Menopause doesn’t have a great reputation. It’s that time in life when hot flushes, bladder problems and low mood tend to dominate. But what happens when you come through it and enter a phase called post-menopause? This article aims to help you understand what can you expect from this new period in your life and how to best take care of yourself.
When will I be in post-menopause?
The average age of menopause for UK women is 52. Most women reach this milestone of their periods stopping somewhere between ages 45 and 55. Many of the symptoms associated with menopause happen before periods stop, in a phase called the perimenopause when your oestrogen levels gradually decrease. Women are said to have “achieved” menopause itself 12 months after their final period. At this point they are said to be post-menopausal.
Post-menopause. The good news!
Once you’re post-menopausal, many of the symptoms you may have experienced during perimenopause and menopause should fade and eventually stop.
Even better perhaps is the fact you will no longer have to deal with the disruption, pain and mood changes that are often part of the menstrual cycle for so many women. No more periods! Plus, you don’t need to worry about unplanned pregnancy. However, if you choose to take HRT that allows your periods to continue, you won’t see those changes.
Just because you can’t get pregnant you should still take steps to protect yourself from sexually transmitted infections (STDs) if you’re not confident of your partners’ sexual histories.
Many women (as many as 70-80%) suffer from uterine fibroids at some point. These are small benign growths that can develop in the wall of your womb and cause some women to have heavy periods or experience pain. The hormone changes in menopause stop these tumours growing and of course the heavy bleeding linked with fibroids also stops.
The emotional impact of the menopause
It’s easy to get bogged down in the physical symptoms of menopause, but it’s important to step back and look at the overall impact of this time in life.
Whether the menopause arrives suddenly, prematurely or over a period of months or years, it’s not surprising that alongside the hormonal and consequent physical changes, there will be conflicted feelings, confusion, anxiety and (unnecessary) shame. There are physical and psychological losses to be faced and perhaps an acceptance that some hopes and aspirations will not be fulfilled.
But the menopause also creates opportunities for change. Space to make lifestyle changes, deepen relationships and develop a new understanding of a new developing identity.
Acknowledging the changes, facing the losses, and adapting to a new stage in your life by asking for and accepting support from friends and family and seeking medical or psychological help if needed, are the first steps towards managing an ending and beginning to enjoy a new stage in your life.
Many women feel liberated by menopause. It can be a time to take stock of the next phase of your life. Don’t forget you have half your life still to live. You can make many new decisions, perhaps take more risks.
There are lots of support groups for menopause which are listed at the end of this article. But however you experience the menopause before, during or after, your GP should support you during this time
Dealing with the physical effects of menopause
It might feel like you spend a lot of time with healthcare professionals while you’re going through menopause and it can be a relief for many women to ‘reach the other side.’ That’s because this period of your life can bring new health issues – some are part of the typical ageing process, others are unique to the decrease in your body’s natural production of oestrogen.
This hormone has an effect throughout a woman’s body, not just the reproductive system. So with a decrease in oestrogen, your body’s major systems can be affected too. Some people see the post-menopause as a natural part of ageing, accepting the effects of low oestrogen. Some see it as a hormone deficiency that needs treatment. This article is intended to help you make informed choices over your approach and your treatment. Let’s look at how and what you can do to look after yourself.
It’s important to pay attention to your menopause and when your periods stop. If you experience bleeding more than a year after your periods have stopped or a vaginal discharge, it’s important to see your doctor as it may indicate a serious medical issue. You should also talk to your doctor about any health issues you experience post-menopause that cause discomfort or pain.
Lingering menopausal symptoms
Few women make sudden, easy jumps from the different stages of the menopause and symptoms can last months or even years. So even though you may not have had a period for 12 months and are therefore, post-menopausal, you may still experience typical menopausal symptoms. Your GP should help you through this period. They should offer advice about lifestyle changes to try during and after menopause, as well as information about both non prescribed and prescribed medication, including hormone replacement therapy. You can read about what to expect from your GP and get an overview of the available treatments in our complete guide to the menopause.
Keep track of your overall health
Remember, there’s life after menopause and it’s important to look after yourself. So make sure you keep up with any tests and screenings you’re offered. Tests and screenings you should expect following menopause include: smear tests, mammograms and other cancer screenings and immunisations.
Heart/Cardiovascular system
Oestrogen is thought to protect the lining of artery walls and help regulate blood flow. That’s why researchers believe a decline in oestrogen after menopause may be a factor in the increase in heart disease among post-menopausal women, according to the American Heart Association.
Hormone replacement therapy (HRT) taken before the age of 60 does not increase your heart disease risk. HRT protects against heart disease to some extent but most women will eventually stop. If you smoke, it’s really important that you quit and there’s lots of support available.
What you eat and drink and keeping physically active will also help protect your heart and cardiovascular system. Our article on six steps to a healthy heart might help.
Bones and osteoporosis
There is a direct relationship between the lack of oestrogen after menopause and thin bones. This is called osteoporosis, when bones become fragile and break easily. These breaks are most common in bones of the spine, wrists and hips. People may also be at increased risk of osteoporosis because it runs in their family or because of the side effects of some medications such as steroid tablets or injections. Therapies and treatments are available to help prevent fractures in people with osteoporosis. You may be assessed for fracture risk if you have any of the risk factors outlined below.
