Author: Winona Healthcare
Of the three phases of the menopause transition – menopause, perimenopause, and postmenopause – postmenopause is the least discussed. It is not as well understood, and there is plenty of misinformation on the subject. Postmenopause begins once a woman has crossed through menopause, meaning she has gone twelve months without a period. At this stage, some menopausal symptoms start to subside, but many continue, and some can actually worsen.
Hot flashes and night sweats are examples of symptoms that can gradually decrease in postmenopause, but as estrogen, progesterone, and testosterone continue to decrease during postmenopause, women are at increased risk for a number of health conditions, like osteoporosis, type 2 diabetes, and heart disease.
This article reviews post-menopausal symptoms, the use and benefits of hormone replacement therapy (HRT), and other alternative therapies for managing those symptoms.
What Can I Expect During Postmenopause?
Once postmenopausal, a woman may regain some of the energy she lost due to sleep disruptions during menopause, but she may also be at higher risk for certain health conditions. HRT and/or healthy lifestyle changes can help reduce the risk of some of the conditions associated with decreased hormones during postmenopause.
The following are the most common persistent menopause symptoms and health risks during postmenopause (1,2):
- Vasomotor symptoms (hot flashes and night sweats) and decreased sleep quality
- Increased risk of cardiovascular disease
- Difficulty concentrating, anxiety, moodiness and/or irritability
- Reduced energy and quality of life
- Poorer health status and bone loss
- Skin and hair changes
- Decreased libido and painful sex
- Ongoing weight gain
- Vaginal changes that lead to genitourinary syndrome and incontinence
Hot flashes and night sweats, also called vasomotor symptoms, are probably the most discussed symptom when talking about menopause. Hot flashes are characterized by a sudden feeling of heat that spreads over the body, creating flushing and sweating, especially on the face and upper body. Hot flashes can range from mild to severe, and they can last from 30 seconds to 10 minutes. Hot flashes that occur in the middle of the night and are accompanied by profuse sweating are referred to as “night sweats.”
Because they are so disruptive, hot flashes and night sweats generally decrease sleep quality and can lead to difficulty concentrating, irritability, reduced quality of life, and poorer overall health (1). Untreated hot flashes are associated with increased bone loss and are linked to an increased risk of cardiovascular disease and mental challenges (1).
On average, women typically experience hot flashes and night sweats for a period of 7.4 years, but this can vary based on other demographics. The average duration is 5 years among Asian women, 7 years among white women, 9 years among Hispanic/Latina women, and 10 years among black women (1).
HRT is the most effective option for relieving hot flashes and night sweats. Both oral and transdermal estrogen (creams or patches) relieve hot flashes and night sweats typically within 2 weeks (1).
Untreated, persistent hot flashes have been shown to increase the risk of cardiovascular disease and dementia (1). Post-menopausal women have a 2–3 times higher risk of heart disease, stroke, and type 2 diabetes than premenopausal women. This increased risk is caused by increased blood pressure, high blood sugar, excess body fat around the waist, and elevated cholesterol levels associated with menopause (3).
Together, heart disease and stroke are responsible for the death of 1 in 3 women each year, but the good news is that cardiac and stroke events can be prevented. The changes in heart health may be one of the most overlooked risks associated with the drop in hormones during menopause and postmenopause, but HRT can help mitigate these risks (4).
Mental & Cognitive Effects, Mood Swings, Anxiety, Irritability, & Depression
Many women are alarmed when they have trouble remembering things, experience mental blocks, or have difficulty concentrating as they move through their menopause transition. While disconcerting, we know that these mental changes are likely caused by fluctuating estrogen levels that are expected at this time of life.
As a result, women may also experience dizzying, spinning sensations accompanied by a feeling of light-headedness or unsteadiness. Menopausal mood swings are also common, because as estrogen levels drop, so does the production of mood-regulating neurotransmitters. The production of the mood regulating chemical “serotonin” decreases, which can lead to depression, anxiety, and mood disorders.
Fixing the underlying hormonal imbalance with HRT is one of the most effective ways of reducing menopausal mood swings, cognitive disruptions, and mental health challenges.
Reduced Energy & Quality of Life
One of the most common menopause symptoms is a persistent feeling of weakness, tiredness, and low energy. With fatigue might also come irritability and decreased attention span. Since estrogen regulates energy use at a cellular level, as it decreases at this time, so do energy levels.
Joint pain is another common symptom of menopause that can negatively affect quality of life. Estrogen helps prevent inflammation in the joints, so low levels of estrogen during menopause can lead to increased inflammation and increased joint pain.
Skin & Hair Changes
Collagen is the building block of healthy skin and is what keeps skin toned, fresh-looking, and resilient. As estrogen drops, so does collagen production. Changes in a woman’s skin may be some of the first evidence that estrogen levels are decreasing.
It is common during perimenopause for skin to get thinner, drier, and less youthful-looking and for small wrinkles to deepen; HRT can help reverse these effects.
Weight Gain & Metabolism Changes
Hormonal changes during menopause influence weight gain and the redistribution of fat. With menopause, not only do estrogen and progesterone decrease, but so does testosterone. Lower testosterone translates to less lean muscle and increased fatigue. These factors combined can result in a decreased metabolic rate and subsequent weight gain.
From menopause onwards, women need fewer daily calories, and once a woman enters postmenopause, her metabolism is at an all-time low. HRT can speed up and revitalize the metabolism and assist with weight loss.
