By Veronica Mrema
For women, reaching menopause is not simply the end of menstruation. It marks the beginning of a period of bodily changes that can affect the functioning of the entire body.
Sleep patterns, emotions, the ability to concentrate, relationships and other aspects of daily life can all be affected.
Johari Kibena began experiencing several changes when she reached the age of 40. She started having sudden episodes of intense heat, suffered from lack of sleep and became increasingly irritable.
What troubled her most, however, was what she described as changes in her mental state. Much of the time, she felt as though her thoughts were stuck.
Work that she had previously completed well and within a short period of time began taking much longer. She found herself struggling to complete tasks.
She could no longer concentrate as she used to, and at times she felt that something unusual was happening to her.
At first, Johari did not know that these symptoms could be linked to hormonal changes associated with the transition to menopause. She began looking for other explanations.
“I thought perhaps I had been affected by dark spiritual forces,” Johari says, describing how she tried to make sense of the changes she was experiencing.
“I used many different medicines. People would tell me, ‘Use this one and try that one.’ You know how we are we often go to pharmacies and simply buy medicines. I did that, but I did not get positive results.”
One day, when she attended her women’s savings group, she began to realize that things might be different from what she had initially thought.
“There was a woman who was telling us about what she had gone through during menopause. I compared her experience with mine and realized that perhaps I was also dealing with the same condition.
“I took action and went to the hospital. I am now receiving treatment,” Johari says.
Her experience raises a central question that forms the basis of this article:
How much does Tanzania know about women reaching menopause, the challenges they face, and the extent to which solutions are available to address those challenges?
THE REALITY
Tanzania has national data showing the proportion of women who have reached menopause, but there remains an information gap regarding what these women experience in their daily lives.
According to the Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 [TDHS-MIS 2022], 10.6% of women aged 30 to 49 were identified as menopausal according to the criteria used in the survey.
The figures increase with age. Among women aged 30 to 34, the proportion was 3.1%, while among those aged 35 to 39 it was 4.5%.
For women aged 40 to 41, the figure was 8.2%; among those aged 42 to 43, it was 11%; and for those aged 44 to 45, it was 12.1%.
Among women aged 46 to 47, the proportion reached 26.6%, while among those aged 48 to 49, it was 46.1%.
However, these figures mainly show how many women had reached menopause at the time of the survey. They do not provide a detailed picture of how this stage affects their lives.
For example, they do not show how many women experience hot flashes, lack of sleep, mood changes, difficulty concentrating or what is commonly described as “brain fog”.
Nor do they show the extent to which these symptoms affect women’s work, families and relationships.
This is where the information gap becomes apparent.
M24 TANZANIA conducted an exclusive interview with Professor Muzdalifat, a specialist in Obstetrics and Gynaecology and Medical Director at Aga Khan Hospital.
She says more research is needed to gain a deeper understanding of the experiences and needs of women going through menopause.
Therefore, it is not that Tanzania has no menopause data at all. Rather, the question that remains is: What are these women experiencing, how severe are the challenges, and what services do they need?
MENOPAUSE IS A STAGE OF LIFE
Professor Muzdalifat says menopause is a normal stage in a woman’s life.
It can occur between the ages of 45 and 55, when the ovaries begin to reduce their production of the hormone oestrogen.
Before reaching menopause itself, a woman goes through a period known as perimenopause, which is accompanied by hormonal changes and a range of symptoms.
These symptoms may include hot flashes, lack of sleep, headaches, mood changes, irritability and dizziness.
They may also include forgetfulness, difficulty concentrating, what is commonly described as “brain fog”, as well as muscle and joint pain.
For some women, these symptoms may appear to be caused by completely different problems. That is what happened to Johari.
Without accurate information, a woman may begin looking for other explanations for the changes she is experiencing before realising that they may be associated with perimenopause or menopause.
MENOPAUSE AT WORK
For Dr Zuhura Majapa, the challenges of menopause do not end at the hospital. They can also enter the workplace.
Dr Zuhura, who has also served as a Chief Medical Officer at a hospital, says she has encountered situations in which women going through perimenopause or menopause appeared to experience a decline in their performance at work, while the reason for those changes was not understood.
“A woman may experience poor sleep at night, wake up tired, struggle to concentrate or experience mood changes.
“At work, she may take longer to complete a report or fail to work at the pace she was previously accustomed to.
“The problem comes when these changes are automatically interpreted as negligence,” she says, referring to situations she has witnessed.
