Do you think you're postmenopausal? While you may believe you've got a good grip on what happens in the run-up to menopause, you're probably less clear on what takes place after. This stage of life, which can arrive for women anytime between their 40s and 60s, comes with its own changes and challenges.
It's worth getting acquainted with how your body will evolve since these post-menopause symptoms will then last until the end of your life. We've enlisted the experts to explain exactly what happens after menopause—which takes place at an average age of 51 in the United States—and why women may have very different experiences, due to varying hormonal fluctuations.
They'll also reveal nine of the key changes that lay ahead, positive as well as negative. Because while you may have to deal with postmenopausal hot flashes and weight gain, menopause can be associated with more liberating sex and no need to worry about regular bleeds. So, if you're well aware of key menopause symptoms and want to understand what comes next, then you're in the right place.
What does it mean to be postmenopausal?
"The menopause is when a woman has not had a menstrual cycle for 12 months," says Dr Laila Kaikavoosi, a GP, menopause specialist, and founder of the Online Menopause Centre. "After this point, she has entered the post-menopause stage and will remain post-menopausal for life."
What's happened to the body? "The main change is the absence of female hormones—estrogen, progesterone, and testosterone—which affect the body in many different ways and cause a whole host of symptoms," explains Dr Kaikavoosi. "These include everything from hot flashes to aches and pains, and much more."
Post-menopause symptoms
There is much overlap between menopause and perimenopause symptoms, and the same goes for post-menopause symptoms. "Menopause is a single moment in time, exactly 12 months after the last menstrual cycle," says Dr Kaikavoosi. "Beyond this time women stay in the post-menopausal stage, and there are a wide range of signs and symptoms."
Does everyone have the same experience? No. "These don’t all happen together and in everyone, so what each woman will experience is very individual," continues Dr Kaikavoosi. "For example, some might report a worsening of joint pain and skin, or the emergence of thyroid disease, as well as osteoporosis and muscle weakness."
Ways the body changes after menopause
Changing hormone levels can cause several things to happen—positive as well as negative. "The effects of menopause can last indefinitely without treatment, and may worsen with time," explains Dr Sarah Brewer, GP and medical director of Healthspan. "However, they are not always troublesome."
Dr Kaikavoosi adds, "Women can enjoy an active and productive post-menopause life, especially once their hormones have been balanced and replaced using hormone replacement therapy (HRT). It is always best to seek help and treatment from a menopause specialist who can advise on the correct treatment path depending on symptoms."
1. Postmenopausal hot flashes
Although there are plenty of things that cause hot flushes apart from menopause, this well-known symptom may persist, unfortunately. "There are estrogen, progesterone, and testosterone receptors in almost every cell and organ in our body and, so when there is a drop in the levels of these hormones, there may be symptoms like hot flashes," explains Dr Kaikavoosi. Indeed, it may take a while for them to settle and get better after menopause.
There is another factor that may influence their length. "If you are not on HRT, you may continue to have hot flashes for at least a year after menopause, with some having them for as long as five years afterward," notes Dr Brewer. "Around 29% of women aged 60 still experience hot flashes. Eventually, however, they will cease as your body and hypothalamus, a part of the brain that triggers them, adapts to lower estrogen levels."
2. Sex
While you don't need to worry about an accidental pregnancy, you may come across some other more intimate changes. "A medium-term symptom of the menopause can include thinning of vaginal tissues and increased dryness, leading to discomfort, especially during sex," reveals Dr Brewer. "There may also be reduced sensation in the skin, nipples, and genitals." Which could all impact the enjoyment you receive from intercourse.
However, there are upsides too. "Sex may become more liberating," adds Dr Brewer, speaking on how this period of life can come with less stress and responsibilities, helping you get in the mood. "Although it's best to use an intimate moisturizer." You may want to stock up on lube to help things go smoothly, and one of the best sex toys could aid you in rediscovering your libido.
3. Postmenopausal bleeding
It's important to know that bleeding doesn't just disappear overnight as you go through perimenopause and beyond. "The main reason for excessive bleeding at this time is due to a lack of progesterone," explains Dr Kaikavoosi. "Ovaries are still making some estrogen which builds the lining of the womb, known as the endometrium, but the counterbalancing hormone, progesterone, which stabilizes the endometrium is absent. This is because progesterone is released when ovulation has occurred and perimenopausal women have more and more anovulatory cycles as they come closer to their menopause."
