CONDITIONS

Postmenopause

What Is Postmenopause

The time of a woman’s life after menopause is postmenopause. Technically, a woman is postmenopausal from the moment menopause occurs until the end of her life.

During postmenopause, hormone levels will not fluctuate, but will stay at low levels for the rest of your life. The good news is that many of the possibly bothersome signs and symptoms that may have been experienced during menopause will fade away during postmenopause. For instance, you will not have hot flashes, and if you have mood swings or trouble sleeping because of changing hormone levels, then this may also stop.

Postmenopausal women, however are at increased risk for a number of health conditions, like osteoporosis and cardiovascular disease—thought to be due to lower levels of estrogen. Other problems, such as vaginal dryness, will continue if untreated. If your sexual desire has decreased, it may stay low—but there are treatments that can help.

What Causes Postmenopause

All women experience menopause at some point in their lives, typically between the ages of 45 and 55. Occasionally, women can experience premature menopause(onset before age 40). All the stages of menopause are a natural part of a woman’s life, brought on by the ovaries’ decreased production of estrogen and progesterone. As estrogen and progesterone levels decrease, the woman no longer ovulates (her ovaries stop making and releasing eggs) and menstruation ceases—postmenopause just refers to the years after menopause.

 

Diagnosing Postmenopause

A woman enters natural menopause when she has not had her period for a year—and is, at this point, considered to be in postmenopause. Diagnosis is usually not necessary as most women know when they have reached this point; but your health care provider can measure your FSH (follicle stimulating hormone) levels to help confirm if you have entered postmenopause. FSH levels rise considerably as your ovaries shut down—these levels can be checked via a blood test, though many doctors don’t like to rely on these tests as hormonal fluctuations can render the results inaccurate.

 

Symptoms of Postmenopause

During the years leading up to postmenopause, many women experience a variety of common symptoms, which range from bothersome to uncomfortable. These include:

  • Hot flashes
  • Mood swings
  • Lowered libido or loss of libido
  • Vaginal dryness
  • Irritability
  • Forgetfulness
  • Trouble sleeping

During the postmenopause years, however many of these symptoms will likely fade away. For instance, you will not have hot flashes, and if you have mood swings or trouble sleeping because of changing hormone levels, then this may also stop. In fact, many women report that once they became postmenopausal, they had renewed energy and overall feeling of well-being.

On the other hand, however, some women report feeling a few lingering symptoms, perhaps due to still fluctuating hormone levels, which in some cases can last for as long as 10 years after menopause. Here are some of the more common and less common postmenopause symptoms:
Vaginal Changes. As the estrogen levels in the body fall, the tissues lining the vagina become thinner and dryer. This can cause:

  • Dryness
  • Itching
  • Irritation
  • Pain during sexual intercourse (which can begin in perimenopause)
  • Discharge

Once a woman’s body starts producing less estrogen, vaginal walls my thin, and cause dryness, which can lead to bothersome itching, soreness and pain during intercourse.  These symptoms can be successfully treated, however, with lubricants or vaginal estrogen rings. If you experience discharge that has blood in it, there may be something else going on, and you should seek medical attention.

Weight gain

Weight gain is one of the most common postmenopausal symptoms—many women gain between 10 to 20 lbs., even though they have not changed their regular diets. Hormone changes are the primary reason for this—lower estrogen levels allow the body to retain more fat cells in an attempt to naturally boost estrogen levels. As well, psychological factors like depression, anxiety, or stress can also add to postmenopausal weight gain.

Stress or urinary incontinence

As many as 40% of postmenopausal women have stress incontinence—a condition which lead to a loss of bladder control, that accompanies physical exertion such as coughing, sneezing, laughing, or lifting something heavy. Estrogen supports the strength of bladder muscles, and as levels decline, the chances for stress incontinence increase. Here’s something that can be done to counter the effects of stress incontinence: kegel exercises, which can strengthen your pelvic floor muscles. These are the muscles that control the flow of urine, and hold your pelvic organs in place.

Kegel exercises: By squeezing the muscles in the pelvic floor—the same ones that can start and stop the flow of urine—you can strengthen the muscles that prevent your bladder from leaking.  Kegel exercises are easy to do and can be done anywhere, at any time, without anyone knowing. An added benefit is that this can increase sexual satisfaction and make your orgasms stronger!

