The Most Common Postmenopausal Symptoms to Keep on Your Radar

So, you've officially hit menopause, but you're still dealing with disruptive symptoms like hot flashes and brain fog. What gives? If you find yourself experiencing postmenopausal symptoms, you might wonder what’s going on—and what you can do to feel better, fast.

It’s not all in your head: Some symptoms go away while others really can linger after you hit menopause, which is defined as 12 months after your last menstrual period. This typically happens around age 51 for American women. After that—and for the rest of your life—you’re considered to be in postmenopause. The good news is you can always find help and support for symptoms that stick around.

Here, we’ll cover why postmenopause symptoms happen, what to expect, the effects of postmenopause on your long-term health, and what types of treatment options might make you more comfortable. (Reach out to a Midi clinician for personalized guidance about the best treatments for you and your health history.)

What Is Postmenopause?

There’s often confusion when comparing menopause and postmenopause. Menopause is a single point in time, specifically 12 months after your last period. This usually happens around age 51, but it can occur anytime between age 45 and 58. It marks the end of your reproductive years.

After you reach menopause, you’re in postmenopause for the rest of your life. Postmenopause can only be identified by looking back; you’re postmenopausal after you have experienced 12 consecutive months without a period (without any other obvious cause).

While menopause often gets blamed for symptoms like hot flashes and irregular periods, a third stage called perimenopause is actually to blame. This typically occurs throughout the 4 to 6 years leading up to menopause (although it can be shorter or longer than that).

During perimenopause, your ovaries gradually produce less and less of the hormones estrogen and progesterone, resulting in very low levels at menopause. These low hormone levels continue throughout postmenopause, which is what drives most symptoms you might experience during this chapter of life.

What Causes Postmenopausal Symptoms?

Postmenopause symptoms are largely caused by the hormonal changes that start during perimenopause and culminate with menopause. You have noticeably less estrogen and progesterone after menopause, which affects your vaginal health, bladder, bones, heart, brain, and skin.

For example, with less estrogen in your blood, your brain’s temperature control center doesn’t function as well. That results in hot flashes, those intense responses to even minor increases in body temperature.

Hot flashes might ease after menopause as your estrogen levels stabilize. But this can take some time, since estrogen levels can continue to fluctuate for years after hitting menopause. 

Meanwhile, symptoms such as vaginal dryness, painful sex, and weakening bones can get worse over time. For example, vaginal tissue may also continue to gradually get thinner and dryer. And you lose bone density more quickly without as much estrogen, which can lead to a higher risk of fractures. 

It’s largely unclear why some people experience postmenopause symptoms at age 60 or otherwise, but underlying genetic factors may play a role. 

The severity of your symptoms can be influenced by:

• whether you choose to use hormone therapy
• your diet and exercise habits
• your body weight 

Some symptoms or long-lasting effects can also be worse if you entered menopause early or because of surgery.

Common Postmenopausal Symptoms

Postmenopausal symptoms are different for everyone, and you may not even experience them at all.

If you do, the most common concerns are:

• Vasomotor symptoms: intense and sudden feelings of heat, flushing, and sweating, sometimes with heart palpitations or anxiety
• Genitourinary symptoms: vaginal dryness, burning, itching, painful sex, the need to urinate urgently or frequently, and recurrent urinary tract infections (UTIs), together called genitourinary syndrome of menopause (GSM) 
• Mood and brain symptoms: trouble concentrating, brain fog, sleep challenges, irritability, anxiety, and depression
• Physical symptoms: joint pain and stiffness, thinning hair, dry and sagging skin, and weight gain, especially around the waist

Certain symptoms are more frequent than others. For example, some research estimates as many as 87% of postmenopausal women experience some signs of GSM. But according to other research, only 16% of women ages 50 to 60 experience sleep apnea, for example.

Postmenopause symptoms can also vary in severity. Even though a majority of women will experience vasomotor symptoms, only about 20% of those who do say hot flashes interfere with their quality of life. 

Postmenopause and Long-Term Health Risks to Know

The postmenopausal symptoms above can be frustrating and at times challenging to manage. But beyond daily symptoms, there are some long-term health risks that pop up after menopause, driven by the loss of that protective estrogen.

These include:

• Bone loss: You can lose up to 20% or more of your bone mass in the 5 to 7 years after menopause, according to the Bone Health and Osteoporosis Foundation. That increases your risk of osteoporosis, a condition that occurs when you lose too much bone, upping your risk of fractures.
• Heart disease: Postmenopausal women have a higher risk of heart disease—which is still the leading cause of death for women in the United States—compared to premenopausal women.
• Metabolic syndrome: Postmenopause is linked with high cholesterol, insulin resistance, and a greater chance of developing type 2 diabetes.
• Cognitive decline: Not getting enough restful sleep and the loss of estrogen are both risk factors for dementia.
• Urinary incontinence: The changes that occur after menopause tend to get worse if they’re not addressed.

While these risks can be more than a little off-putting, try not to worry too much: You can take steps to protect your health, such as exercising regularly, eating a balanced diet, and prioritizing your sleep. 

You can and should be screened regularly for measurable effects on bone density, blood pressure, and cholesterol. And if a clinician is concerned about any of these levels or other symptoms, there are effective ways to treat all of the above, should they arise.

How Long Do Postmenopausal Symptoms Last?

Postmenopause itself is lifelong after 12 months without a period. But your symptoms can shift over time. That means your postmenopause symptoms at age 60 might be totally different from your postmenopause symptoms at age 70.

