Post-menopause: what happens after the change?

Your last period is now more than a year behind you, the fiercest hot flushes have passed, and yet your body feels different than it used to. That is not in your head. Post-menopause is not a finish line but a new phase, one that can last for decades, in which your hormone levels settle at a low, stable point.

I find it a shame that so much information about menopause stops at the hot flushes. The years afterwards deserve attention, because the body quietly builds up risks you cannot feel. The good news: those exact risks are measurable and largely within your influence.

What exactly is post-menopause?

You are post-menopausal from the moment you have gone twelve months in a row without a period. According to Thuisarts, the average age of menopause in the Netherlands is around 51, but a few years earlier or later is completely normal. From that point your ovaries produce almost no oestrogen, and that value stays low.

That low oestrogen explains why some complaints actually appear or persist after menopause: vaginal dryness, more frequent bladder infections, thinning skin, and over the longer term, bone loss. You do not have to see everything as a problem, but it helps to know what your body is now more sensitive to.

Three things that change quietly

1. Your bones break down faster

Oestrogen protects your bones. When that protection falls away, bone breakdown outpaces bone building. The Gezondheidsraad advises women after menopause to get enough calcium and vitamin D and to keep moving, precisely to slow bone loss. A bone density scan (DEXA) through your GP can show where you stand, especially if fractures or osteoporosis run in your family.

2. Your cardiovascular profile shifts

Before menopause, women on average have a more favourable cholesterol profile than men. After menopause that changes: LDL cholesterol may rise and protective HDL cholesterol may fall. The Hartstichting points out that the risk of cardiovascular disease in women increases after menopause. That does not mean something is wrong, but it can be worth mapping out your values.

3. Your energy and mood find a new balance

Many women notice the mood swings of perimenopause ease off. At the same time, fatigue can persist, and it is by no means always hormonal. An underactive thyroid or a low ferritin gives similar complaints and becomes more common around this age.

Which values are worth tracking?

Testing hormones after menopause usually adds little: they are predictably low. More interesting are the values that say something about your long-term health. This table helps you choose what to watch.

If you want a clear picture of your cardiovascular profile and hormonal status, a Menopause Check can be a logical starting point. Always discuss the result with your GP, because numbers only gain meaning within your story.

What you can do yourself

• Keep moving with weight. Strength training and walking signal your bones to stay strong. The Gezondheidsraad advises adults to do muscle- and bone-strengthening activity at least twice a week.
• Mind your vitamin D. A daily supplement is advised for women from age 70; even younger, a top-up can be sensible, especially in winter.
• Keep your heart values in view. Having your cholesterol and blood pressure checked once every few years is little effort.
• Take complaints seriously. Persistent fatigue, low mood or bone pain are not an automatic part of ageing. Discuss them with your doctor.

Vaginal and bladder complaints are part of it, but treatable

A topic many women find hard to talk about: low oestrogen can make the lining of your vagina thinner and drier. That can cause irritation, pain during sex or more frequent bladder infections. It is not a sign that something serious is wrong, but it is something you do not have to put up with. According to Thuisarts, these complaints are well treatable, for example with moisturisers or local oestrogen that barely affects the rest of your body. Feel free to discuss it with your GP, even if it feels awkward: it belongs to this phase, and your doctor hears it more often than you think.

Menopause is over, your health is not

Post-menopause is not a period to grit your teeth through, but a phase in which a few targeted choices can mean a lot for your future. Your hormones have settled, which leaves room to focus on what really matters now: your bones, your heart and your energy. Read on via our guide to perimenopause and the article on osteoporosis after menopause.