  1. Find the muscles you use to stop urinating midstream—these are your pelvic floor muscles. The act of stopping and restarting the flow of your urine is the essential movement involved with kegel exercises
  2. Squeeze these muscles for 5 seconds. Then relax for 10 seconds.  Work to isolate this muscle movement to your pelvic floor muscles—try not to clench your thigh or stomach muscles for best results

Repeat this movement 10 to 15 times per session.  As you get more accustomed to doing kegels, trying doing them at least 3 times a day.

Urinary Tract Infections (UTI)

As estrogen levels decrease, there is increased risk for developing UTIs. Estrogen is key in maintaining the acidity level of the vagina, and as it decreases a woman’s vagina is at greater risk for bacteria that can travel to the urethra and cause a UTI. Easily treatable with antibiotics, UTIs are not usually serious—but if you experience pain or burning when urinating, be sure to speak with your healthcare professional.

Skin texture changes

As hormones fluctuate, changes in skin often occur, sometimes leading to acne, or increased wrinkles.

Hair growth in unexpected areas

Since testosterone levels increase in postmenopause, it is not unusual for a postmenopausal woman to experience hair growth on the chin, chest or upper lip.

Insomnia

Hormonal fluctuations can affect sleep, causing trouble with both falling and staying asleep. Doctors often recommend chamomile tea or warm milk to help the body get ready for sleep. While not as common as during menopause, this can still be a bothersome symptom in the postmenopause years.

Hot flashes

Common during perimenopause and menopause, postmenopausal women typically experience a marked drop in frequency and number of hot flashes when they enter postmenopause.  But they can still occur. Talk to your doctor if hot flashes become more frequent or become more intense as it could be a sign of something else.

Vaginal bleeding

Heavy bleeding is rare after menopause and could be a sign of something more serious, like certain types of cancer, and should always be evaluated by a physician.

 

 

Living With Postmenopause

The best defense against long-term health risks after menopause is taking good care of your health.  Eat a balanced diet, supplement with calcium and vitamin D if needed, and get enough exercise—this should include both cardiovascular exercise to protect your heart, and a mix of strength training and weight-bearing exercise to strengthen your bones and muscles.

If you smoke, stop. Talk to your doctor about other ways you can care for yourself after menopause. Menopause is a natural part of life, but it is different for every woman. Understanding your body and taking charge of your health can help you keep yourself healthy into menopause and beyond.

Though perimenopause symptoms may be disruptive and last several years, there are lifestyle changes you can make that add immeasurably to your quality of life during your transition

  • Exercise regularly. Aim for 20 to 30 minutes 5 days a week, and vary the routines – walking, swimming, etc., so you don’t get bored. Exercise can help regulate moods, rebuild lost muscle and bone tissue, strengthen the muscles responsible for urinary incontinence, and prevent weight gain. Researchers at Pennsylvania State University found that menopausal women who exercise may experience fewer hot flashes in the 24 hours following physical activity.
  • Don’t smoke. Smoking has been found to cause early onset menopause symptoms as well as increase the severity of symptoms. A recent study has found that a genetic variant found mainly in white women places smokers at an even higher risk of early onset menopause – as early as nine years in the heaviest of smokers.
  • Maintain a Healthy Weight. A study done at Kaiser Permanente and published in Menopause found that losing just 10 pounds helped relieve menopausal symptoms, in particular hot flashes.
  • Consider the Advantages, you no longer have to deal with your periods and you don’t have to worry about an unplanned pregnancy. However, be sure to continue using contraception until at least 12 months have passed without a period and always have a new partner use a condom in order to protect you from STDs, including HIV/AIDS.
  • Consider hormone replacement therapy or alternative treatments if symptoms persist and are bothersome to you. 

 

Complementary and Alternative Treatment

There are ways to treat the symptoms of menopause and postmenopause without hormone replacement therapy, though these alternative treatments are not FDA approved, and research is not always clear on effectiveness. Some of these treatments include:

Herbal Medicines. Research has shown that several herbal medicines may be useful in treating many perimenopausal and menopausal symptoms.  Before taking natural or herbal products, discuss with your doctor, who will be able to notify you of any health risks and potential interactions with medications. Because natural products can have side effects and can interact with other botanicals or supplements or with medications, research in this area is addressing safety as well as efficacy. Some findings from this research are highlighted below.

