Health Changes to Expect After Menopause

Understanding Menopause and Its Stages

The end of your periods can be considered menopause, but this change doesn't happen overnight. The menopausal transition typically has three stages: perimenopause, menopause, and postmenopause. When you have not had a period for 12 consecutive months, it is considered menopause.

Perimenopause

Perimenopause is also called the menopausal transition. Many of you experience symptoms for several years before menopause. During this time, your ovaries gradually begin to make less oestrogen. This is a transitional period from the menstruating phase to the menopause, which is the complete cessation of menstruation. 

Generally, perimenopause symptoms start around your 40s, typically 8-10 years before menopause. But it can even start earlier or later. During this phase, the level of oestrogen in your body fluctuates unevenly during perimenopause. You may have your period, but your menstrual cycle may be irregular. You may not have a period for several months during the last year or two of perimenopause. 

You may also experience heavy or scanty bleeding. Symptoms similar to those experienced during menopause may also bother you during perimenopause. Throughout the perimenopause, various physical and psychological changes may occur in your body. 

Many of the symptoms that most women experience after menopause, from hot flashes to irregular periods, actually start in perimenopause. That means during perimenopause, you will experience symptoms similar to menopause. Various physical, mental and emotional changes happen during this period. 

Menopause

You won't know you've gone through menopause unless you've gone 12 months without a period. You should consider menopause official when you've gone 12 months without a period.

But why wait for a year to consider it menopause? Because some people think they've gone through menopause if they don't get periods for a few months. However, once you've gone a full year without a period, you can be sure you've made the transition. Usually, this happens around age 52, although age between the mid-40s and late 50s is considered normal.

Common menopause symptoms are hot flashes and night sweats; other symptoms like irregular periods, vaginal dryness, sleep problems and mood changes are not less common.

Postmenopause

Postmenopause is the stage after your last period, and it continues for the rest of your life. At least one-third of your life will be spent in the menopausal stage. For many people, menopause reduces symptoms and relief from daily discomfort. For a woman, this stage of life is filled with new freedom.

The best part of reaching menopause is not having to worry about getting periods anymore. But there are other benefits, too. Many of the uncomfortable or disruptive symptoms you might have experienced in perimenopause usually go away as well. Your hormone level settles into steady, low levels instead of fluctuating like during your reproductive life.

A few of the symptoms of perimenopause may continue into postmenopause. Hot flashes can continue for a few years or more, and vaginal dryness may remain as it is or even worsen with time. Also, other body changes often occur over time.

All three stages of menopause are associated with physical, mental, and emotional changes caused by hormonal imbalances. Ovaries produce the hormones oestrogen and progesterone, which together control your menstrual cycle. Menopause occurs when the ovaries stop producing reproductive hormones. The hormonal changes that occur during menopause can cause uncomfortable physical and emotional symptoms.

As you approach menopause, your levels of these hormones fluctuate. You may experience subtle changes in your hormone levels for a few years before menopause.

Initially, your progesterone levels drop. This can cause ovulation to stop in some menstrual cycles. Then, as menopause approaches, your oestrogen levels also drop.

Weight Gain and Changes in Body Composition

Women may find it harder to stay at their usual weight when they approach menopause. Menopause weight gain starts a few years before menopause, during the time known as perimenopause. 

Weight gain in and around menopause is common. But you can minimize it by incorporating healthy eating habits and leading an active lifestyle.

Hormonal changes during menopause can cause women to gain weight around the abdomen rather than the hips and thighs. However, hormonal changes need not be the cause alone. It's usually related to ageing, as well as lifestyle and genetic factors.

How to prevent menopause weight gain?

No single magical formula can prevent or reverse weight gain. 

• Physical activity, including aerobic exercise and strength training, helps you burn extra fat and stay at a healthy weight. 
• Pay attention to what you're eating and drinking. Include more fruits, vegetables and whole grains, especially those that are less processed and contain more fibre. 
• A plant-based diet is healthier than meat. Legumes, nuts, soy, fish and low-fat dairy products are good choices. Eat fish and seafood instead of red meat. Instead of butter, use oils such as olive or vegetable oil.
• Avoid sugar-rich foods such as soft drinks, juices, energy drinks, flavoured waters, and sweetened coffee, tea, cookies, pies, cakes, doughnuts, ice cream, and candy. 
• Limit alcoholic beverages which contain extra calories and raise the risk of weight gain.

Bone Health and Osteoporosis

Bone density starts to decrease when oestrogen levels decline when you approach menopause. So, lower levels of oestrogen increase the risk of developing osteoporosis.

