You did it! You got through years of annoying hot flashes, brain fog, and other menopause symptoms, and are officially on the other side.
Does this mean you’ll never have another menopause symptom again? Unfortunately, no. And there are new physical changes you may experience on the other side of menopause, too. Postmenopause is its own new normal — with its own ups and downs.
What Exactly Is Postmenopause?
The technical definition of menopause is 12 consecutive months without a menstrual period. After that, you’re in post menopause, says Karyn Eilber, MD, a urogynecologist in Los Angeles, and co-author of A Woman’s Guide to Her Pelvic Floor: What the F*@# Is Going On Down There? “What gets confusing is that people use the term as a reference to time, as in ‘the time after menopause,’ but it’s basically the same thing,” Eilber says.
Menopause (and Postmenopause) Are A Spectrum
On average, women go through menopause around 51 years of age. Since you are no longer ovulating, you no longer have periods. (If you experience bleeding after menopause, consult your doctor.) And conceiving a baby after menopause is highly unlikely, since menopause marks the end of natural fertility.
A reality of menopause is that it’s a continuum, and the symptoms don’t necessarily end after a period-free year. “Menopause is a natural process of transition, like puberty in reverse,” Eilber explains. “In perimenopause, your hormones are fluctuating like crazy, and then after menopause happens, the decline of hormones like estrogen and progesterone levels out.” Now you’re in a postmenopausal status quo — or more precisely, a status low, when it comes to estrogen.
Does Postmenopause Mean That Menopause Symptoms Stop?
Some do. “For many women, hot flashes and night sweats start to dissipate once your hormone fluctuations stabilize and the body gets used to lower levels of estrogen,” says Monica Grover, DO, an OB-GYN and chief medical officer at VSpot in New York City. While these symptoms tend to subside, some may linger. “Due to decreased estrogen, you might still have moments of mental cloudiness or random hot flashes after menopause, even months or years afterward. And other issues may appear, such as vaginal dryness and weight gain.”
Does this mean that you could be swapping out one set of problems for another? For many women, the answer is yes. “With menopause and hormones, expect the unexpected,” Eilber says. “In the same way that every woman experiences PMS symptoms differently, the longevity and severity of menopause symptoms is totally individual. It just depends on how your body reacts to hormonal changes.”
What to Expect in Postmenopause
The physical changes that most often accompany postmenopause are vaginal dryness and urinary incontinence. “Both men and women tend to get an overactive bladder with age, but it’s a common menopause indicator, too. This is what we call the ‘genitourinary syndrome of menopause,’ and it’s due to age-related hormone decline — primarily estrogen,” Eilber says. Vaginal dryness and atrophy, which affects approximately 50% of postmenopausal women, is also a sign of diminished estrogen. “Estrogen is food for your vaginal tissues, so with a decline in estrogen, they become thinner, drier, and less flexible,” Grover says. “Natural vaginal lubrication is diminished, and this can contribute to irritation and painful intercourse.” Still, sex after menopause can be pleasurable and better than ever — it just helps to use a lubricant during intercourse or masturbation.
How a Doctor Can Help
Whether you’re in perimenopause or postmenopause, discuss any concerns with your OB-GYN, who can talk to you about therapeutic options. “For example, hormone therapy can help with vaginal dryness, and you don’t have to take systemic hormones to treat it,” Eilber says. “Vaginal estrogen in the form of a cream, suppositories, or a time-released ring, helps to improve vaginal lubrication, and can sometimes improve urinary symptoms too, because the bladder is right next to the vagina.” Moisturizing with a hypoallergenic, fragrance-free gel is another excellent way to improve dryness and irritation. (A 2018 study actually found that a vaginal moisturizer was equally as effective as vaginal estrogen at treating dryness.) “Women don’t have to just live with vaginal dryness or painful sex,” Grover says.
You’re at a Higher Risk for Other Health Conditions
We think of estrogen primarily as a reproductive hormone, but there are estrogen receptors all over the body, and the hormone works to protect the bones and the heart, and regulates cholesterol levels. Because it helps maintain bone density, the significant decrease of estrogen after menopause puts you at increased risk for things like bone fractures due to osteoporosis. Evidence suggests that estrogen also has protective effects on the cardiovascular system, and the incidence of cardiovascular disease in postmenopausal women increases due to lower estrogen levels.
Consider this time after menopause to be a window of opportunity to take proactive, preventive steps toward managing your good health for the years ahead. This is the perfect opportunity to see your healthcare provider for an annual physical to check your blood pressure, cholesterol levels, and osteoporosis risks. As Grover says: “Postmenopause can be a journey to finding a wonderful second act. It shouldn’t limit you.” We second that.
Gina Way is a writer and editor specializing in beauty, health, and lifestyle content. Her work has been featured in Marie Claire, Harper’s Bazaar, Martha Stewart Living, Real Simple, Cosmopolitan, and Shape. She also writes digital content for Allure, The Cut, Refinery29, Vogue, Oprah Daily, Violet Grey, Well+Good, and more.
