Postmenopause

Overview

What is postmenopause?

Postmenopause is a term to describe the time after someone has gone through menopause. When you're in postmenopause, 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 (releasing eggs). The menopausal symptoms you’ve experienced in the past may become milder or go away completely. However, some people continue to experience menopausal symptoms for a decade or longer after menopause.

There are three stages of menopause: perimenopause, menopause and postmenopause.

  • Perimenopause is the time leading up to menopause. It describes a time when hormones start to decline and menstrual cycles become erratic and irregular. You may start to experience side effects of menopause, like hot flashes or vaginal dryness.
  • Menopause occurs when you’ve stopped producing the hormones that cause your menstrual period and have gone without a period for 12 months in a row. Once this has occurred, you enter postmenopause.
  • Postmenopause is the time after menopause has occurred. Once this happens, you're in postmenopause for the rest of your life. People in postmenopause are at an increased risk for certain health conditions like osteoporosis and heart disease.

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 have stopped releasing eggs.

What hormonal changes happen after menopause?

Your ovaries are making very little of both estrogen and progesterone by the time you're in postmenopause. Some people still experience side effects from low hormone levels.

At what age are you considered postmenopausal?

There is not an age at which that you are automatically in postmenopause. Once your period has been absent for more than one year, you're in postmenopause regardless of age. On average, people go through menopause around 51 years of age.

Symptoms and Causes

What are the symptoms of postmenopause?

Most people in postmenopause feel lingering symptoms from menopause. The symptoms are less intense. In some cases, they almost disappear. Lingering symptoms are caused by low levels of reproductive hormones.

People in postmenopause can feel symptoms such as:

If your symptoms become more intense or interfere with your daily life, talk with your healthcare provider. They may want to rule out any underlying condition causing these symptoms.

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 or uterine fibroids, infections like endometritis, or cancer. Contact your healthcare provider if you experience any vaginal bleeding so you can be evaluated.

Will my hot flashes stop after menopause?

Some people still experience hot flashes after menopause. Postmenopausal hot flashes are caused by decreased estrogen levels. It is not uncommon to experience a random hot flash for years after menopause. If your hot flashes are bothersome or intensify, speak with your healthcare provider to rule out other causes.

Diagnosis and Tests

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 will 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.

Management and Treatment

What medications are used to treat postmenopausal symptoms?

Hormone therapy could be an option, although healthcare providers often recommend using it for a short amount of time and in people under the age of 60. There are health risks associated with hormone therapy like blood clots and stroke. Some healthcare providers do not recommend using hormone therapy after menopause has ended or if you have certain medical conditions.

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

  • Antidepressants for mood swings or depression.
  • Vaginal creams for pain related to sexual intercourse and vaginal dryness.
  • Gabapentin (Neurontin®) to relieve hot flashes.

Oftentimes your provider will recommend lifestyle changes to help manage your symptoms.

How do I manage symptoms of postmenopause on my own?

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

  • Using a water-based vaginal lubricant during sex to make it more pleasurable. Lubricating the vagina helps with dryness and pain.
  • Regular exercise, meditation and other relaxing activities can help with depression and other side effects of postmenopause.
  • Eating a diet rich in phytoestrogens (plant-based sources of estrogen) such as whole-grain cereals, flaxseed, chickpeas and legumes. Reducing caffeine and alcohol intake has also been shown to help.

Prevention

Are there any health risks associated with postmenopause?

People in postmenopause are at an increased risk for several conditions:

Cardiovascular disease

Estrogen helps protect against cardiovascular diseases like heart attack, heart disease and stroke. It is also common for people in postmenopause to become more sedentary, which contributes to high cholesterol and high blood pressure. These factors combined can increase a woman’s risk for cardiovascular diseases after menopause. A healthy diet, not smoking and getting regular exercise are your best options to prevent heart disease. Treating elevated blood pressure and diabetes as well as maintaining cholesterol levels are also ways to lower your risk.

Osteoporosis

People lose bone more rapidly after menopause due to decreased levels of estrogen. You may lose up to 25% of your bone density after menopause (approximately 1% to 2% per year). When too much bone is lost, it increases your risk of developing osteoporosis and bone fractures. The bones of the hip, wrist, and spine are most commonly affected. Bone mineral density testing, also called bone densitometry, can be done to see how much calcium you have in certain parts of your bones. The test is used to detect osteoporosis and osteopenia, a precursor to osteoporosis.