- If you break a bone
- If you are currently using steroid tablets or injections or have used them frequently and recently
- If you have a history of falling
- If have a family member who has had a hip fracture
- If you have another condition known to cause osteoporosis.
- If you are underweight for your height (called a low body mass index)
- If you smoke
- If you drink more than 14 units of alcohol a week
There are a number of ways fracture risk can be assessed including taking a questionnaire and having a bone scan, which is usually offered if you’re thought to be at particularly high risk of fracture. Bone scans are also known as ‘DXA’ or ‘DEXA’ scans and measure bone density.
You can read more about what NICE (National institute for Clinical Excellence) recommends for the treatment of osteoporosis here. There’s also a lot you can do to support your bones after menopause with changes to your lifestyle.
- Exercise. Weight-bearing exercise and resistance exercise can improve bone density and help to prevent osteoporosis so even more reason to do some form of exercise regularly. Our exercise to energise article has lots of ideas. However if you’ve been diagnosed with osteoporosis, it’s a good idea to talk to your GP or health specialist before starting a new exercise programme.
- Vitamin D. Vitamin D is crucial for strong bones. There’s loads of information on how to boost your intake, including advice on when to supplement in our article on the sunshine vitamin.
- Stop smoking and drink less. Smoking is associated with an increased risk of osteoporosis. There’s lots of support out there to help you quit. There are also clear links to alcohol and osteoporosis and particularly binge drinking. Try to cut back on your intake with these tips.
Urinary problems
You may find it’s harder to maintain control of your bladder after menopause. That might mean more trips to the loo and bladder leakage. According to the NHS, around 70% of women relate the onset of their urinary incontinence to their last period. That’s because lower levels of oestrogen can cause the lining of the tube (called the urethra) leading from the bladder to the outside to thin. When this drop in oestrogen is combined with natural ageing of the pelvic muscles around the urethra, it’s no surprise many women have bladder issues.
Kegel or pelvic floor exercises can really help and what’s more you can do them at any time. Other things you can do include cutting back on caffeine, drinking less alcohol and drinking more water. The NHS has some useful advice on this.
Sexuality and vaginal dryness
Oestrogen helps maintain the natural lubrication in the walls of the vagina. Lower levels mean the vaginal walls become thinner and can mean the vaginal tissues are more easily irritated and dry out, making sex less comfortable. It can also lead to an increase in urinary tract infections. Your doctor can prescribe oestrogen treatments that are put directly into your vagina as a pessary, cream or vaginal ring. You can also buy vaginal moisturisers and lubricants at your pharmacy. Vaginal dryness isn’t something that will improve after menopause so you may need to use something indefinitely. If you are suffering from any irritation around your vagina, steer clear of perfumed soaps, creams and lotions.
Metabolism
Many women seem to put weight on after menopause. Reduced oestrogen may lower your metabolic rate, which prompts your body to store fat instead of burning it. But menopause alone isn’t to blame. Age-related weight gain often occurs with a natural decrease in physical activity. So the general message is to stay active and eat well.
When to stop Hormone Replacement Therapy post-menopause
Many women are prescribed hormone replacement therapy (HRT) to help them deal with the effects of the menopause. You can read more about the benefits and risks of HRT in our guide to HRT.
But how do you know when it’s the right time to stop HRT once you’ve reached menopause? Some take the view that the post-menopause is a hormone deficiency that requires protective treatment long term. That is an argument for continuing HRT indefinitely unless there are medical reasons why you can’t be prescribed it. There’s no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment. However, the choice of whether to treat always remains with you. Most women stop taking it once their menopausal symptoms pass, which is usually after a few years. You can either stop immediately or gradually reduce your dose. Your GP should give you more advice about this. Gradually decreasing your HRT dose is usually recommended because it’s less likely to cause your symptoms to come back in the short term. Contact a GP if you have symptoms that persist for several months after you stop HRT, or if you have particularly severe symptoms. You may need to start HRT again.
Other sources of advice and support
The menopause can mean big changes for women before, during and afterwards. Don’t be afraid to ask for help. Our articles might help.
Menopause:Treatment and Support
There are also lots of other support groups and information available too.
Menopause Support UK
The Daisy Network
Menopause matters
The Menopause exchange
Fertility friends
Women’s health concern
You can also go to NHS Choices for more information
Not got the app yet? Download the Evergreen Life app and look out for a notification about your Menopause questionnaire*. Start taking more control of your health and wellbeing.
*Must be 30 or over and female to receive the Menopause Check. If you haven’t told us your age and sex, please first take the GP Check in your Records section.
Reviewed by:
Dr James Harmsworth King MBBS MPhil PhD Biotechnology & Medical Expert
Dr Brian Fisher MBBCh MBE MSc FRSA Medical Expert
Postmenopause: Signs, Symptoms, & Treatments | University of Utah Health
Postmenopausal Health: What to Expect (healthline.com)
