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Postmenopause is the time in your life after you haven’t had a menstrual period for a full 12 months. You’ve reached menopause and will be in postmenopause for the rest of your life. Your hormone levels will stabilize and typically most of the symptoms of perimenopause and menopause stop.

You may find that you enjoy a sense of well-being as you adapt to your new lower hormone levels. During this stage, however, it’s still important to understand some the physical changes and new health considerations.

Changes in bone health

One of the biggest concerns in postmenopause is the health of your bones.

Estrogen plays an important role in keeping your bones strong. As estrogen levels decrease, you are more likely to lose bone mass, which means your risk of developing osteoporosis goes up. You can lose 1% to 2% of your bone mass every year after menopause. This bone loss means you can more easily get fractures.

Here are some ways you can help protect your bones:

  • Calcium and vitamin D: Make sure your diet includes calcium-rich foods like dairy products, leafy greens and fortified foods. You need 1,000 to 1,500 milligrams of calcium a day. Be sure you get enough vitamin D as well, since it helps your body absorb calcium. You need 800 to 1,000 IU (international units) of vitamin D every day – and many people have low vitamin D. Ask your health care provider if you should take supplements.
  • Weight-bearing exercise: Engage in regular exercise that challenges your bones – like jogging or weightlifting – to keep your bones strong.
  • Regular screening: Talk to your health care provider about bone density testing. Testing can check your risk for osteoporosis and help your provider decide if you should take medication. Tests are recommended for all women at age 65 and younger women at high risk.

Heart health risks

In postmenopause, your risk of cardiovascular issues - including heart disease and stroke - is higher. That’s because estrogen helps protect your cardiovascular system. With lower estrogen levels, your risk goes up.

Here are some ways to reduce cardiovascular risks:

  • Choose a healthy diet: Opt for a heart-healthy diet rich in fruits, vegetables, whole grains and lean proteins, and low in saturated and trans fats.
  • Get regular exercise: Aim for at least 150 minutes of moderate intensity exercise per week.
  • Manage blood pressure and cholesterol: Monitor and manage your blood pressure and cholesterol levels. Take the steps your health care provider recommends to keep your levels low.
  • Control diabetes: If you have diabetes, keep your blood sugar levels well controlled.
  • Don't smoke: Smoking greatly increases your risk of cardiovascular issues.
  • Manage stress: Stress can take a toll on your heart. Try stress-reduction techniques such as mindfulness, yoga or meditation.

Vaginal dryness

While many of menopause symptoms go away, vaginal dryness may continue throughout postmenopause. Vaginal dryness can make sexual intercourse uncomfortable or painful. You may want to try an over-the-counter (OTC) vaginal cream that you use regularly or a vaginal lubricant when you have sex.

Your provider may prescribe an estrogen cream, ring or tablet. The non-hormonal medications ospemifene (Osphena) and prasterone (Intrarosa) can also make sexual activity more comfortable.

Urinary problems

Lower estrogen levels and weaker pelvic floor muscles due to age may make you more likely to have incontinence (leaking urine).

You may feel like you need to pee urgently, or you may leak urine when you cough, sneeze, laugh or exercise. Kegel exercises and vaginal estrogen may help with incontinence.

You may also be at higher risk for urinary tract infections (UTIs) postmenopause. Talk to your doctor about treatment options if you get UTIs frequently.

Emotional well-being

Postmenopause can also impact your emotional well-being and mental health. In this life stage, you may notice mood swings, have more stress or feel sad. These changes are normal. Addressing any challenges is very important for your well-being.

  • Mood swings: Practicing mindfulness and stress reduction techniques can help manage mood swings.
  • Increased stress: Life changes during postmenopause (such as caregiving responsibilities or adjusting to an empty nest) can increase your stress. Finding healthy ways to cope, like exercise or seeking support, is important.
  • Feeling sad: Because of lower estrogen levels, you may have feelings of sadness or even depression. It's important to reach out for help if these feelings persist.

You don't have to manage the emotional changes of postmenopause on your own. Seeking support from loved ones, friends or mental health professionals is a sign of strength, not weakness.

Preventive health

As in other stages of your life, you’ll want to stay ahead of any potential health issues during postmenopause. Here are some preventive health steps you may want to take:

  • Regular checkups: Schedule regular appointments with your health care provider to discuss any concerns, update vaccinations and receive screenings. You still need pelvic exams, pap tests and other gynecological screenings after menopause.
  • Cancer screenings: Continue with cancer screenings, such as mammograms and colonoscopies. Early detection is often key to successful treatment.
  • Bone density testing: Your health care provider may recommend bone density testing to check your risk of osteoporosis.
  • Heart health: Keep your blood pressure and cholesterol at healthy levels.
  • Immunizations: Stay up to date with your annual flu shot and other recommended vaccines.

Staying healthy

You can also make choices that support your well-being. You may want to:

  • Prioritize self-care activities such as eating a balanced diet, staying physically active and managing stress.
  • Avoid smoking and limit alcohol consumption. These lifestyle choices play a significant role in overall health.
  • Educate yourself about postmenopausal health issues such as heart disease and osteoporosis. With knowledge, you can make informed decisions.
  • Pay attention to your body's signals. If you notice any unusual symptoms or changes, including vaginal bleeding after menopause, seek medical advice.