Menopause doesn’t have a great reputation. It’s that time when hot flashes, bladder problems and low mood tend to dominate. But what happens when you come through it and enter a phase called postmenopause? This article aims to help you understand what you can expect from this new period and how to best take care of yourself.

When will I be in postmenopause?

The average age of menopause for UK women is 52. Most women reach this milestone of their periods, stopping between ages 45 and 55. Many symptoms associated with menopause happen before periods stop, in a phase called perimenopause, when your oestrogen levels gradually decrease. Women are said to have ‘achieved’ menopause 12 months after their final period. At this point, they are said to be postmenopausal.

Postmenopause: The good news

Once you’re postmenopausal, many of the symptoms you may have experienced during perimenopause and menopause should eventually fade.

Even better, perhaps, you will no longer have to deal with the disruption, pain and mood changes often part of the menstrual cycle for so many women. No more periods! Plus, you don’t need to worry about an unplanned pregnancy. However, if you choose to take HRT, which allows your periods to continue, you won’t see those changes.

Many women (as many as 70-80%) suffer from uterine fibroids at some point. These small benign growths 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 from growing, and of course, the heavy bleeding linked with fibroids also stops.

The emotional impact of 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 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. Physical and psychological losses are to be faced, and perhaps an acceptance that some hopes and aspirations will not be fulfilled.

But 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 and perhaps take more risks.          

There are lots of support groups for menopause which are listed at the end of this article. However, your GP should support you if you experience menopause before, during or after.

Dealing with the physical effects of menopause

It might feel like you spend a lot of time with healthcare professionals 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, and others are unique to the decrease in your body’s natural production of oestrogen.

This hormone affects 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 postmenopause as a natural part of ageing, accepting the effects of low oestrogen. Some see it as a hormone deficiency that needs treatment. This article intends to help you make informed choices regarding your approach and treatment. Let’s look at how and what you can do to look after yourself.

Lingering menopausal symptoms

Few women make sudden, easy jumps from the different stages of menopause and symptoms can last months or even years. So even though you may not have had a period for 12 months and are postmenopausal, 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 and information about non-prescribed and prescribed medication, including hormone replacement therapy.

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 age 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 the 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 the 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 you 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 several 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 a particularly high risk of fracture. Bone scans are known as ‘DXA’ or ‘DEXA’ and measure bone density.

You can read more about what NICE (National Institute for Clinical Excellence) recommends for the treatment of osteoporosis here. You can also do a lot to support your bones after menopause with changes to your lifestyle.

• Exercise. Weight-bearing exercise and resistance exercise can improve bone density and help prevent osteoporosis, so even more reason to exercise regularly. Our exercise to energise the article has lots of ideas. However, if you’ve been diagnosed with osteoporosis, you should 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 between alcohol and osteoporosis and particularly binge drinking. Try to cut back on your intake with these tips.

Urinary problems

You may find it 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) to thin from the bladder to the outside. When this drop in oestrogen is combined with the natural ageing of the pelvic muscles around the urethra, it’s no surprise many women have bladder issues.

Kegel or pelvic floor exercises can help, and what’s more, you can do them at any time. You can also cut back on caffeine, drink less alcohol, and drink 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 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

 Many women are prescribed hormone replacement therapy (HRT) to help them deal with the effects of menopause. You can read more about HRT’s benefits and risks in our HRT guide.

But how do you know when it’s the right time to stop HRT once you’ve reached menopause? Some take the view that postmenopause 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, 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 stopping HRT or particularly severe symptoms. You may need to start HRT again.