So You’ve Reached Postmenopause. Now What?

Many of us may be aware of what menopause is and the symptoms that come along with it. We’ve heard about hot flashes and insomnia, but what happens after menopause? That’s usually when postmenopause kicks in—the third and final stage of menopause. It’s when your menstrual cycle has been absent for at least 12 consecutive months. 

Life after menopause can be both a relief and may also require mental and physical adjustments since so many changes take place. In terms of the physical ones that happen postmenopause, some women notice menopausal symptoms subsiding, which can be a relief. Not having to deal with night sweats, tossing and turning at night, or mood swings can make day-to-day living easier. During postmenopause, women are also officially done with childbearing and no longer ovulating. For some, that may be something to jubilate about while others may grieve the ability to have more kids. 

It’s important to point out that not every woman is freed from menopause symptoms once menopause ends. There are women who still experience symptoms for 10 years after or longer.

Some of those long-term symptoms may include hot flashes, leaking urine, vaginal dryness, or a lower sex drive. Felicia Higginbotham, a registered nurse in Atlanta, says for some patients she works with, sex is “nonexistent” postmenopause.

“They have no desire physically or hormonally because the imbalance has just killed the libido,” she says. “But they all seem very accepting of it as if that chapter of their life is done.” That said, some women may experience the opposite effect and enjoy an improved sex drive once their reproductive and menstruating years end.

Higginbotham also says her clients tend to struggle with weight loss and hot flashes postmenopause. Hot flashes may persist after menopause since estrogen levels decrease in the body. When estrogen levels are low, it can result in the hypothalamus, which is like your body’s thermostat, becoming more sensitive to shifts in your body temperature. 

That said, what happens after menopause is greatly influenced by a woman’s perimenopausal (time around menopause) care. According to an article by the World Health Organization, it can play a pivotal role in how a woman ages moving forward and her quality of life. 

Speaking of life quality in latter years, women may be at higher risk for conditions like osteoporosis and heart disease among others postmenopause. Jenna Perkins, women’s health and gender related nurse practitioner and founder of DiscovHer Health located in Alexandria, Va. says the risk of conditions like heart disease can be especially concerning for Black women. 

“This is noteworthy, especially for Black women who are disproportionately affected by hot flashes and night sweats and also die from heart disease at rates higher than other populations.”

According to the U.S. Department of Health and Human Services Office of Minority Health, in 2019, African Americans were 30 percent more likely to die from heart disease than their non-Hispanic white counterparts. Cardiovascular disease is also the leading cause of death for non-Hispanic Black women according to a study on cardiovascular disease risk factors in women published in AHA Journals.

Heart disease aside, there are other conditions women may be at risk of once menopause ends such as obesity, osteoporosis, depression, Alzheimer’s, sexual dysfunction, overactive bladder and incontinence, according to Perkins.

To minimize the risk of rapidly declining health after menopause, it’s important to care of yourself before, during, and after that transition. In other words, women should try their best to take care of their health both during perimenopause—again, the transitionary period leading into menopause—and menopause. This is something Higginbotham is doing as she edges closer to entering that chapter. 

“I’m preparing by cleaning up my diet, understanding estrogen rich foods and the effects of them, committing to a fitness regimen geared toward toning and building muscle and using natural remedies such as slippery elm, sea buckthorn for vaginal issues and a healthy sex life,” she says. 

It’s critical that women nurture their mental health as well after this transition, especially when menopause symptoms persist. Saying goodbye to reproductive years or watching your body change in big ways can trigger grief for some. Midlife also comes with other transitions, says Perkins, and this can make balancing menopause, and postmenopausal symptoms challenging. 

“Midlife can be an inherently difficult time as women can experience life changes like the loss of their parents or having to become a caregiver for loved ones, becoming empty nesters as their children grow up and leave the home, all while they have to maintain their careers and financial obligations,” she says. “Menopause can affect the resilience women have to be able to deal with these dramatic life changes.”

A part of the contract we involuntarily sign as humans when we enter the world is that we will age and our bodies will follow suit. Every woman will respond differently to menopause, but it’s important to remember that you’re valuable no matter what phase of life you’re in and how your body changes.