What does postmenopausal mean?
It starts 12 months after your last period. Hot flushes may fade, but dryness and joint pain can carry on. And two changes usually give no warning signs at first.
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When are you postmenopausal?
Once you’ve gone 12 months without a period. Menopause is that one point. After it, the NHS calls it postmenopause.
Menopause usually happens between 45 and 55, but it can come earlier.
Three stages, one clear line
- 1
Perimenopause
Periods change. Symptoms may start.
- 2
Menopause
No period for 12 months, if you’re not on hormonal contraception.
- 3
Postmenopause
Every year after that. Some symptoms can carry on.
On the pill, a hormonal coil, an implant or the injection? These can stop or change your periods. That makes it harder to tell when you’ve reached menopause.
If that’s you, ask your GP how to tell and what contraception suits you now.
Post menopausal symptoms: what can carry on?
Symptoms usually last 7 to 9 years, sometimes longer. They can ease or stop after menopause, but some women keep having them for longer.
| Symptom | What helps |
|---|---|
| Vaginal dryness | A moisturiser or lubricant from a pharmacy. A GP can prescribe vaginal oestrogen. |
| UTIs that keep coming back | Drink plenty of water. A GP can prescribe vaginal oestrogen to cut repeats. |
| Leaking pee | Pelvic floor exercises, or vaginal oestrogen. |
| Joint pain | Talk to a GP about your options. |
| Hot flushes | Light clothes, a cool bedroom and CBT, a type of talking therapy. |
Sources: NHS; NHS; NHS inform; NHS
Women from a Black ethnic background are more likely to have hot flushes that are severe and last longer.
Using condoms? Pick a water-based lubricant, because oil-based ones can damage condoms. More in vaginal dryness after menopause and hot flushes.
What changes after menopause that you can’t feel?
The two changes are your bones and your heart. Both risks can rise after menopause, as oestrogen falls.
| What changes | How to check | |
|---|---|---|
| Bones | They can get weaker and break more easily (osteoporosis). Often no signs until a bone breaks. | Your GP looks at your risk and may send you for a bone scan (DEXA). |
| Heart | Cholesterol and blood pressure can go up. Neither usually causes symptoms. | A blood pressure check and a cholesterol blood test, such as at an NHS Health Check. |
Think of a slow leak in a tyre. You can’t feel it as you drive, and it isn’t a flat yet.
A slow leak doesn’t mean a blowout. A quick check finds it, so you can act early.
Menopause before 45 raises the risk of heart disease. The NHS says HRT is especially important for bones if your periods stopped before 45.
In England, aged 40 to 74 and without a condition like heart disease or diabetes? You should be invited to a free NHS Health Check every 5 years.
Not invited? Ask your GP practice. See cholesterol after menopause.
Is bleeding after menopause normal?
No. Any bleeding from your vagina after 12 months with no period needs checking by a GP.
That’s true even if it happened once or was only spotting or pink or brown discharge. It’s also true if you have no other symptoms or you’re not sure it was blood.
It’s not usually serious. The most common causes are a thin or thickened lining, or polyps. Polyps are growths that are usually not cancer.
But it can be a sign of cancer, which may be easier to treat if found early.
What happens after you report bleeding
- 1
See your GP
Even for one small spot of blood.
- 2
Referral
To hospital or a postmenopausal bleeding clinic.
- 3
Tests
These may include a scan and a camera test of the womb.
- 4
Next step
Treatment depends on the cause found.
Source: NHS
What helps after menopause?
Six NHS steps after menopause
- Do weight-bearing exercise like walking or dancing, plus resistance work like lifting weights.
- Eat calcium-rich food like milk, yoghurt and kale.
- Get vitamin D from sunlight in summer and a supplement in winter.
- Stop smoking and cut down on alcohol.
- Cut your chance of falls with shoes that grip and a non-slip bath mat.
- Go to breast screening when invited, every 3 years until your 71st birthday, and cervical screening every 5 years up to 64.
Thinking about HRT? If you’re under 60 and have symptoms, the NHS says the benefits are likely to outweigh the risks. That’s if you aren’t at high risk of breast cancer or blood clots.
HRT lowers your chance of breaking a bone while you take it. NICE says this benefit fades once you stop. NICE also says HRT should not be offered to prevent heart disease or dementia.
Never stop or change a prescribed medicine without your prescriber. See HRT side effects and supplements for osteoporosis.
When to speak to a GP
Book an appointment if:
- You have any vaginal bleeding after 12 months or more with no period, even once.
- You keep getting UTIs. A GP can prescribe vaginal oestrogen to cut repeats.
- You have back pain that isn’t better after a few weeks, or your spine is curving or hunched.
- You’re worried you may be at risk of osteoporosis.
- Your symptoms are troubling you and you want to know your options.
- You notice a fast, pounding or fluttering heartbeat (palpitations).
Get an urgent GP appointment or call 111 if you’ve had a fall or injury and the pain isn’t getting better. Call 999 for severe pain after a fall.
Call 999 for chest pain that feels tight or squeezing, or spreads to your arms, neck or jaw, or if you have severe difficulty breathing. See also blood tests for women over 50.