Postmenopause: the final stage of menopause

If it has been a year since your last menstrual period, you can (retrospectively) confirm that you are in postmenopause. This marks a new phase of life in which high hormone levels are no longer required. On average, postmenopause begins around the age of 51, although this can vary greatly from woman to woman. Some may experience their final period years earlier or later than others.

After your last menstrual period, your ovaries stop producing the sex hormones oestrogen and progesterone. However, they still produce small amounts of testosterone, and the adrenal glands (two small glands located above the kidneys) convert a hormone into a small amount of oestrogen.

Although this production is significantly lower (as these hormones are no longer needed for reproduction), they remain important for other essential functions in your body, such as maintaining bone, heart, and vascular health. For this reason, it is important to take good care of your adrenal glands during this phase, but more on that later.

At the beginning of postmenopause, your body needs time to adjust to these lower hormone levels. Your body seeks a new hormonal balance, which may still cause symptoms.

The symptoms you may experience during postmenopause are often linked to low oestrogen levels. Additionally, the risk of osteoporosis, joint problems, and cardiovascular diseases increases. Research shows that symptoms typically persist for one to two years, but they can last longer. Many women, for instance, report experiencing (severe) hot flushes during the first two years of postmenopause.

Symptoms that may occur (or worsen) during postmenopause:

• Vaginal dryness
• Hot flushes
• Burning sensation in the vulva
• Joint pain
• Poor sleep
• Weight gain
• Reduced libido
• Mood swings
• Skin ageing
• Urinary tract infections
• Pelvic floor issues
• Urinary incontinence
• Hair loss

Ageing also contributes to these symptoms, making it difficult to determine whether they are due to postmenopause or the natural ageing process. Generally, hormonal symptoms gradually decrease during postmenopause. However, the only symptom that does not diminish due to low oestrogen levels is dryness of the mucous membranes, such as vaginal dryness or dry eyes.

For many women, menopausal symptoms gradually subside during postmenopause, but what can you do if this is not the case for you? Which supplements can help? And is hormone therapy still an option?

During postmenopause, it is important to adapt to the changes in your body. Hormone therapist Suzanne Rouhard offers the following advice:

• Eat plenty of fibre, protein, healthy fats, and slow carbohydrates. Focus on vegetables and fruits (fibre) and vary your diet. Ensure sufficient omega-3 intake (important for heart health) and try to reduce salt and sugar. A healthy diet protects your body against cardiovascular diseases, keeps your bones and muscles healthy, and supports your overall health. This is especially important during postmenopause when extra care for your body is needed.
• Exercise is crucial for maintaining healthy bones, muscles, and joints. Strength training (focusing on major muscle groups: chest, shoulders, back, legs, and glutes) and cardio training are particularly beneficial. Strength training also strengthens bones and promotes bone density. Additionally, exercise releases dopamine, which improves your mood. Aim for at least 30 minutes of additional physical activity daily, on top of your usual routine.
• Get more rest, especially at night. Research shows that women in postmenopause often have difficulty falling asleep. Maintain good sleep hygiene and address other factors that may contribute to poor sleep. Reduce stress by taking breaks and engaging in relaxing activities (walking, reading, spending time in nature, breathing exercises, drawing, etc.). Your body needs this extra care.
• Vaginal dryness is the one symptom that will not go away. If you experience discomfort or irritation during intercourse due to a dry or sensitive vagina, lubricants can help alleviate pain and irritation. Take your time with your partner; foreplay can make intimacy more enjoyable and exciting.
• Monitor your health metrics, such as cholesterol levels, blood sugar levels, and blood pressure. These values often change during menopause. By understanding your body, you can take timely action.

In some cases, it may be advisable to start or continue hormone therapy during this phase, particularly if you have a family history of osteoporosis or if you are still experiencing severe symptoms. It is recommended to begin hormone therapy before the age of 60 or within ten years of menopause. After this period, your body has adapted to low hormone levels, and the risks of hormone therapy outweigh the benefits. Current guidelines also recommend limiting hormone therapy to no more than five years.

If you cannot or do not want to use hormones, there are hormone-free medications available to alleviate specific symptoms, such as hot flushes or joint pain.

Consider taking vitamins and minerals to support your health during postmenopause. Your body requires extra attention during this phase. Many people, for example, have low vitamin D levels, and calcium and magnesium are also important. Both contribute to bone health, and magnesium plays a role in calcium absorption. Other essential vitamins and minerals include magnesium (for fatigue, optimal muscle function, and mood*) and omega-3 (supports a healthy heart and blood vessels*).

*Health claims pending approval by the European Commission.