Life after menopause: Understanding postmenopausal symptoms

As you run the winding track of perimenopause, navigating uncomfortable symptoms like hot flushes, vaginal dryness and irregular bleeding, menopause itself can sometimes feel like the finish line you’re aiming for, but when that last menstrual period suddenly becomes your last menstrual period, finishing the course might have you asking: well, what now?

Life after menopause can be hard to define for many women, and often not quite as understood as those earlier phases of menopausal transition, so if you're suddenly scratching your head about why those menopausal symptoms haven't stopped with your periods, you wouldn't be alone.

Here, we’ll try to answer the questions that might be lingering about what exactly postmenopause might look (and feel) like, and what you can do to charter this new part of your life.

What is postmenopause?

Put simply, postmenopause is the final phase of menopause and the stage of a woman’s life when her ovaries no longer release eggs, marking the end of her reproductive years.

As natural menopause happens spontaneously as women age, it can be hard to predict when you might experience it, but research has shown that, broadly speaking, the average age of arriving at postmenopause is 50.

That said, some women may experience late or early menopause, and in rare instances, premature menopause, which occurs before the age of 40 [1].

When it starts and what it means for your body

Menopause is made up of three distinct phases: perimenopause, natural menopause, and postmenopause, which are each underpinned by what’s known as ovarian failure.

While studies are yet to pinpoint the exact cause or trigger of perimenopause, a process sometimes called the menopause transition, it’s generally defined by the onset of irregular menstrual cycles and fluctuations in your reproductive hormones, particularly estrogen and progesterone, before their gradual decline [2]. This stage can last several years before the menopause, which is the total stopping of your menstrual cycle altogether.

Natural menopause is generally spontaneous, and as irregular menstrual bleeding and other menopausal symptoms are a part of perimenopause, you can only know if menopause has truly happened when you haven’t had a menstrual period in twelve months. It’s at the end of these twelve months that postmenopause starts, with your hormone levels reduced, and your reproductive years over [2].

How does postmenopause affect the body?

It’s not uncommon for people to think of menopause as the full stop at the end of a sentence, but the reality is that it’s really more of a comma, marking a transition between two parts of a woman’s life. As a result, menopause has several effects on the body that continue into postmenopause, including everything from urinary symptoms and vaginal dryness to other more serious health risks.

Common hormonal and physical changes

While the symptoms of menopause are broadly well-documented, people can often fail to account for the common hormonal changes occurring in the body during menopause and postmenopause that can not only affect the body, but also have longer-term health implications if not monitored.  

In particular, both menopausal and postmenopausal women have low levels of circulating estrogens. This is due to the fact that estrogen is mostly (although not entirely) produced by the ovaries, and as the ovaries start to fail, the body stops producing it [2].

While estrogen is typically thought of as a reproductive hormone, studies have shown that it serves many purposes well beyond its reproductive functions. In particular, estrogen has been found to play an important role in cardiovascular health, bone health, the metabolic system, urinary system, and the vagina, and as menopause occurs and your hormone levels drop and plateau, you may feel the physical effects on your body, particularly in weight gain and obesity, perimenopausal mood changes and cognitive difficulties, insomnia, elevated blood pressure, osteoporosis, a dry or itchy vagina, and urinary incontinence [2].

While there are many women's health initiative such as the Australasian Menopause Society, working to raise awareness and connect women who experience symptoms with support services and medical professionals, many women are unaware of treatments available to combat these effects, such as hormone replacement therapy, vaginal lubricants, and vaginal oestrogen. They're also often unaware of the importance of monitoring these effects and symptoms of menopause, which is vital. After all, postmenopausal women have been found to be at greater risk of heart health concerns, urinary tract infections and other urogynecological health issues, and vaginal atrophy [3].

How long does postmenopause last?

While you can count the days when it comes to perimenopause and natural menopause as a stage of life, the postmenopausal stage is indefinite and will continue for the rest of your life [1].

What are the symptoms of postmenopause?