One in two postmenopausal women will have osteoporosis, and most will suffer a fracture during their lifetime.

Management

Osteoporosis is not entirely preventable. But you can do something to make your bones stronger. 

• Consuming calcium-rich foods can boost calcium levels in your body. You can include milk, cheese, yoghurt, spinach, sardines, canned salmon, almonds, figs and fortified cereals in your diet. 
• You can also take calcium and vitamin D supplements under the guidance of a healthcare provider. 
• Exercise is important in maintaining bone health during menopause. It also improves muscle strength, balance, and fitness and reduces the risk of falls and fractures.

Cardiovascular Health

Women who have gone through menopause are at greater risk of heart disease. So, in menopause, heart health becomes vulnerable. Oestrogen has a protective effect on the heart. It helps to control cholesterol levels and reduce the risk of fat building up in the arteries. It also helps keep blood vessels healthy.

When oestrogen levels fall, fat can build up in your arteries, causing them to become narrower. This increases the risk of developing coronary heart disease, a heart attack or stroke.

How do you maintain better cardiovascular health?

You can do a few things to reduce your risk of coronary heart disease before, during, and after menopause. 

• One of the most important things you can do is consider making healthier lifestyle choices. These choices will help lower or maintain your blood pressure and cholesterol levels, which can also help your menopause symptoms in relation to cardiovascular health.
• Regular exercise, a balanced diet, a healthy lifestyle, limiting alcohol intake, and quitting smoking can help manage heart health. 
• Regularly visiting your doctor can help you in early diagnosis and timely management of the condition.

Vaginal and Urinary Health

During menopause, oestrogen levels naturally go down. As a result, the walls of the vagina become thin, dry, and sometimes inflamed.  So, vaginal dryness in menopause can be attributed to low oestrogen levels. This causes symptoms like vaginal burning, irritation, pain (especially during sex), bleeding, or discharge. 

Some can also experience urinary symptoms, painful urination and increased frequency. Lack of oestrogen reduces the urinary tract's ability to control urination. These symptoms of the genital and urinary tract are called genitourinary syndrome of menopause. Sometimes this syndrome is also called vaginal atrophy or atrophic vaginitis.

How to Manage?

Vaginal and urinary symptoms that bother you during menopause can be effectively managed with these measures - 

• Using vaginal lubricants or moisturizers can help relieve symptoms. You can use lubricants during sexual intercourse, but you can use moisturizers at all times to relieve dryness. Regular sexual activity can also help relieve vaginal symptoms.
• If lubricants and moisturizers do not provide relief, hormone therapy in the form of oestrogen can be added. It is essential that you seek the advice of your doctor for this. 
• Oestrogen can be used vaginally (vaginal oestrogen) or as a pill or skin patch (systemic oestrogen).
• To treat vaginal and urinary problems, doctors often prescribe vaginal oestrogen. This way, the oestrogen goes directly to the vaginal area without first going through the bloodstream. This reduces the potential for health risks from oestrogen.
• Bladder-training techniques that increase the capacity to hold urine, avoid stress to the pelvic area, and do Kegel exercises (to strengthen the pelvic floor) can also help with urinary incontinence.

Hot Flashes and Night Sweats

A hot flash is a sudden feeling of warmth in the upper body. It can spread mainly through the face, neck, and chest. Night sweats occur when hot flashes occur at night. Up to 85% of women report hot flashes during menopause. Hot flashes and night sweats occur because of changing hormone levels, which affect the body's temperature control.

Management

You can manage your hot flashes with lifestyle changes if your hot flashes are mild. 

• Keep yourself cool, as a slight increase in your body's temperature can trigger them. 
• Dress in layers so that you can remove clothing when you feel warm.
• Keep the window open or use a fan or air conditioner whenever you stay inside a room. 
• If you feel a hot flash coming on, sip a cold drink.
• Avoid hot and spicy foods, caffeinated beverages and alcohol, which can trigger hot flashes.
• Practice mind-body therapies. Include meditation, slow, deep breathing, and stress management techniques. 

Even if these approaches don't help your hot flashes, go for hormone therapy or hormone replacement therapy (HRT) under the guidance of a healthcare professional. They will prescribe you medication that contains oestrogen to regulate hormone levels. This therapy can relieve many menopausal symptoms, including hot flashes and night sweats.

Mood Swings and Mental Health

Hormonal changes, especially lower levels of oestrogen during menopause, can impact your mental health as well. You may experience mood swings, anxiety, stress, and depression. It may also include anger and irritability, forgetfulness, lack of concentration, and loss of self-esteem.

