After menopause: Understanding what postmenopause means for your health

From hot flashes to unexpected weight gain, vaginal dryness to brain fog, menopausal symptoms can last for years, feeling endless until, suddenly, out of the blue, they end. Gone are the night sweats and the irregular periods, the headaches and the anxiety, and what you're left with is a sense that you're not who you were before menopause, but you're not that person either.

Welcome to postmenopause.

One of the least discussed and understood parts of this process, postmenopause, is the final stage of the menopause transition and can mark up to a third of a woman's life [1]. So, let's discuss it. Here, we'll take a look at what postmenopause is, what it might feel like (and any uncomfortable symptoms), what age is postmenopausal life likely to start, and what you can do to move into this new chapter in a way that keeps you healthy, happy and feeling good.

What is postmenopause?

When we talk about menopause, we’re not talking about any one single event, but rather a natural process consisting of three unique stages.

The first is called perimenopause, which generally takes several years. Put simply, it’s your ovaries winding down their duties, slowly decreasing your estrogen levels and causing your menstrual cycle to become longer and more irregular before it finally stops altogether [4].

That permanent end to your menstrual cycle is the stage known as natural menopause. In this, your ovaries stop releasing eggs and producing estrogen. When it happens naturally, menopause is generally spontaneous, making it an unpredictable phase in your body’s functioning.

The final stage in this process is known as postmenopause, and marks the end of the reproductive stage of your life [1].

How it fits into the menopause timeline

Postmenopause only begins 12 months after menopause occurs. In other words, a year after your final menstrual period, your body will enter its postmenopausal phase, which will then continue for the rest of your life [1].

Why postmenopause matters

Postmenopause is a natural part of ageing, and understanding the physiological, emotional and mental changes that can happen as a part of that is crucial to navigating not just daily life, but your overall health. In particular, knowing that you’re now in the post-menopause phase should encourage you to undertake preventative health checks with your doctor, and become more aware of the risks associated with ageing, including developing several new health complications [2].

It's also vital to be aware of whether you’re menopausal or post-menopausal in the instance of vaginal bleeding or blood clots, as experiencing this during postmenopause can be an indication of a serious medical issue [3].  

How hormonal changes continue to affect your health

During perimenopause and menopause, certain hormone levels will dramatically decrease, particularly estrogen and progesterone, and while these should stabilise during postmenopause, it can still lead to changes in your weight, as without these hormones, your body stores more fat and burns calories less efficiently.

Gaining weight can increase the risk of developing metabolic syndrome, obesity and other health challenges, so understanding that postmenopause may require you to make lifestyle changes is vital not just to weight management, but to your overall health [1].

How does post-menopause affect the body?

The importance of estrogen in maintaining women’s health is not just in the reproductive system, but throughout the body, which means that the loss of it in postmenopause can have a really significant effect. In particular, studies have found that postmenopause can affect:

• The skeletal system. Research has found a direct relationship between the lack of estrogen after menopause and bone density loss, with postmenopausal women as a result having a higher risk of developing osteoporosis.
• The cardiovascular system. Some studies have shown a link between estrogen and supporting cardiovascular health, leading some researchers to suggest that the menopause transition may lead to an increased risk of heart health concerns.
• The urinary system. Low levels of estrogen have been found in some cases to cause the urethral lining to thin, which, paired with weaker pelvic muscles (particularly for women who’ve had children), can increase the risk of bladder leakage, urinary tract infections, and other urogynecology health issues in menopausal women.
• The metabolic system. While menopause alone isn’t to blame for weight gain, lower levels of estrogen have been found to lower your metabolic rate, which causes your body to store fat instead of burn it. Eating well and getting regular exercise can help most women to manage the postmenopausal stage as a result.
• The vagina. As estrogen is what helps keep your vagina lubricated, losing it during menopause can cause you to dry out, resulting in pain during sexual activity. It can also lead to an increase in urinary tract infections or atrophic vaginitis [3].