In many ways, one of the good things about postmenopause is that it marks the end of menopause, which is generally where you’re likely to experience those menopausal hot flashes, mood swings and night sweats that many associate with this phase of life. Still, there are a few physical, emotional and mental health postmenopause symptoms to be on the lookout for during these years of your life.

Physical symptoms

The main physical symptoms of postmenopause are:

• A dry or itchy vagina, leading to painful sexual intercourse and decreased sexual desire
• Urinary symptoms that urge incontinence, including both urinary incontinence and stress incontinence, a more frequent need to urinate, and recurring urinary tract infections
• Weight gain and obesity
• Hair loss and dry skin
• Musculoskeletal symptoms such as bone loss, which can lead to osteoporosis [4]

While many of these symptoms will likely present mildly and can be managed with healthy lifestyle changes and over-the-counter medications, they can sometimes be more severe. In these cases, there are treatments such as menopausal hormone therapy that may help you to lessen these severe physical symptoms.

It's also important to note that some of the other symptoms of menopause transition include vaginal bleeding and blood clots. These are not postmenopausal symptoms, and if you experience any type of bleeding, you should seek medical attention immediately.

Emotional and mental health changes

Increasingly, studies are finding that some women are at a higher risk of experiencing emotional symptoms and mental health changes during postmenopause. The most common of these include:

• Emotional changes and mood disorders
• Cognitive issues such as memory problems, brain fog and trouble focusing, which in rare cases may lead to cognitive decline; and
• Changes to sleep patterns, including sleep disturbance and insomnia [4]

If you have a history of mental health issues, or feel you are at risk to develop any, you should speak to your doctor.

How do you know if you’re in postmenopause?

If you have any of the above symptoms, you may be experiencing postmenopause, but the most definitive way to know is to monitor your menstrual cycle. Once it has been twelve months since your last period, with no irregular vaginal bleeding in between, you are in postmenopause.

Signs that menopause is complete

While you might start to suspect menopause is complete because you have fewer symptoms of menopause, the only way to know for sure is when you haven’t had any menstrual bleeding for twelve months [1].

What is the difference between menopause and postmenopause?

Natural menopause is ultimately the point when your ovaries fail, and your menstrual cycle ends. In that sense, it’s really what carries you from your reproductive years into postmenopause and, ultimately, the rest of your life.

Much of the time, people can find that postmenopause is actually pretty stable compared to the hot flushes, unpredictable bleeding and flux of the perimenopausal years, and the spontaneity of natural menopause can feel like a comforting end to that.

You and your doctor both knowing that you have entered the postmenopausal chapter of your life also means that you can plan for your current and future health needs, book the appropriate medical appointments and tests, and make lifestyle changes that will meet your body where it’s now at.    

How do you know when postmenopause is over?

Postmenopause isn’t a phase your body goes through; it’s a stage of life, and in that sense, postmenopause is indefinite. It will last the rest of your life [1].  

Long-term health considerations and lifestyle support

Entering the postmenopausal phase of your life does come with health considerations that are reflective of not just the hormonal changes within your body, but the simple fact that you’re now of a certain age. Most women experience menopause around the age of 50, and as a result, are at an increased risk of several medical conditions and disorders, along with obesity, aneamia and other vitamin deficiences.

As you enter postmenopause, it’s vital that you see your doctor regularly in order to ensure you’re up to date on your health checks and tests, but it’s also important to eat a balanced diet and get regular exercise, not just to maintain a healthy weight, but to support pelvic floor muscles, bone health and mobility. Social exercise can also be a great way to fill your cup with family and friends, giving you regular times to catch up with those you love, or branch out and meet new people.

If you’re looking for more guidance on how to plan a healthy diet, discover what exercise is right for you, or just general weight loss or weight maintenance support, Juniper’s Weight Reset Program is here for you.

Led by dieticians and designed with health coaches, this program offers you advice on how to centre your health and wellbeing no matter what stage of life you’re at, keeping you connected with healthcare professionals, recipes, exercise tips and a like-minded community on their own health journeys.

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