Dr Zuhura gives the example of an employee who fails to submit a report on time and ends up being criticised by her supervisor, without anyone considering whether there may be another challenge affecting her.
However, she stresses that not every decline in workplace performance should be attributed to menopause. Sometimes negligence is simply negligence.
What is needed, in her view, is understanding.
Rather than workplace situations ending with blame and warning letters, Dr Zuhura says education and open conversations can help employers and employees understand the changes that may occur during this stage of life.
LIFE OUTSIDE THE OFFICE
For women, there is also life outside the workplace. Dr Zuhura explains that menopause can affect family and marital relationships.
Some women may experience a reduced interest in sexual intercourse or develop symptoms that make sexual intercourse uncomfortable.
In situations where a partner does not understand what is happening, these changes may be misinterpreted.
That is why, in her view, menopause education should not target women alone. Families and partners also need to understand what women may be going through.
HRT: TREATMENT IS NOT SELF-MEDICATION
As awareness of menopause symptoms increases, some women may look for ways to reduce the challenges they experience.
One option may be Hormone Replacement Therapy, commonly known as HRT. However, the use of these medicines requires medical assessment.
The Tanzania Medicines and Medical Devices Authority [TMDA] says HRT is among medicines that require a prescription.
M24 TANZANIA conducted an exclusive interview with Dr Yonah Mwalwisi, a pharmacist and Director of Human and Veterinary Medicines Control at TMDA.
He says HRT should be used following consultation with and under the supervision of a healthcare professional.
According to TMDA information, a total of eight HRT medicines have been registered in Tanzania, available in the form of tablets, capsules and pessaries.
However, the availability of these medicines on the market does not mean that every woman experiencing menopause symptoms should use them.
Professor Muzdalifat explains that a woman who may need HRT should first undergo a medical assessment to determine whether she is suitable for the treatment and whether she has any factors that could increase her risk of adverse effects.
“First, you need to educate that person and carry out an evaluation to determine whether she is at risk of complications,” she says.
The type of medicine, dosage, method of administration and duration of treatment may depend on the woman’s condition, age, medical history and other risk factors.
According to TMDA, inappropriate use of HRT may be associated with risks such as blood clots and stroke.
For some women who use a combination of oestrogen and progestogen over a long period, there may also be an increased risk of breast cancer.
For women who have a uterus, using oestrogen alone without appropriate progestogen may increase the risk of cancer of the lining of the uterus.
Other possible side effects may include abnormal vaginal bleeding, breast pain, headaches, fluid retention and interactions with other medicines.
TMDA DATA
TMDA data shows that between 2021 and 2025, a total of 2,624 reports of suspected adverse drug reactions or effects were associated with hormonal medicines used by women.
In 2021, there were 14 reports; in 2022, there were 28; in 2023, the number rose to 1,052; in 2024, there were 726; and in 2025, there were 804 reports.
However, these figures need to be interpreted carefully. They do not mean that all 2,624 reports were caused by HRT alone.
Dr Mwalwisi says that so far, no reports during that period have involved serious adverse effects resulting in permanent disability or death.
He also says that over the past five years, no HRT product has been reported or found to be unregistered, counterfeit or substandard.
“Women using HRT should use registered medicines and obtain them through legitimate outlets such as hospitals, health facilities and pharmacies, and follow instructions on dosage, method and duration of use,” he advises.
THE NEED FOR SPECIALISED CLINICS
Professor Muzdalifat further points out that menopause requires more than medicines.
Tanzania needs national guidelines on menopause, specialised services and adequately trained healthcare professionals in this area.
At present, she says, there remains a gap in specialized menopause expertise in Tanzania.
This has encouraged her to continue pursuing specialized training related to menopause through a programme in the United Kingdom.
Another challenge is the cost of treatment for some women who require medical care.
“For one woman, the cost can be around TZS 300,000 to 400,000 per month for some medicines and services related to treatment,” she says.
Therefore, the extent to which these services are covered by health insurance also requires further discussion, particularly if Tanzania aims to build comprehensive services for women going through menopause.
Ultimately, Johari’s experience shows that menopause can be more than a biological transition.
For some women, it can affect how they sleep, think, work, relate to others and understand their own bodies.
Tanzania has national statistics showing how many women reach menopause, but a broader picture of their experiences is still needed.
The challenge is therefore not only to provide treatment to women who reach health facilities, but also to improve awareness, strengthen research.
Expand specialized services and ensure that women receive accurate information before turning to self-medication or advice from friends and informal sources.
For women like Johari, recognising what is happening may be the first step towards finding the right care.
Chapisha Maoni