Common physical and emotional changes

Most women experience menopause symptoms during the perimenopausal phase of the process, and these common physical and emotional changes can include:

• Hot flushes and night sweats
• Mood changes
• Sleep problems and fatigue
• Forgetfulness or brain fog
• Headaches
• Muscle and joint pain
• Dry or itchy vagina, leading to pain during sexual intercourse
• Sore breasts [6]

Many of these will present as mild symptoms and can be managed by counselling and over-the-counter medication, but in some more severe cases, your doctor may recommend menopausal hormone therapy [6].

Most of these changes, except for a dry or itchy vagina, should disappear during the post-menopause phase; however, you may find that you need to urinate more frequently and that you may also get urinary tract infections more than you did previously [1].

What is the average age of postmenopause?

Most Australian women enter menopause between the ages of 45 and 60, with 51 years being the average age for postmenopause to be reached [1].

Factors that can cause it to start earlier or later

Generally speaking, the start of menopause seems to be triggered by our genetics; however, some studies have found that factors that are toxic or harm a person’s ovaries can cause menopause to start earlier. In particular, women who smoke, who have had surgery on their ovaries, or who have had a hysterectomy where they've retained their ovaries, may experience early menopause as a result of primary ovarian insufficiency.

Premature menopause (menopause before the age of 40 years) has also been connected to certain diseases and health conditions, such as autoimmune disorders and chromosomal abnormalities, as well as toxic exposure [5]. If you have any concerns about these or have experienced irregularities in your menstrual bleeding or menstrual cycle, you should speak to your doctor immediately.

How do you know when menopause is over?

When you have not had a menstrual period or any intermittent bleeding in 12 months, menopause is over.

Signs you’ve officially entered postmenopause

Except for a dry or itchy vagina or the more frequent need to urinate, your postmenopausal symptoms are really the end of your menopausal ones. Most women start to feel more levelled out during postmenopause, and while there are health risk factors to be monitored, you should generally start to feel better during postmenopause.  

How to stay healthy after menopause

Staying healthy after menopause is vital not just when it comes to managing your weight and broader health, but to living well. In particular, getting regular exercise, eating a healthy diet with nutrient-rich foods, reducing how much caffeine, sugar, salt and alcohol you consume, quitting smoking and making sure you get enough sleep are great ways to not just manage any menopausal symptoms, but to have you looking and feeling your best.

Lifestyle, diet, and long-term wellbeing tips

Knowing that you need to get more active and eat better is one thing, but making sustainable and holistic lifestyle changes that can help you to manage symptoms of menopause and maintain a healthy weight isn't always easy.

Many women struggle to navigate the menopausal transition, which can severely impact their quality of life, so if you're struggling, you're not alone. The important thing to remember is that Rome wasn't built in a day, and making small changes you can maintain rather than big ones you can't is key. In particular, remember:

• There are a hundred ways to exercise, and focusing on activities you’ll enjoy rather than what’s going to get you the fastest results is crucial to building sustainable habits that won’t feel like work. Making a regular time to go walking with a friend, or trying out social exercise like Park Run, signing up for a bi-weekly yoga class, joining a netball team, or trying your hand at a half-marathon before you aim for a full one can all be great ways work towards an active lifestyle that you’ll enjoy.
• Eating a healthy diet with nutrient-rich foods doesn’t have to be difficult either. Following a meal plan, stocking up on cookbooks, and meal prepping can all be effective ways to help you open the fridge door instead of reaching for the takeout menus. If you’re postmenopausal, making sure you get enough calcium and vitamin D is a must for bone health too [3].
• Talk to your doctor during your annual physical exams about your health and ensure you’re getting your regular preventive screenings, but don’t feel like you should suffer through the smaller stuff. Talk to them about any symptoms you may have that might be making you feel less than stellar, as there are plenty of treatments for menopausal symptoms, including hormone replacement therapy, incontinence treatments, supplements, estrogen therapy, vaginal estrogen and vaginal lubricants that can make your life that much easier.

Looking for more advice? Juniper’s Weight Reset Program offers more than just weight loss tips. Designed with dieticians and physiotherapists, this program is designed to put health coaching at your fingertips, and keep you supported with healthcare professionals, recipes, exercise tips and a like-minded community looking to change their lifestyles.

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