It’s hard to predict how long your symptoms will last. For example, hot flashes eventually subside for many women. They typically begin about a year before menopause and decline over an average period of 5 years.

But other symptoms, like vaginal dryness or urinary changes, are typically ongoing—and they can even get worse over time without treatment. Bone loss and heart disease risk also stay elevated throughout postmenopause.

That said, postmenopausal symptoms are treatable at any age. It’s never too late to speak with a healthcare professional, such as a Midi clinician, about what you’re experiencing and the available options that might bring you some relief.

Treatment and Relief Options to Help You Feel Better

A variety of treatment and relief options can help you manage postmenopausal symptoms. A menopause-informed clinician is best suited to discuss these options with you and determine the safest and most effective course of treatment. They’ll take into consideration your symptoms, medical history, and preferences.

The most likely options include:

• Systemic hormone therapy: This type of treatment can help with hot flashes, sleep issues, and mood changes. If you start hormone therapy within 10 years of menopause, it can also help protect your heart health. Not everyone is a good candidate for systemic hormone therapy, however, so ask your clinician whether it’s right for you. 
• Vaginal hormone therapy: Vaginal estrogen (usually in the form of a cream, tablet, or ring) delivers a lower dose of hormones exactly where you need it for genitourinary symptoms. 
• Non-hormonal prescription medications: Your clinician may prescribe a non-hormonal medication that acts in your brain to ease hot flashes. These include various options developed specifically for hot flashes, as well as others originally used to treat depression, seizures, and urinary symptoms, which have also been found to help with hot flashes.
• Lifestyle habits: Regular weight-bearing exercise (like running, dancing, or hiking) can help you keep your bones strong, and it can help you maintain a healthy weight. Optimizing your sleep hygiene can help you get the best rest possible; keep your bedroom cool, dark, and quiet, and try to maintain a consistent bedtime and wake-up time. Find relaxing activities that help you manage stress, and consider reaching out to a mental health professional if you think you could use more support.
• Supplements and botanicals: After menopause, you need about 1,200 milligrams of calcium per day to support healthy bones, and 600 international units (IU) of vitamin D (800 IU once you’re 70 or older) to help your body absorb that calcium. Talk with your clinician about the best vitamins for you, how much you’re already getting in your diet, and whether supplements might help you. Other supplements made from botanicals like Siberian rhubarb or black cohosh may help ease hot flashes, although the evidence supporting these is often preliminary or conflicting. 

When to See a Clinician

A few postmenopausal symptoms warrant immediate medical attention:

• Bleeding: Any postmenopausal bleeding is worth bringing up with a clinician as soon as possible. You’ll likely need a transvaginal ultrasound.
• Severe pain: Any intense itching or pain on your vulva or inside your vagina requires an in-person exam.
• Severe mood changes: If signs of depression or anxiety are getting in the way of your ability to function or causing you to have thoughts of harming yourself or others, reach out to a clinician right away.

But other, less serious symptoms deserve care too, not just tolerance. Any time your postmenopause symptoms disrupt your sleep, mood, sex, or daily functioning, it’s worth a discussion with a trusted, menopause-informed clinician. There’s likely a treatment option that can help.

Midi clinicians can help assess your symptoms and build a personalized plan for addressing your unique postmenopausal concerns.

You should also see a healthcare professional regularly to keep on top of standard screenings. A primary care clinician can help determine the best schedule for you for bone density screenings and cholesterol or blood pressure testing, for example.

Key Takeaways

• Menopause is a specific moment in time, when you’ve gone 12 months without a period. Any time after that is considered postmenopause.
• Many of the symptoms attributed to menopause actually occur in perimenopause, the years leading up to your final period, when hormone levels fluctuate. Some of these symptoms will gradually fade with time as hormone levels stabilize. Others can linger, or worsen, due to consistent low levels of estrogen after menopause. 
• Postmenopausal symptoms like vaginal dryness, urinary problems, trouble sleeping, brain fog, and hot flashes can be disruptive for many women.
• Hormone therapy, vaginal estrogen, and non-hormonal prescription treatments can help ease various symptoms of postmenopause. Talk with a menopause-trained clinician about the best treatment for you.
• Seek urgent medical attention if you have any bleeding or spotting after menopause or any severe pain or mood changes. 

Frequently Asked Questions (FAQs)

What is the average age for postmenopause?

The average age for postmenopause is after 51 for American women. Menopause, which is marked by 12 months without a period, usually happens around age 51—but it can occur anytime between ages 45 and 58. Right after women hit menopause, they are considered postmenopausal for the rest of their lives. 

How long do postmenopausal symptoms last?

It varies from person to person and between symptoms. Some, like hot flashes, tend to fade away over a few years. Others, like the urgent need to pee frequently, can stick around and get worse with time. If your postmenopausal symptoms are lasting a long time and interfering with your quality of life, it’s time to talk with a clinician about possible treatment options.

Does your body go back to normal after menopause?

It depends what you mean by “normal.” For many women, postmenopause is a new normal: No more periods, but new concerns like brain fog and sleep problems. For some, perimenopausal symptoms like hot flashes continue for several years and then fade away

Is spotting or bleeding after menopause normal?

Bleeding after menopause is never considered normal and is always worth discussing with a clinician. Most causes of spotting or bleeding after 12 months without a period aren’t major concerns and are treatable. But it’s important to always see a healthcare professional to make sure, as for some women, it could be a sign of cancer.

What's the difference between menopause and postmenopause?

Menopause is a single moment in time, when you’ve gone 12 months without a menstrual period. Postmenopause is the rest of a woman’s lifespan after menopause.