Hydration

Hydration means taking in enough fluid to replace what your body uses and loses. The NHS describes dehydration as losing more fluid than you take in, and says that if it is not dealt with, it can get worse and become a serious problem.

The simplest check the NHS offers needs no measuring at all: drink enough through the day that your pee is a clear pale yellow.

Several things in these years can tip the balance.

Sweat is the obvious one. Hot flushes and night sweats both make you sweat, and the NHS lists sweating a lot and spending too long in the heat among the things that make dehydration more likely. In a Pakistani summer, the weather does the rest.

Some women drink less on purpose. If you are running to the toilet more often, cutting back on water can feel like the fix. The Pakistan Menopause Society asks doctors to ask about urinary urgency and frequency at a menopause visit (Table 2), because these are symptoms to raise, not something to manage by going thirsty.

Then there are the conditions and medicines that pull water out. The NHS dehydration page names diabetes, and medicines that make you pee more, among the causes.

• The Pakistan Menopause Society lists adequate fluid intake as part of healthy eating (Table 5).
• The NHS water and drinks page says water is a healthy and cheap choice, and that other drinks, tea and coffee included, also count. It advises drinking regularly through the day, drinking extra after sweating, and choosing drinks low in sugar.
• The NHS lists a cold drink among the ways to ease a hot flush, and hot drinks among the possible triggers to cut down on.
• The NHS water page also says to drink caffeine in moderation; more on that in chai, coffee and caffeine.

The PMS table and the NHS page each give a daily figure. Roshara leaves it out on purpose: your needs depend on your body, your health and your weather. The NHS water and drinks page is there if you want the number.

The NHS dehydration page lists signs to watch for: feeling thirsty, a headache, feeling dizzy or light-headed, feeling tired, a dry mouth, peeing less often, and dark yellow pee with a strong smell.

It says to get urgent help if you feel unusually tired, feel dizzy when you stand up and it does not pass, have dark yellow pee or are peeing much less than normal, or are breathing quickly or have a fast heartbeat. The NHS treats dehydration with pale, grey or blotchy skin, cold skin, confusion or being hard to wake as an emergency.

If you have been drinking less to avoid leaks or rushing to the toilet, tell your doctor. Urinary symptoms are on the list doctors are asked to cover, so you will not be raising something odd. See bladder and urinary symptoms.

Ramadan changes everything about drinking. No water from sehri to iftar, in some years through the hottest months, sometimes with flushes on top. Women ask how to get through a fast with night sweats, and how to fit enough fluid into the hours between iftar and sehri. The Ramadan and fasting topic and the blog's piece on fasting and temperature go into that. Questions about the fast itself belong with a qualified scholar, and questions about medicine timing in Ramadan belong with whoever prescribes it.