Postmenopausal syndrome: What is it and how do you handle it?

So, you’ve made it through Menopause. Or at least you thought you did. You can’t remember the last time you had a period, but those dang Menopause symptoms have not gone away. This is known as Postmenopausal syndrome, and it’s way more common than you think. But don’t worry. In a lot of cases, most symptoms are treatable. Here’s what you need to know.

Stages of Menopause

But first, a quick review of the proper terms for each stage so we’re all on the same page.

Premenopause: This refers to girls and women who – aside from the effects of birth control or other medications and conditions – have a menstrual cycle.

Perimenopause: This literally translates to “around Menopause,” and is generally used to describe the time of the Menopause transition. What do we mean by transition? Well, although by this point, around your mid-40s, you’re likely experiencing the effects of the early and mid stages, you’re still some way off the actual Menopause

During this stage, you may well see symptoms including night sweats, brain fog, and the like, as well as changes in your cycle length and irregular periods. Eventually, your periods will stop altogether, but crucially, even then, you’re still considered to be in Perimenopause. Menopause proper doesn’t even start until you’ve been period-free for 12 consecutive months and no less.

Menopause: This one’s a bit tricky. It’s often used as a blanket statement to describe the entire process — before, during, and after. But, if you want to be specific — which we like to be here at Hormona — this is the actual transition phase. Menopause starts 12 months after your last period and can last for a year or more. You’ll likely still experience many of those Perimenopausal symptoms, but they should start to decrease in frequency and severity as you transition through. In the U.S., the average age to start the transition through Menopause is 51.

Postmenopause: This stage comes after your periods have been gone completely for at least 12 months, and your symptoms have, at the very least, started to recede. Now, this can take just 12 months, or it can take a lot longer. But once you’re here, you’re in the Postmenopause stage for the rest of your life. You may have noticed that Menopause and Postmenopause have some overlap there.

First of all, well spotted Hormonas. That overlap is partly because all three stages share a lot of characteristics, so the stages often look very similar. Which makes sense as they all involve the same hormones. And it’s partly because for some women, the whole experience is over in a relatively short time, whereas for others, it can take over a decade.

What is Postmenopausal syndrome?

As you go through the Menopause transition it’s highly likely you’ll experience a variety of symptoms, including, but in no way limited, to:

• Hot flashes
• Night sweats
• Chills
• Irregular periods
• No periods
• Sleep issues or insomnia
• Sexual dysfunction or low libido
• Vaginal dryness
• Vulvar changes
• Mood changes
• Weight gain
• Memory loss
• Thinning hair
• Dry skin

Of course, once your period has been MIA for 12 consecutive months, you’d be forgiven for expecting your symptoms to disappear soon afterward. Unfortunately, as many women will attest, this is not always the case.

Disappointed? We don’t blame you. Women spend a third or more of their lives Postmenopausal, yet there’s still an enormous lack of information about how that works. And the information that we were taught is often based on outdated research. So, no wonder our expectations for Menopause and Postmenopause aren’t accurate. 

Postmenopausal syndrome describes former menstruators who haven’t had a period in well over a year — and still experience many of the symptoms listed above. And we hate to be the bearers of sad news, but these symptoms can last anywhere from seven to 14 years. Annoying. We know. The good news, though, is that there are some treatments and things you can do to help mitigate the worst of your symptoms. 

Most common symptoms of Postmenopausal syndrome

Everyone will experience different symptoms during their transition, but a few are more common — and more annoying — than others. Understandably, those are the ones that have been studied the most, and those are the ones with treatment options. So, let’s talk about them.

Hot flashes

Hot flashes, or vasomotor symptoms, are both incredibly common and incredibly irritating. Reportedly, a whopping 80% of women experience hot flashes! And, on average, they can last for several years! So, you’re likely to be in good company.

Full disclosure… The medical community isn’t 100% sure why sweating features so heavily during Menopause. But, we do have a pretty good idea. It’s widely accepted that the main cause of hot flashes is: Fluctuating hormones. Shocker, right? This is significant because it’s thought that Estrogen plays an important role in helping your body regulate its temperature. And when Estrogen levels are all over the place, your temperature regulation gets a little confused.

Hormone replacement therapy for hot flashes

The good news is, because hot flashes are so darn common, there is an effective treatment: Hormone Replacement Therapy, AKA HRT.

Now, if you’ve had a poke around the blog or read any of our other posts, you’ll know that at Hormona, we don’t like pushing people into taking medications for every issue or symptom. We aim to provide a variety of options — favoring the ones backed by rigorous research — and encourage you to choose what’s right for you with the help of your doctor. 

HRT is exactly what it sounds like. It replaces some of the hormones your body stops creating during and after Menopause. There are different kinds of HRT and several ways it can be administrated, including one or more hormones, and via a pill, patch, implant, gel, or spray. Your doctor can look at your medical history, assess your symptoms and help you decide which is best for you.

Note that HRT is not the same as birth control. The hormone levels in HRT are lower, so it doesn’t protect against pregnancy — which is still possible until your periods have stopped — and carries lower risks than birth control. In other words, HRT and birth control are not interchangeable.

Other ways to manage

Not everyone wants or needs HRT. In fact, some women who experience mild hot flashes find that they can manage their symptoms without additional hormones. How? Well, dressing in light layers is a good option if your body temperature fluctuates significantly. As is a motorized or manual fan. You may also want to invest in lightweight bedding, pillows, or blankets that stay cool during the summer. And it’s always a good idea to stay hydrated.