Management

Mental and emotional issues may not be as easily seen as other conditions. But they are no less painful, limiting, and potentially devastating. 

• Counselling, medication, or a combination of treatments can help you come out of this.
• Hormone replacement therapy (HRT), Cognitive behavioural therapy (CBT), regular exercise, a healthy diet, and getting enough sleep.
• Developing good social relationships can help you with the emotional aspects of menopause.

Read more on Mental Health in Menopause: Handling Emotions, Stress and More - The Natural Way

Sleep Disruptions

Sleep problems in menopause are one of the most common symptoms experienced by women during menopause. As your hormone levels fluctuate, you may feel as if you're having sudden increases and drops in your body temperature, causing hot flashes and night sweats. 

Because of a sudden burst of energy, your body feels difficult for you to fall back asleep. Decreased sleep quality, decreased sleep duration, and difficulty falling asleep are the main sleep issues you face during menopause.

Management

It doesn't mean you can't still get good sleep after menopause. There are various ways you can help yourself get good sleep. 

• Maintaining good sleep hygiene is the most essential thing that can help to have a sound sleep. 
• Make it a habit to go to bed at the same time every night. 
• Make sure your bedroom is free of distractions and has good ventilation. 
• Avoid excessive caffeine, alcohol, and nicotine. 
• Practise regular exercise, but avoid exercising right before bed. 
• Avoid naps during the day, which can prevent you from sleeping well at night. 
• Talk to your doctor about prescription medications that can help you sleep.
• Practice relaxation techniques like yoga, breathing exercises and meditation. 
• Herbs like Ashwagandha, Brahmi, Gotukola, and Gooseberry help improve your sleep.
• Contact your healthcare provider for different herbal remedies out of these herbs with the proper dosage.

Skin Changes and Aging

Skin changes after menopause are very common. Your skin becomes dry and thin, or you may begin to see more wrinkles. Some people may experience acne during menopause as a result of hormonal fluctuations. When oestrogen and progesterone levels rapidly drop off, most people see it in their skin. The skin may become dry or less plump.

How to Manage?

You can follow specific steps to make your skin look its best even after menopause.

• Maintaining hydration is essential for menopausal skin. Make sure to drink a sufficient quantity of water in a day.
• Your face and body will feel drier than usual, and using a moisturizer may help draw moisture into the skin. 
• Use a sun protection factor every day, especially when you go out. 
• A cleanser with salicylic acid can help keep hormonal acne at bay. 
• Along with these kinds of skin care products, make sure to eat hydrating foods, drink plenty of water, and try to get quality sleep.

Read more on Ayurvedic Skincare For Menopause: A Complete Guide for Better Skin Health in the 40s & Beyond.

Sexual Health and Desire

Sexual health in menopause becomes completely different from the previous.  During menopause, many women face sexual difficulties, mainly a lack of interest in sex and trouble having an orgasm. The main reason for this is declining levels of oestrogen, which can reduce a person's desire to have sex and make sexual arousal more difficult.

Experiencing pain during sex after menopause is a big challenge. Deficient levels of oestrogen can reduce natural lubrication in the vagina and cause the vaginal canal to become less stretchy. This causes pain during sexual intercourse.

Lack of interest and pain during the act can prevent sexual relationships between the partners. This can decrease physical intimacy and cause a sought of disconnection between the partners. This, in turn, can lead to mental stress. 

Management

Everyone might not find sex as gratifying after menopause, and that's absolutely normal. However, you should take different measures to overcome the difficulties you face. 

• Lubricants and vaginal moisturizers can make intercourse and other sexual activities more comfortable. 
• Reaching orgasm can take longer, so stimulation by foreplay can help you reach orgasm.
• Above all these, understanding between partners is very much necessary.
• Discussing your difficulties and experiences with your partner can help them understand your situation better. 
• Non-sexual forms of intimacy can even continue to strengthen your bond with your partner.

Read more on Essential Things to Know About Menopause.

Wrapping Up

Menopause is a natural process that occurs in your body, which can cause so much discomfort. Menopause brings about physical, mental, and emotional changes, as well as various health problems. Once you attain menopause, it becomes a permanent part of your life. The health issues you experience can also be permanent.

But it doesn't have to be a permanent part of your life. By making changes in your diet, lifestyle, sleep, other habits, and personal care methods, you can certainly get rid of these discomforts. Although complete elimination of symptoms is impossible, significant improvement in your condition is always possible.

Embracing this inevitable process of life with confidence can empower you to overcome your problems. Follow the tips outlined in the blog to improve your quality of life. But do not hesitate to contact the team of qualified doctors at Nirva Health for medical advice whenever necessary.