What Is Postmenopause?

Introduction

Postmenopause is a critical stage in a woman's life, and is defined as the period that follows menopause, during which a woman no longer experiences menstruation or the associated hormonal fluctuations.

If you think that you are in the postmenopausal phase and would like more information about what to expect then this article is perfect for you.

We will explore the concept of postmenopause in depth, starting with an understanding of menopause and its hormonal changes. We will then discuss the transition to postmenopause, its characteristics, the hormonal changes that occur during this phase, and potential health implications.

What is menopause?

Menopause is one of the most significant events that all women go through. This natural biological process marks the end of a woman's reproductive capacity. It is defined as the point in time when a woman has not had a menstrual period for 12 consecutive months, signifying the end of her menstrual cycles.¹

Menopause typically occurs in a woman's late 40s to early 50s, with the average age being around 51. However, the age at which menopause occurs can vary from person to person.

During menopause, there is a significant decline in the production of the female sex hormones, oestrogen and progesterone. These hormonal changes can lead to various physical and emotional symptoms.

Transition to Postmenopause

The transition to postmenopause is a pivotal stage in a woman's life, following the perimenopausal phase. During perimenopause, women often experience irregular menstrual cycles, hormonal fluctuations, and the onset of menopausal symptoms such as hot flashes, mood swings, and vaginal discomfort.² This transition is a gradual process that eventually culminates in postmenopause, marked by the complete cessation of menstrual periods. This therefore means that ovulation no longer occurs, meaning that at this point it will not be possible to conceive naturally, although there are other options available should you wish to have a child.

Characteristics of Postmenopause

Postmenopause is the period that begins after menopause (i.e. your period has stopped for longer than 12 months in a row) and continues for the rest of a woman's life. The duration can vary, but it generally encompasses several decades.

During postmenopause the hormonal changes (such as consistently low oestrogen and progesterone levels) continue, and although symptoms of menopause may have settled or completely stopped, for some women the symptoms may continue for longer.

Hormonal Changes in Postmenopause

As you transition into the postmenopausal phase, you'll likely notice a significant and lasting shift in your hormonal balance, particularly concerning oestrogen and progesterone. These hormones, which played pivotal roles in your reproductive system and overall health during your fertile years, will undergo significant changes. 

Your oestrogen levels, which once fluctuated throughout your menstrual cycle, will drop to consistently low levels. This decline is due to the gradual cessation of ovarian oestrogen production.³ 

Progesterone, another essential reproductive hormone, will also remain at low levels. These hormonal changes will bring you to a state of hormonal equilibrium, distinct from the monthly fluctuations you've had since puberty. This new hormonal baseline will have profound implications for your body and overall health during postmenopause.

Physical and Psychological Changes

The first sign of perimenopause is usually irregular periods, followed by the complete cessation during menopause. After 12 months you may still be experiencing some of the symptoms that began during menopause. 

Physical symptoms

• Hot flashes and night sweats: this may start to disrupt daily life and sleep
• Vaginal dryness and atrophy: this may in turn affect sexual health 
• Bone health: decreased bone density as a result of the loss of oestrogen may increase risk of fractures (further discussed below)

Psychological symptoms

• Mood changes: some women may experience irritability, anxiety or depression
• Cognitive effects: these could include brain fog, memory issues or difficulties concentrating.

Health Considerations

Osteoporosis risk

Following menopause, women face a greater risk than men when it comes to the development of osteoporosis, a condition characterised by the accelerated breakdown of bone tissue compared to its formation. This is particularly pronounced during the first three years post-menopause.⁴

Regular bone health assessments are recommended to monitor bone density and identify potential issues. Additionally, incorporating an adequate amount of calcium into your diet is vital for maintaining strong bones. 

Cardiovascular health

The reduction of oestrogen levels in your body during menopause elevates the risk of cardiovascular disease.⁵ This hormonal change can lead to the narrowing of coronary arteries. This in turn increases the likelihood of developing conditions such as coronary heart disease and stroke.

Breast cancer risk

Breast cancer risk also warrants consideration. While the relationship between postmenopausal hormone changes and breast cancer is complex, some studies have suggested that extended exposure to oestrogen, particularly through hormone replacement therapy (HRT), may be associated with a higher risk.⁶ It's essential for women to discuss the potential risks and benefits of HRT with their healthcare providers when considering this treatment.

