Postmenopause

What is postmenopause?

Postmenopause is a term to describe the time after you’ve gone through menopause. When you’re in postmenopause (or postmenopausal), your menstrual period has been gone for longer than 12 consecutive months. At this stage in life, your reproductive years are behind you and you’re no longer ovulating (or releasing eggs).

Uncomfortable symptoms of menopause like hot flashes and night sweats may become milder or go away completely in postmenopause. People in postmenopause are at an increased risk for osteoporosis because their bodies don’t make a lot of estrogen, which is essential for maintaining strong and healthy bones.

How long does postmenopause last?

Once you enter postmenopause, you’re in this stage for the rest of your life. Your hormone levels will remain low and you’ll no longer have a monthly period. You can’t get pregnant because your ovaries stop releasing eggs.

What age is postmenopause?

There isn’t an exact age for postmenopause. Once your period has been absent for more than one year, you’re in postmenopause regardless of age. On average, this happens around age 52.

What are the symptoms of postmenopause?

Many people in postmenopause feel lingering symptoms from menopause, although the symptoms are usually less intense. Lingering symptoms occur due to low levels of reproductive hormones. Some people have no symptoms in postmenopause.

If you have symptoms, some of the most common are:

• Hot flashes and night sweats.
• Vaginal dryness and pain during sex.
• Depression.
• Changes in sex drive (low libido).
• Insomnia.
• Dry skin.
• Weight changes.
• Hair loss.
• Urinary incontinence.

If your symptoms become more intense or interfere with your daily life, talk with your healthcare provider. They can recommend treatment or order tests to determine what may be causing your symptoms.

Can you have hot flashes after menopause?

Yes. Some people still experience hot flashes in the years after menopause. Low estrogen levels cause postmenopausal hot flashes. If your hot flashes are bothersome or intensify, speak with your healthcare provider to rule out other causes.

What causes postmenopausal bleeding?

Vaginal bleeding during postmenopause isn’t a normal side effect of decreasing hormone levels. In some cases, the dryness in your vagina could cause some light bleeding or spotting after sex. In other cases, it could indicate a condition like endometrial hyperplasia, uterine fibroids, endometritis or cancer. Contact your healthcare provider if you experience postmenopausal bleeding.

Are there any health complications in postmenopause?

People in postmenopause have a higher risk for health conditions like osteoporosis, cardiovascular disease and genitourinary syndrome of menopause (formerly called vaginal atrophy).

Osteoporosis

You lose bone density more rapidly after menopause due to decreased levels of estrogen. You can lose 25% of your bone density or more after menopause (approximately 1% to 2% per year). Losing too much bone increases your risk of developing osteoporosis and bone fractures. Bone mineral density testing, also called bone densitometry, can see how much calcium you have in certain parts of your bones. The test helps detect osteoporosis and osteopenia.

What can I do to prevent osteoporosis?

Osteoporosis isn’t entirely preventable, but you can take steps to strengthen your bones. Eating foods high in calcium — like cheese, yogurt, spinach or fortified cereals — can help boost calcium intake. Adding a calcium supplement can also help. Some people also need a vitamin D supplement because it helps their bodies absorb calcium.

Cardiovascular disease

Before menopause, your body’s own estrogen helps protect against cardiovascular diseases like heart attack, heart disease and stroke. Risks for these conditions increase after menopause. It’s also common for people in postmenopause to become more sedentary, which contributes to high cholesterol and high blood pressure.

What can I do to prevent cardiovascular disease after menopause?

The best ways to prevent cardiovascular diseases are to eat healthy and nutritious foods, get regular physical activity and avoid tobacco products. Managing chronic conditions like high cholesterol, diabetes and high blood pressure are also essential to lowering your risk for cardiovascular diseases.

Genitourinary syndrome of menopause

Decreased estrogen levels cause the tissues in your vagina to become thin and dry. People in postmenopause may continue to struggle with vaginal dryness for years after their last period. Using vaginal lubricants can help ease your discomfort. Using lubrication and topical creams or getting laser therapy to your vagina may help with vaginal dryness. Decreased estrogen levels can also impact your urinary tract and bladder and make leaking pee a problem. Your healthcare provider should evaluate you if you have persistent dryness, painful intercourse or leak pee uncontrollably.

Mental health issues in postmenopause

People in postmenopause may experience moodiness, anxiety and depression. Things like stress, sexual tension or other life challenges can cause mental health disruptions. You may feel sad that your reproductive years are over or long for the days of your youthfulness. Hormone levels can also affect your mood. It might help to talk with a therapist or counselor about what you’re feeling to see if they can offer ways to cope with this new phase of your life.

How do you know you’re in postmenopause?