  • Black cohosh (Actaea racemosa, Cimicifuga racemosa). This herb is one of the best-studied traditional herbs for relief of perimenopuase and menopause symtoms. It seems to work by supporting and maintaining hormone levels, and for many women lessens the severity of hot flashes.
  • Dong quai (Angelica sinensis) can help maintain the natural balance of female hormones and does not have estrogenic activity. It is well known in China and the West and one of the most common herbs used to treat bothersome perimenopause and menopause symptoms. However, Dong quai should not be taken if a woman is experiencing heavy bleeding.
  • Ginseng (Panax ginseng or Panax quinquefolius). The 2005 NIH panel concluded that ginseng may help with some perimenopausal and menopausal symptoms, such as mood symptoms and sleep disturbances, and with one’s overall sense of well-being. However, ginseng has not been found helpful for hot flashes.
  • Kava (Piper methysticum). According to the 2005 NIH panel, kava has been found to decrease anxiety, thought there is no evidence that kava decreases hot flashes. If one has any liver disease, please beware that the U.S. Food and Drug Administration (FDA) has issued a warning to patients and providers about kava because of its potential to damage the liver.
  • Whole Soy foods. The scientific literature includes mixed results on soy extracts for hot flashes—it is the isoflavones in soy foods that are thought to help balance hormone levels, and have some effect on estrogen levels. Some studies find benefits, but others do not.  Eating natural foods for whole soy beans is seen as more healthy than taking supplements—some foods that fit this description include: tofu, tempeh, soy milk, and edamame among other. Although information on adverse effects is limited, soy extracts appear to be generally safe when taken for short periods of time.
  • Evening primrose oil or black currant oil. The essential fatty acids in these oils can help with moderate symptoms of perimenopause and menopause.

Dietary supplements. Certain dietary supplements can help to restore deficiencies that may occur as a result of decreased estrogen and progesterone production. These include:

  • DHEA. DHEA is a naturally occurring substance that is changed in the body to the hormones estrogen and testosterone. DHEA is manufactured and sold as a dietary supplement. A few small studies have suggested that DHEA might possibly have some benefit for hot flashes and decreased sexual arousal, although small randomized controlled trials have shown no benefit. Because levels of natural DHEA in the body decline with age, some people believe that taking a DHEA supplement can help treat or prevent conditions related to aging; however, there is no scientific evidence to support this notion.
  • Calcium. Calcium helps protect against osteoporosis and bone loss. Women 51 and older need 1,200 mg of calcium per day. Calcium can be found in milk, fortified cereals and soy milks, dairy products, green leafy vegetables, and tofu—and a calcium supplement may help you keep your levels where they need to be if you are not getting sufficient calcium from your diet.
  • Vitamin D. Vitamin D helps your body absorb calcium, so it is just as important as calcium when it comes to bone health. Sunlight is the best source of vitamin D. While it protects you from harmful rays that can cause skin cancer, sunblock can also block out the rays needed for vitamin D production. Only a couple of minutes of exposed sun exposure are needed to absorb the right amount of sunlight for normal vitamin D levels. Make sure that for time longer than that you protect yourself with sunblock. Vitamin D can also be found in food (fortified milks, cheese, tuna) and can be taken in pill form.
  • Vitamin E. A daily dose of 400 IU of natural vitamin E—derived from natural ingredients–(can help alleviate symptoms of hot flashes in some perimenopausal and menopausal women

Bioidentical Hormone Replacement Therapy. Bioidentical hormone replacement therapy,” or BHRT, is a marketing term that is not recognized by the FDA. It is a term used to describe medications that are prepared in specialized pharmacies. BHRT may contain any variation of hormones including estrone, estradiol, estriol, progesterone, and testosterone. Compounded bioidentical hormones are often marketed as natural and safe alternatives to conventional hormone therapy prescription medications. However, compounded formulas are often inconsistent and can vary depending on the batch or the pharmacist. While FDA-approved hormone preparations have been tested for efficacy, purity, safety, and potency, there is a lack of scientific evidence surrounding BHRT and the safety and efficacy of these compounds. As a result, compounded bioidentical hormones are not approved by the FDA. For additional information, see the FDA publication Bio-Identicals: Sorting Myths from Facts.

Acupuncture. Studies have shown that acupuncture, which aims to restore the bodily flow of energy through the insertion of needles into acupuncture points around the body, can help to reduce the severity of hot flashes and night sweats.

 

Questions For A Doctor

As you go through perimenopause, you may want to talk to your health care provider about what is going on. Here are some questions that might be good for you ask:

  • Should I have an examination to rule out other causes for my symptoms?
  • What can I expect as I go through menopause?
  •  Where can I get more information about menopause?
  • What is my risk of developing diseases related to the loss of estrogen such as heart disease, osteoporosis, and hypertension? What can I do to decrease my risk?
  • Can you explain the potential benefits and risks of hormone therapy?