Vaginal atrophy

Decreased estrogen levels cause the tissues in your vagina to thin and deteriorate, making your vagina dry. People in postmenopause may continue to struggle with vaginal dryness for years after their last period. Using vaginal lubricants can help ease any discomfort caused by sex. Decreased estrogen levels can also impact the urinary tract and bladder and make leaking urine a problem for some people. Persistent dryness and painful intercourse should be evaluated by your healthcare provider to rule out other conditions. Using lubrication and topical creams or getting laser therapy to the vagina can help with vaginal dryness.

Mental health issues

Many people in postmenopause experience moodiness, anxiety and depression. This could be caused by stress, sexual tension or other life challenges that occur during this time. Some people feel sad that their reproductive years are over. Mood symptoms can also be caused by decreased hormone levels. It might help to talk with a therapist or counselor about what you are feeling.

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 body absorb calcium.

What can I do to prevent cardiovascular disease after menopause?

The best ways to prevent cardiovascular diseases are to eat a healthy diet, exercise regularly and avoid smoking. Conditions such as high cholesterol, high blood pressure and having obesity are usually related to poor diets and lack of physical activity.

Outlook / Prognosis

Can you get pregnant after menopause?

Once your menstrual period has been absent for over a year, you are unlikely to get pregnant. Until your healthcare provider has confirmed you are 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.

Living With

How often do I need to see my doctor after menopause?

You should still see your healthcare provider for routine gynecological care even though you aren't menstruating. This includes Pap tests, pelvic exams, breast exams and mammograms. You should continue to schedule annual wellness appointments. Since you are 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.

When should I call my doctor?

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 have 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 still 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.

Frequently Asked Questions

How should you feel after menopause?

Some people continue to feel symptoms of menopause for years after their last menstrual period. It's common to have hot flashes or feel depressed about getting older. Speak with your health care provider if you are still suffering from symptoms so they can offer support or treatment.

How do I stay healthy after menopause?

It is important to maintain a healthy lifestyle, especially as you age and your risk for certain medical conditions increases. Some ways for people in postmenopause to stay healthy include:

  • Exercising regularly. Walking, doing yoga or strength training can help lower your risk for many medical conditions.
  • Weight-bearing exercises can strengthen your bones and muscles.
  • Eating a healthy diet. 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.

A note from Cleveland Clinic

Going through menopause can be uncomfortable and present new challenges and health concerns. Speak with your healthcare provider about any symptoms you feel or questions you have. They can help make sure you are supported through this time and get the care you need.

Last reviewed by a Cleveland Clinic medical professional on 10/05/2021.

References

  • National Health Service. Postmenopausal Bleeding. (https://www.nhs.uk/conditions/post-menopausal-bleeding/) Accessed 10/12/2021.
  • American Heart Association. Postmenopausal Hypertension. (https://www.ahajournals.org/doi/10.1161/hypertensionaha.108.120022) Accessed 10/12/2021.
  • Hormone Health Network. Postmenopause. (https://www.hormone.org/menopausemap/postmenopause.html) Accessed 10/12/2021.
  • American Family Physician. Health Maintenance for Postmenopausal Women. (https://www.aafp.org/afp/2008/0901/p583.html) Accessed 10/12/2021.
  • The North American Menopause Society. Menopause FAQs: Understanding the Symptoms. (https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/menopause-faqs-understanding-the-symptoms) Accessed 10/12/2021.
  • Dalal, P. K., & Agarwal, M. (2015, July). Postmenopausal syndrome. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539866/) Indian Journal of Psychiatry, 57(Supplement 2), S222-S232. Accessed 10/12/2021.
  • The American College of Obstetricians and Gynecologists. The Menopause Years. (https://www.acog.org/womens-health/faqs/the-menopause-years) Accessed 10/12/2021.
  • Office on Women’s Health. Menopause. (https://www.womenshealth.gov/menopause) Accessed 10/12/2021.
  • American Family Physician. Hormone Therapy and Other Treatments for Symptoms of Menopause. (https://www.aafp.org/afp/2016/1201/p884.html) Accessed 10/12/2021.

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