Your healthcare provider will be able to tell you if you’re in postmenopause based on your symptoms and how long it’s been since your last menstrual period. In some cases, your healthcare provider may take a blood sample and check your hormone levels to confirm you’ve gone through menopause. Remember, you’re not considered to be through menopause until it’s been over one year since you’ve had a period.

What medications are used to treat postmenopausal symptoms?

Hormone therapy (HT) is the most effective option. Your provider typically recommends HT within a decade of menopause or for people under the age of 60. There are possible health risks associated with hormone therapy like blood clots, breast cancer or stroke. These risks depend on dosage and your personal risk factors.

Some medications your healthcare provider may consider to help with postmenopausal symptoms are:

• Antidepressants for mood swings, depression, or hot flashes.
• Vaginal creams for pain related to sexual intercourse and vaginal dryness.
• Gabapentin (Neurontin®) or fezolinetant (Veozah™) to relieve hot flashes.
• Oxybutynin for treatment of hot flashes.

How do you deal with symptoms of postmenopause?

Certain lifestyle or at-home changes can help you manage symptoms of postmenopause. Some of these include:

• Using a vaginal lubricant during sex to make it more pleasurable. Lubricating your vagina helps with dryness and pain.
• Getting regular exercise, doing yoga or lifting weights can strengthen your bones and muscles. It can also help you maintain a weight that’s healthy for you and lower your risk for depression.
• Eating healthy and well-balanced meals. Foods like fruits, vegetables, lean meats and whole grains should make up the bulk of your diet. Avoid lots of salt or sugar and limit your consumption of alcohol.
• Maintaining a healthy weight can help manage lingering symptoms and reduce your risk for cardiovascular diseases, diabetes and other conditions.
• Staying socially active by joining clubs, volunteering or going out with friends can help give you the emotional support you need.
• Meditating or engaging in other relaxing activities can help with depression and other side effects of postmenopause.

Can you get pregnant after menopause?

Once your menstrual period has been absent for over a year, you’re not likely to get pregnant. Until your healthcare provider has confirmed you’re no longer ovulating and can’t get pregnant, continue to use birth control if you don’t want to become pregnant.

Do people in postmenopause lose interest in sex?

No, not all people lose interest in sex after menopause. Vaginal dryness and discomfort during sex can make sex less pleasurable. Using a vaginal lubricant can help with dryness. Some people are less interested in sex because of other symptoms like depression or feeling tired. If your feelings about sex have changed, ask your healthcare provider for help if these symptoms bother you.

When should I see my healthcare provider?

If any of your postmenopause symptoms bother you or prevent you from living your daily life, contact your healthcare provider to discuss possible treatment. They can confirm you’ve completed menopause and are in postmenopause.

Some questions you might ask are:

• Are these symptoms normal for people in postmenopause?
• Is there treatment for my symptoms?
• Is hormone therapy an option?
• What can I do to feel better?

If you experience any vaginal bleeding during postmenopause, contact your healthcare provider to rule out a serious medical condition.

Do I still need Pap tests after menopause?

You should still see your healthcare provider for routine gynecological care even though you aren’t menstruating. This may include Pap tests, pelvic exams and mammograms. You should continue to schedule annual wellness appointments. Since you’re at an increased risk for osteoporosis, providers usually recommend bone density screenings, as well. Talk to your healthcare provider to determine how often you should make check-up appointments based on your health history.

Does your body go back to normal after menopause?

Although your body won’t go back to the way it was before menopause, many people experience relief from menopausal symptoms once they reach postmenopause. Uncomfortable or disturbing symptoms like hot flashes, sweating and mood swings can get milder or go away completely. But this isn’t always the case, and you may continue to have symptoms of menopause for years. If these symptoms disrupt your life, contact your healthcare provider so they can recommend treatment options.

What supplements are good for postmenopause?

One of the most important nutrients you need after menopause is calcium. Calcium is essential to your bone health and is especially important in postmenopause because a decrease in estrogen can increase your risk of osteoporosis. Vitamin D is also important because it helps your body absorb calcium.

But it’s always best to talk to your healthcare provider about supplements you should be taking because they can recommend what’s best for you based on your health history.

A note from Cleveland Clinic

Menopause is a significant point in your life. It’s normal to feel a lot of emotions and wonder what comes next. The years after menopause can present new and unique health challenges. Some of the more bothersome symptoms of menopause (like hot flashes and night sweats) may disappear. But decreased estrogen levels put you at risk for health conditions like osteoporosis and heart disease.

Be sure to talk to your healthcare provider about this new chapter of your life. Just because you’re no longer getting your period doesn’t mean your gynecological care ends. Eating healthy foods, getting physical activity and managing chronic health conditions become even more important in postmenopause. Discuss any symptoms, concerns and questions you have with your healthcare provider so they can give you the care you need.