Vaginal Changes & Loss of Sex Drive
Among the many things that change as women age, what can happen to the vagina and a condition called “genitourinary syndrome” are discussed less frequently. Genitourinary syndrome affects almost half of postmenopausal women, and it can lead to issues in the bladder, vulva, and vagina (1). Symptoms include vaginal dryness, burning, irritation, lack of lubrication, pain with sex, urinary urgency and frequency, incontinence, and recurrent urinary tract infections (1).
When estrogen levels drop, the vaginal tissue becomes drier, thinner, and less elastic, and the vagina can become smaller. Lack of lubrication can lead to sex becoming uncomfortable, and the vagina is frequently itchy, easily irritated, and more prone to infections. If left untreated, vaginal dryness can cause sores or cracks in the vaginal tissue.
In menopausal and postmenopausal women, the main cause of low sex drive is hormonal imbalance, but libido can also be impacted by symptoms of genitourniary syndrome and other menopause symptoms like depression. When these symptoms go underdiagnosed, as they often are, it can adversely affect a woman’s personal relationships and quality of life.
Vaginal irritation and vulvar atrophy are extremely common problems for women in postmenopause, but there are many easy, healthy, and safe options to choose from to optimize vaginal health and lubrication.
HRT can address genitourinary syndrome, normalize acidic vaginal pH, and help restore vaginal epithelium, flora, moisture, and secretions via topical cream, patches or tablets. Vaginal estrogen can also diminish urinary urgency and decrease the risk of recurrent urinary tract infections, as well as improve libido (1).
As estrogen levels drop with age, vaginal tissue supporting the bladder and urethra thin and weaken. This can manifest as three different types of incontinence:
- Stress Incontinence – leaking occurs while laughing, coughing, sneezing, or with exertion. This usually happens when the internal muscles fail due to age, surgery, or childbirth.
- Urge Incontinence – the bladder doesn’t listen to the signal of “holding it” and instead empties.
- Overflow Incontinence – someone isn’t fully aware their bladder is full, and they accidentally urinate.
Estrogen replacement can return the vaginal tissue to a more youthful state, which in turn provides better support to the bladder and urethra. This can go a long way to improve urinary incontinence.
Guidelines for HRT Use
HRT remains the most effective therapy for vasomotor symptoms related to menopause. In women who begin HRT before the age of 60, or within 10 years of menopause, there are fewer cases of diabetes and heart disease and no increased health concerns (1). However, there may be an increased risk of coronary heart disease and stroke among women who begin HRT after the age of 70.
In women aged 50-59 taking HRT, data has suggested a reduced risk of cognitive and mental dysfunction. There is also decreased risk of hip fracture by approximately 33%, and a combination of HRT can reduce the risk of colorectal cancer (1). In the decades of research conducted on HRT, no significant increase in overall mortality has been recorded, nor has HRT been found to be related to cardiovascular disease or cancer mortality (1).
Extended Use of Hormone Therapy
The American College of Obstetricians and Gynecologists and the North American Menopause Society suggest that the decision to continue or stop hormone therapy should include assessment of its risks and benefits, which include relief from hot flashes, protection against bone loss, and preservation of quality of life (1). Many women successfully continue HRT for the rest of their lives. Always consult with your doctor about your course of treatment.
Other options for postmenopausal symptom relief include changes in lifestyle. The old standard of using fans, keeping cooler indoor temperatures, wearing layered clothing, and avoiding spicy food, alcohol, cigarettes, and hot drinks can all help with vasomotor symptoms.
Non-hormone prescription therapies that have been shown to reduce the frequency and severity of hot flashes include serotonin-reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, and gabapentinoids. Antidepressants tend to relieve hot flashes within about 3 weeks of use (1).
Nonprescription therapies like Black Cohosh (which is associated with liver toxicity), Dong Quai, Evening Primrose oil, flaxseed, and red clover are not suggested, no matter how compelling the advertising. Trials of phytoestrogens and soy isoflavones have shown mixed results, and there is concern about cancer-causing effects (1).
Other types of treatment like mindfulness, hypnosis, acupuncture, exercise, and yoga for relief of vasomotor symptoms have shown inconsistent results (1).
Winona helps women receive better, more up-to-date, and more informed guidance about their menopause journey. As a group of knowledgeable scientists solely focused on helping women embrace their bodies while adjusting to menopausal changes, Winona provides doctor-trusted anti-aging treatments and HRT.
Winona offers a variety of HRT treatments and provides the expertise to help design the right treatment strategy for each individual woman. Both estrogen and progesterone come in the form of tablets and body cream, and estrogen is also available as a patch. When paired with estrogen, progesterone can also act as an effective anti-aging skincare treatment.
Contrary to popular belief, women do need testosterone, and during the menopause transition, it helps to minimize the effects of aging, improve muscle strength, increase metabolism, boost bone strength, prevent thinning of vaginal tissue, and even enhance memory. In order to supplement testosterone, Winona offers DHEA (Dehydroepiandrosterone) in pill-form.
The best candidates for HRT are women nearing menopause, under the age of 60, or within 10 years of menopause. Women who take HRT have experienced relief from their hot flashes, improvements in their sleep, and reported fewer cases of heart disease and diabetes. Start your free visit with Winona today to consult with a doctor and find the right treatment for you.