What Happens After Menopause? Symptoms, Treatment, Health Risks, and Management

Postmenopause is the phase of life after your ovaries stop producing eggs and the transition to your nonchildbearing years is complete. Menopause starts after you’ve had no period for 12 consecutive months. Once you are postmenopausal, you stay in this phase for the rest of your life.

During this time, your ovaries make very little estrogen and progesterone. This causes bodily changes that can be different for each person. Some will continue to have menopausal symptoms, like hot flashes and night sweats, for a decade or longer after menopause. For others, these symptoms stop entirely.

Once your menstrual period has ended for more than a year, pregnancy is unlikely. But until your healthcare provider has confirmed you aren’t ovulating anymore, keep using birth control if you don’t want to get pregnant.

Signs and Symptoms of Postmenopause

Some people may not experience any symptoms after menopause. But the permanent end of menstrual periods doesn’t always mean the end of unpleasant menopausal symptoms.

Common Postmenopause Symptoms

• Hot flashes and night sweats
• Vaginal dryness and sexual discomfort
• Depression
• Changes in sex drive
• Insomnia
• Dry skin
• Weight gain
• Hair loss
• Urinary incontinence

If any of these symptoms interfere with your daily life, talk with your healthcare provider about treatment options and to rule out other possible underlying conditions.

Postmenopausal Bleeding

• Benign uterine polyps or fibroids
• Thinning uterine or vaginal tissues
• Endometrial hyperplasia, when the lining of the uterus thickens
• Hormone therapy, tamoxifen, or other medications
• An infection of the uterine lining
• Bleeding from the urinary tract or rectum
• Injury, sexual assault, or abuse
• Cancer of the uterus, cervix, or vagina

Contact your healthcare provider if you experience unexpected bleeding after menopause. They can help determine the cause and rule out potentially serious conditions.

Hot Flashes After Menopause

How Is Postmenopause Diagnosed?

Treatment for Postmenopause

Medications

• Antidepressants for mood swings or depression
• Vaginal creams for pain related to sexual intercourse and vaginal dryness
• Fezolinetant (Veozah), and elinzanetant (Lynkuet) to relieve hot flashes
• Gabapentin (Neurontin) and oxybutynin, used off-label to treat hot flashes

Lifestyles Changes

• Eat a healthy diet. Include plenty of fruits, vegetables, lean meats, and whole grains. Limiting caffeine and alcohol intake can also help minimize hot flashes and sleeping difficulties.

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• Increase your calcium and vitamin D intake. Lower estrogen levels lead to bone loss, which increases your risk of osteoporosis. Eat foods high in calcium, such as spinach, yogurt, and cheese, to boost your intake. A vitamin D supplement can also help your body absorb more calcium.
• Exercise regularly. Moderate physical activity like walking for 30 minutes three times a week can help you maintain a healthy weight and lower your risk of depression. Resistance training can help strengthen your bones and muscles.
• Don't smoke. Your risk of heart disease increases after menopause. Avoiding smoking can help reduce your risk.

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• Take care of your mental health. Staying social can provide emotional support, and practicing relaxation techniques like meditation and yoga can help with stress and depression.
• Use vaginal lubricant. Applying water- or silicone-based lubricant during sex can help reduce dryness and pain.
• Schedule regular checkups. You still need gynecological care even if you aren't menstruating anymore. This includes Pap tests, pelvic exams, breast exams, and mammograms.

Health Conditions Related to Postmenopause

• Cardiovascular Disease Estrogen helps protect against cardiovascular disease like heart disease and stroke. Lower estrogen levels after menopause increase your risk for these conditions.
• Osteoporosis You lose bone density more quickly after menopause, up to 1 to 2 percent per year. Losing bone increases your risk of developing osteoporosis, which can lead to fractures.
• Bladder Problems Lower levels of estrogen can thin the lining of your urethra. The pelvic muscles around your urethra may also become weaker due to aging or vaginal childbirth. These factors can increase your risk of incontinence, urinary tract infections, and other urinary problems.

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• Vaginal Issues Estrogen helps maintain vaginal lubrication. Lowered estrogen during postmenopause thins vaginal tissues, which dries them out and makes them more easily irritated during sex.
• Mental Health People in postmenopause can experience moodiness, anxiety, and depression. These can be triggered by stress or other life challenges related to this stage of life. Mood symptoms can also be caused by decreased hormone levels.
• Sleep Disorders Hot flashes, changing hormone levels, and mood disorders may impact sleep quality. People in postmenopause may also experience sleep-related disorders, including sleep-onset insomnia, sleep apnea, and restless leg syndrome.

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The Takeaway

• Postmenopause is the stage of life that occurs after menopause. During this time, your body produces very little estrogen, and symptoms of menopause may start to decrease. Postmenopause typically begins after you've had no menstrual periods for over a year.
• While menopause symptoms like hot flashes can become mild or stop in postmenopause, some people may continue to experience them for up to a year or more. Depending on the severity of your symptoms and your health history, treatment can involve lifestyle and behavior changes or hormone therapy.
• Low estrogen levels in postmenopause increase your risk of certain health conditions, including osteoporosis, sleep disorders, and cardiovascular disease. Eating a healthy diet, exercising regularly, and getting regular checkups with your ob-gyn can help minimize your health risks.