So what about post-menopause? Well, this is defined as vaginal bleeding that happens a year or longer after the last menstrual period. While it may be a symptom of vaginal dryness as previously discussed or polyps, there could be something more serious happening. If this is a symptom you're experiencing, it's best to consult your doctor as research by the National Cancer Institute has found that post-menopausal bleeding happens in 90% of cases of women who have endometrial cancer, among other serious conditions.
4. No more PMS symptoms
However, postmenopausal women can enjoy a huge benefit—saying goodbye to their periods. "The main positive changes at menopause are the lack of monthly menstrual cycles, as well as not worrying about unwanted pregnancies," says Dr Kaikavoosi.
In addition to there being no need to fear being caught short without menstrual products, there are further perks. Dr Brewer adds, "You don't have to worry about monthly premenstrual symptoms, like mood swings and bloating. Similarly, you can forget about contraception."
5. Postmenopausal weight gain
There is a natural tendency for weight gain after menopause. "From middle age onwards, your metabolism starts to slow, sometimes by as much as 3% per year," says Dr Brewer. "Between the ages of 25 and 70, the average woman sees her body fat percentage increase from 27% to 40% and she loses 5kg of muscle." She continues, "Falling levels of female sex hormones also mean you start to store excess fat compared to when you were younger. Rather than gaining weight on your breasts, hips and thighs, for example, you put it on around your abdomen.
Can anything be done to ward off menopausal weight gain? "If your exercise levels remain the same, you then need to reduce your calorie intake," explains Dr Brewer. "By the time you are 75, a woman needs around 300 calories less per day than when she was 18, and 130 calories per day less than when she was 50."
6. Postmenopausal cramping and lower back pain
While PMS-related discomfort may fade, some other pains can arise. "Post-menopause effects can include muscle cramps as well as aching ankles, knees, wrists or shoulders and waking up with sore heels," notes Dr Brewer. This can be due to declining levels of estrogen, which is known to help reduce inflammation.
Suffering from lower back pain? This is common in postmenopausal women. Research from Rutgers Robert Wood Johnson Medical School noted that low levels of vitamin D—a nutrient deficiency highly prevalent in many women especially—were linked to degenerative disc disease in the spine.
Additionally, there is some pain that you should pay closer attention to. For example, if you are experiencing cramping post-menopause, then it could be a sign of conditions such as constipation, endometriosis and uterine fibroids, as well as ovarian or uterine cancers. As always, seek the advice of your doctor if you experience any of these symptoms.
7. You'll have more energy
Very often the focus on this life stage can be negative—which is why menopause needs an image rebrand—including a greater ability to rattle off your to-do list. "You may find you have more energy from working fewer hours, retirement and the kids having left home," says Dr Brewer.
If you're struggling with postmenopausal fatigue, due to changes in hormone levels and difficulty sleeping, then there are some lifestyle tweaks you can make. Indeed, a study by the University of Georgia showed that moderate or high-intensity exercise could boost energy levels. So, as well as investing in the best sleep aids, it may also be worth picking up a pair of the best running shoes or walking shoes and heading out to break a sweat.
8. Tender breasts after menopause
While the likes of hot flashes and disappearing periods may be better-known aspects of the various stages of menopause, one of the lesser-known side effects is what happens to your breasts. They may shrink, change shape and lose firmness, due to hormone changes and weight fluctuations.
If your breasts feel more tender after menopause, it could be due to a condition called mastalgia, as research from Istanbul Medeniyet University found it affects 70% of women during their lifetime. While before menopause it will be linked to the menstrual cycle, once you're postmenopausal it's non-cyclical. It may be caused by certain types of medication, infection, or a lack of bra support. If it's accompanied by breast lumps or nipple discharge, then it could be a sign of breast cancer—the risk of which increases with age—and, as such, you should check with your doctor.
9. Health conditions
Some post-menopausal changes may take a while to arise. "Long-term problems due to lack of estrogen tend not to appear for at least five years after your last period," says Dr Bewer. "Estrogen has lots of important effects on many different parts of your body, including your arteries, bones, and brain. As your levels fall, your metabolism starts to change which can lead to an increased risk of high blood pressure, coronary heart disease, and stroke, as well as type 2 diabetes, ‘bad' LDL cholesterol, and dementia."
It is also the reason why women in later life are at particular risk of osteoporosis, adds Dr Brewer. Bone loss speeds up post-menopause, with the possibility that you could lose 20% of your density within five to seven years. The risk can be reduced by eating a healthy diet—full of the best foods and supplements for menopause—and doing activities that build strength.