Screenings and preventive measures

Screenings and preventive measures are vital in managing health during postmenopause. Regular check-ups and screenings for conditions like osteoporosis, heart disease, and breast cancer are crucial. 

Additionally, lifestyle choices, including maintaining a healthy diet, engaging in regular physical activity, and managing stress, can help mitigate the potential health implications of postmenopausal hormonal changes. 

Overall, understanding the health risks associated with postmenopause and taking proactive steps to manage them can help you to embrace this life stage and all that comes with it.

Management and Treatment

Lifestyle modifications

As mentioned before, osteoporosis is one of the many risks associated with the postmenopausal period. One way to reduce your chances is to exercise regularly, particular weight bearing and resistance exercises. In addition, eating a healthy balanced diet with calcium-rich foods, such as yoghurt and milk. This can also be achieved through taking calcium supplements, as well as vitamin D supplements which can help to increase absorption of calcium.

Other lifestyle modifications such as reducing alcohol consumption and stopping smoking can also improve bone strength and reduce the risk of osteoporosis.⁷ 

Explore stress-relief techniques such as mindfulness, meditation, yoga, or deep breathing exercises to reduce the impact of stress on your physical and mental health.

Hormone replacement therapy (HRT)

Given the decline of hormones that occurs during menopause, one option that is commonly recommended for the postmenopausal time is HRT - specifically continuous combined HRT. It is particularly useful for women who are experiencing hot flushes, mood swings and vaginal dryness (which are all a result of the hormone changes)

Combined HRT uses both oestrogens and progestogens to raise the levels of hormones in the body. The reason for using both is because oestrogen-only HRT can thicken the lining of the womb, which unfortunately increases the risk of endometrial cancer. Taking progestogen alongside it reduces this risk and therefore makes it safer.

Continuous combined HRT comes in several different forms - tablets, capsules or patches. It can take several months to fully start taking effect and for you to start feeling relief of your symptoms. HRT tends to be taken for at least 2 years, but depending on your symptoms you may need it for longer.

Increasing the hormones that are naturally suppressed during menopause also means that it can prevent osteoporosis. 

It is only available on prescription and it is therefore important to discuss in detail the pros and cons of starting HRT with your doctor, and whether you are suitable for it. There are some cases where it may not be appropriate, such as previous gynaecological cancers or a history of blood clots.

Alternative therapies

Some women may find relief from postmenopausal symptoms through natural remedies like herbal supplements (e.g., black cohosh), acupuncture, or dietary changes. 

Cognitive behaviour therapy has been found to improve some of the psychological and emotional changes that occur as a result of menopause.

If you experience vaginal dryness or discomfort, consider using water-based lubricants and moisturisers. Consult with a healthcare provider for additional options like prescription therapies.

Quality of Life in Postmenopause

Maintaining physical and mental well-being

Quality of life in postmenopause is a paramount consideration for women as they navigate this transformative life stage. Maintaining physical and mental wellbeing is essential. Staying physically active through exercise, adopting a balanced diet, and managing stress can alleviate symptoms and promote overall health. Equally vital is nurturing your mental wellbeing by seeking social support, engaging in activities you enjoy, and exploring stress-relief techniques.

Importance of regular healthcare visits

Regular healthcare visits are critical to monitor health status, address specific postmenopausal concerns, and discuss preventive measures. These appointments offer an opportunity to discuss hormone therapy options, address potential health issues, and ensure your overall well being. 

Support and resources available

Support and resources are readily available for women in postmenopause. Support groups, healthcare providers, and educational materials can provide valuable information and emotional support to help you thrive during this life stage. By prioritising physical and mental health, maintaining a proactive approach to healthcare, and accessing available support and resources, you can enhance your quality of life in postmenopause.

Summary

Postmenopause is a transformative phase in a woman's life, marked by significant hormonal changes and various physical and emotional adjustments. We've explored the impact of hormonal shifts, the importance of maintaining physical and mental wellbeing, and the significance of healthcare check-ups. Understanding the nuances of postmenopause is crucial for embracing this life stage with confidence and grace.

It's important to emphasise that postmenopause is not just a phase, but an opportunity to prioritise your health and well-being. Remember, you're not alone in this journey. Seek support from healthcare providers, support groups, and educational resources when needed. 

While it may present unique challenges, this time also offers new beginnings, personal growth, and a chance to live life to the fullest.