Vulvar changes

The vulva is an all-encompassing term used to discuss all tissues and structures of the female genitals. The vaginal opening, the urethra, or where urine comes out, the labia, the clitoris, everything!

You won’t be surprised to learn that all of those structures and tissues are incredibly sensitive to Estrogen levels. And when levels fall, some of those structures, like the vagina, can atrophy, which means that the cells or tissues decrease in size or waste away.

And while not everyone experiences this particular symptom, for those who do, it can be increasingly uncomfortable. So, if you’re experiencing painful sex, dryness, itching, or burning please talk to your doctor. There’s effective treatment out there, you just need access to it.

How to manage

The most important thing you can do is to monitor your vulva and see your doctor if you are concerned at any time. Unlike hot flashes and other vasomotor symptoms, issues arising from atrophying genitals will not resolve on their own. So, you must seek treatment as soon as possible.

Sleep disturbances

We don’t know for sure why so many women experience trouble sleeping during the Menopause transition and into Postmenopause. Part of the cause may be vasomotor symptoms, like chills, hot flashes, and night sweats. But it’s also possible that low levels of hormones are to blame again. This time though, it could be down to low Melatonin, Progesterone, or Estrogen.

You see, Progesterone may well play a role in sleep quality. Because Progesterone levels plummet just before your period and remain low for a few days, it’s thought that this could be part of the reason menstruators have trouble sleeping during those times. So, it makes sense that it’s also true for Menopausal and Postmenopausal women.

Estrogen, it seems, could also be involved in how well you’re sleeping. If you’ve ever struggled to sleep in the early stages of your cycle, or low levels might be part of the cause.

Melatonin, as you may well know, is a hormone your body produces to help you sleep, generally as a reaction to darkness. But this hormone is also affected by your menstrual hormone levels, and therefore can help or hinder sleep, depending on which stage you’re in. And if you’re Menopausal, low levels could be a factor in sleep disturbance.

How to handle

As much as we hate to repeat ourselves, HRT may also help with this, and it does that in two ways. First, it will likely help to reduce hot flashes and night sweats, and second, it’ll help smooth out the jagged Estrogen levels, which should have a knock-on effect on brain fog, sleep quality, and energy, among other things.

However, if your temperature fluctuations are on the mild side, or you’d rather not use HRT, here are some other ways to manage sleep disturbance:

• Take a melatonin supplement, but please talk to your doctor first
• Regular exercise
• Avoid screens at least 30 mins before bed
• Have a consistent bedtime routine
• Use breathable bedding and clothes
• Have a hot bath or shower in the evening

If, though, your sleep disturbance doesn’t right itself, or starts to impact your daily life, please talk to a healthcare type. They can help rule out underlying causes, and advise you on the best ways to get some sleep.

Mood changes

Moods can be affected by so many things. And that makes it really difficult to nail down why mood swings can be so prevalent in Menopausal women and in Postmenopausal syndrome. When they’re not sleeping because of low hormone levels, hot flashes, chills, and night sweats, it’s no wonder many women with Postmenopausal syndrome report unexpected mood changes. In all likelihood, it’s probably a combination of everything at once.

How to manage

Tracking your moods is invaluable. And yes, shameless plug time, but you can customize your tracking in the Hormona app to include a spot to do this.  Or, you can track your moods on a calendar or with pen and paper. Whatever works best for you. You’ll be able to see when and how things are affecting you at a glance, and whether or not there’s anything else going on that might be contributing.

At the same time, try to manage your other Postmenopausal syndrome symptoms. Take on one at a time and give it a couple of weeks. Then, see if your mood improves. Keep tracking, and keep trying to solve new symptoms. It may also help to ask a partner or close friend to help you assess mood changes.

Tip: Please don’t leave this symptom out when talking to your doctor. We know it seems small. And, sometimes, talking to doctors who aren’t licensed mental health professionals can be difficult. But, to get the best treatment, you must be as detailed as possible with all your symptoms. Mood swings aren’t just a fact of life. Never forget that.

Sexual dysfunction

During the Menopause journey, sexual dysfunction can mean low libido, painful sex, difficulty reaching orgasm, and the like. But, just as with mood changes, there doesn’t seem to be a direct correlation between sexual dysfunction, Postmenopausal syndrome, and hormone levels. There’s a good chance, though, that a combination of poor sleep, vasomotor symptoms, and mood changes likely influence sexual dysfunction.

How to manage

Try tackling your other symptoms first and see if there are any changes in your libido. If you’re experiencing vaginal dryness, this might also be contributing to low libido. Some excellent, water-based vaginal lubricants are available without prescription and are definitely worth a try.

But, if they don’t help, please see your doctor or a sex therapist. Tell them what you’ve tried and give details about your symptoms.

Postmenopausal syndrome: the prognosis

The good news is that for the vast majority of women, Postmenopausal syndrome symptoms will end. Or, at the very least, they’ll probably decrease in severity and become much more manageable over time. Hopefully.

In the meantime, keep records of your symptoms, and don’t be afraid to contact your doctor regularly, particularly if your symptoms increase in frequency or severity. Find solutions that work for you, whether that’s HRT or yoga, and keep doing them. The strength of Postmenopausal women is legendary. You got this.

Medically reviewed by: Dr. Anna Targonskaya, MD, OBGYN, Medical advisor at Hormona

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