Postmenopause: symptoms and health after menopause

To define it simply: postmenopausal means you've gone through menopause, with at least 12 months in a row without a period. Your ovaries now make very little estrogen and progesterone, and you can no longer get pregnant. You stay postmenopausal for the rest of your life, although the symptoms of the change usually ease over time.

Once you've gone 12 months without any period or spotting, when you're not using hormonal contraception. For women 45 and over, a doctor can confirm this from your history without blood tests. After a hysterectomy, or on hormonal treatments that stop periods, it's judged from your symptoms and age instead.

Postmenopause starts at the age you reach menopause, usually between 45 and 55, and 52 on average in the United States. There's no upper limit: once postmenopausal, you stay that way. If menopause comes before 45, you're postmenopausal earlier and need extra care for your bones and heart.

The most common are hot flashes and night sweats, which continue for several years for many women, and vaginal dryness, soreness, pain during sex and urinary symptoms, which often get worse without treatment. Joint pain can also continue. Sleep and mood problems often improve as hot flashes fade.

At 55 many women are in the first years after menopause, when hot flashes are still common: in one Australian study, 15.1% of women aged 55 to 59 had moderate to severe hot flashes. Vaginal dryness, pain during sex, poorer sleep and joint aches are also common at this age, and bone loss is fastest around the final period.

For the rest of your life. The early postmenopause, when hormones change and then settle, lasts about 5 to 8 years. Hot flashes continued for a median of 4.5 years after the final period in SWAN. After that comes late postmenopause, when hormones are stable.

Menopause is a single point: the moment you've gone 12 months without a period. Postmenopause is everything after that point. In everyday speech, people often say menopause to mean the whole transition and the years after it, which is why the terms get mixed up.

No more periods and no more pregnancy risk. Many women get relief from period problems, but hot flashes may continue for several years, and vaginal dryness is common. Your risks of osteoporosis, heart disease and stroke rise, so regular screening, exercise, calcium and not smoking matter more than before.

Yes. In SWAN, frequent hot flashes continued for a median of 4.5 years after the final period, and in the Penn Ovarian Aging Study a third of women still had moderate to severe hot flashes 10 years or more after menopause. They can be treated with HRT or non-hormonal medicines.

Depressive symptoms tend to fall after menopause for most women. But women who've had depression before are at much higher risk: in the Penn Ovarian Aging Study, they were 8 times more likely to have depressive symptoms after menopause. Low mood lasting weeks should be checked, whatever your age.

For hot flashes, HRT is most effective, and it also prevents bone loss; it's most favorable when started before 60 or within 10 years of menopause. For vaginal and urinary symptoms, low-dose vaginal estrogen works best. Non-hormonal medicines, CBT, exercise, calcium and vitamin D fill the gaps.

Postmenopause. Menopause itself is the point 12 months after your final period, and everything after it is the postmenopausal stage. Doctors split it into early postmenopause, lasting about 5 to 8 years, and late postmenopause.