussions.
“Workplaces also need to evolve. Many employers have wellness policies but few recognize menopause as a legitimate health issue affecting productivity and psychological wellbeing. Workplaces must understand that menopause is not a weakness but a life stage,” she says.
For Nwachukwu, the goal is simple. A society where women experiencing menopause feel informed, supported, and respected.
Prepare your body, but society must also prepare itself
Gynecologist Doctor Edgar Kuchingale believes the country’s silence around menopause does more harm than people realize.
He explains that while every woman will eventually reach menopause, their experiences differ widely and lifestyles play a major role.
“Women who regularly exercise, stay active or engage in physically demanding work tend to have milder symptoms while those with sedentary routines often experience more intense hot flashes and even heart palpitations,” Kuchingale says.
He adds; “The palpitations are among the scariest symptoms. Some women feel like they are dying. Yet, with proper information, many women could avoid unnecessary anxiety.”
Kuchingale stresses that no matter the symptoms, before prescribing medication, doctors should first guide women toward lifestyle adjustments, including physical fitness, balanced nutrition, and emotional preparation.
He also highlights that emotional symptoms like irritability, sadness or mood fluctuations are deeply shaped by culture.
He says since emotions are often culturally managed, some women may struggle more in environments where emotional expression is discouraged.
“This is why I believe community-level conversations are essential. We need to put the information out there, in churches, workplaces, and social gatherings. Women must know this is normal,” he says.
To Kuchingale, menopause is not a problem to cure but a transition to prepare for.
He says; “If women know what to expect, and if their communities understand as well, their experiences will become less frightening.”
It is a stage in life but support makes the journey easier
Menopause is more than just a private experience. It intersects with sustainable development goals, including good health, gender equality, reduced inequalities and descent work.
When women receive proper support during midlife, they remain healthier, emotionally stable, and economically active.
For too long, Malawian women have carried the burden alone. But stories from the woman who feared she had cancer to the young mother forced to renegotiate her emotional limits, to older women demanding dignity, reflect a new momentum. Women are beginning to speak, advocate, and push for recognition.
“It is a stage in life we all go through. How we handle it determines our strength but support makes the journey easier. Letting those around us know what you are going through and what they are to expect will help them understand this stage, which will help you handle it smoothly as a family,” says a woman, who entered menopause at the age of 37.
She adds; “Education and awareness is key. Also, if we can have more doctors who would specialize in this field where us women would feel free and comfortable to talk and be told it will be okay, and get the best advise on how best to handle our stage, things will be easier.”
The conversation has begun. Whether Malawi chooses to listen will define the future of women’s health in the country.
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