Menopause symptoms, and what happens after menopause

What is menopause, exactly?

Menopause is when your periods stop for good because your ovaries make much less estrogen and stop releasing eggs. It's confirmed only when you've had no bleeding or spotting for a full 12 months.

The years of change before that are called perimenopause. Everything after your last period is called postmenopause, and it lasts for the rest of your life.

What age does menopause start?

Most people reach menopause between ages 45 and 55, and the range can stretch from about 45 to 58. The average in the US is about 51 or 52. The age your mother went through it can give you a rough idea.

Smoking is linked with earlier menopause. Menopause before 45 is called early menopause, and before 40 it's called premature menopause. Both are worth discussing with a doctor.

What are the most common menopause symptoms?

Symptoms vary a lot. Some people have very few, while others find them hard to live with. Common ones include:

• Hot flashes and night sweats.
• Trouble sleeping.
• Mood changes, anxiety or low mood.
• Brain fog and trouble concentrating.
• Vaginal dryness, itching or pain during sex.
• Needing to pee more often, or more urinary infections.
• Lower sex drive.
• Weight gain, often around the belly.
• Joint aches.

What are the signs menopause is ending?

Menopause itself is a single point in time, so the change you'll notice is that symptoms slowly ease. For many people, hot flashes become less frequent and milder over the years after the last period.

That can take a while. Hot flashes last about 9 years on average and can continue for up to 14 years after menopause. Some symptoms, like vaginal dryness, often don't fade on their own and may get worse without treatment.

How does postmenopause affect your bones?

Estrogen helps keep bones strong. In the first 4 to 8 years after menopause, bone is lost faster, which raises the risk of osteoporosis, a condition where bones become weak and break easily, most often at the hip, wrist and spine.

Getting enough calcium and vitamin D, doing weight-bearing exercise like walking, strength training, and balance work like yoga or tai chi can all help. Ask your doctor about a bone density test and when it makes sense for you.

Does menopause raise your risk of heart disease?

Yes. Before menopause, estrogen gives some protection against heart attack and stroke. After menopause, that protection falls, and cholesterol can rise.

Midlife is also when high blood pressure, high cholesterol and being less active become more common. Regular checks of blood pressure and cholesterol, staying active, not smoking and a balanced diet all help protect your heart.

Why does vaginal dryness happen after menopause?

Lower estrogen makes the tissues of the vagina and bladder area thinner, drier and less stretchy. Doctors sometimes call this group of changes genitourinary syndrome of menopause (GSM). It can cause dryness, itching, pain during sex and more urinary infections.

Over-the-counter vaginal moisturizers, used every 2 to 3 days, and lubricants during sex can help. Low-dose vaginal estrogen is another option to ask your doctor about. Dryness can also cause small tears during sex, so condoms still matter for protection against STIs (sexually transmitted infections).

Is bleeding after menopause normal?

No. Any bleeding or spotting after 12 months without a period should be checked by a doctor, even if it's only a small amount or happened only once.

It's often caused by something harmless, like thinning of the vaginal or uterus lining, or polyps. But it can be a sign of cancer of the uterus, which is easier to treat when found early.