Quality of life post-menopause
A couple of weeks ago, I wrote a post on living with perimenopause and menopause. I thought it would be appropriate to follow up with a discussion about life after menopause…what we can expect and what we can do to improve the quality of life post-menopause.
In addition, it was pointed out that my last post did not address the possibility of hormone replacement therapy (HRT). That was somewhat intentional in that hormone replacement is most useful after menopause, and HRT is a discussion best had with your healthcare provider. Not being a doctor myself, I didn’t want to overstep. That said, it doesn’t hurt to share what I have learned as a health and wellness coach about HRT, so you can go to your healthcare provider more informed.
What is menopause vs. post-menopause?
First, though, a reminder of the clinical definition of menopause: 12 months after the last period. If you have had a hysterectomy, ablation, IUD, or hormonal birth control that stopped your periods, menopause is determined by two follicle-stimulating hormone (FSH) lab tests taken several months apart indicating menopause.
If you have met either of those conditions, you are now a postmenopausal woman. The erratic hormone ups and downs of perimenopause have given way to consistently low levels of estrogen, progesterone, and testosterone. Those hormone levels will not come back up on their own. No amount or quality of diet, exercise, or sleep can turn your hormones back on.
What can I expect post-menopause?
In the previous blog post about perimenopause, we discussed the many organ systems that are affected by these changes in hormones…which basically comes down to all of them. In addition to those items previously discussed, here are some additional symptoms you may experience post-menopause:
- Eye: Age-related vision degeneration and cataracts
- Mouth: Reduction in saliva, causing dry mouth and an increased risk for dental issues
- Gut: An increased risk of colon cancer
- Urinary tract/Vagina: Genitourinary Syndrome of Menopause (GSM), causing symptoms like vaginal dryness, burning, itching, pain during intercourse, and urinary urgency or infections
- Bones: Accelerated bone loss
What can I do to improve my quality of life post-menopause?
While every woman born with female organs, who lives long enough, will experience menopause, no two women will experience it exactly the same. That said, there are lifestyle habits from which all women can benefit:
Lifestyle behaviors
- Strength training
- Balanced nutrition
- Quality sleep
- Regular health screenings
These behaviors are discussed more in depth in this blog post about perimenopause.
What about hormone replacement therapy (HRT)?
As mentioned previously, even the healthiest lifestyle will not bring back your hormones post-menopause. For many women, HRT is an effective way to alleviate symptoms and even protect the body’s organs.
If you are suffering through post-menopausal symptoms or have been diagnosed with bone loss, high blood pressure, or type 2 diabetes, you may want to discuss HRT possibilities with a medical professional well versed in postmenopausal hormone treatments. To help you go into those conversations with a better understanding of the options, benefits, and risks, here is a brief rundown.
Hormone therapy options
- Estrogen only: This treatment is often prescribed post-hysterectomy. It is also a good option for GSM. This therapy can be delivered vaginally or transdermally and can be given in low levels.
- Combined therapy (estrogen+progesterone): This is the most common treatment and can be delivered orally or transdermally, through a patch, gel, or pellets.
- Testosterone: Testosterone replacement is not FDA-approved for women (in the USA), but is often used off-label to improve libido, energy, and mood. Delivery can be topical, injectable, or pellet.
Risk/benefit ratio
Since no two women are the same, the risks and benefits of HRT should be discussed thoroughly with your healthcare provider. Your provider will likely request a detailed health history, discuss quality of life issues, perform lab work and possibly order some imaging, such as a mammogram, DEXA, and colonoscopy. Treatment can then be tailored to your symptoms, labs, and life context. The treatment will likely need to be adjusted over time, so regular check-ins with your provider are crucial.
Benefits of HRT
With that in mind, here are some of the benefits you can expect to receive from your tailored HRT.
- Relief of vasomotor symptoms (night sweats and hot flashes): Hot flashes and night sweats are the most easily treated symptoms of post-menopause using pharmacological products, both hormone and non-hormone.
- Reduced sleep disturbances: Not only does the relief of vasomotor symptoms improve sleep, but progesterone’s calming effect can help as well.
- Vaginal dryness: This is another symptom easily treated with topical or vaginal estrogen, and the good news is that vaginal estrogen can be used even by most breast cancer patients. (Again, this is a discussion to have with your healthcare provider.)
- Reduction of risk for several chronic conditions: In addition to alleviating immediate symptoms, HRT can help prevent bone loss, urinary tract infections, heart disease, and cognitive decline.
Contraindications for HRT
HRT is not for everyone. Certain conditions may mean you are not eligible for most HRT.
- Personal history of breast or endometrial cancer
- Unexplained vaginal bleeding
- Active liver disease or clotting disorder
- Recent heart attack or stroke
- Allergy or hypersensitivity to hormones
Even if you fall into one of these categories, you don’t have to suffer in silence. A candid discussion with your healthcare provider can help you develop a treatment plan that does not include hormone replacement.
When should I start HRT?
Timing of HRT matters. The best outcomes occur when women start HRT within 10 years of menopause. Later starters may still benefit, but require a more indepth evaluation before initiating hormone treatment.
The most important question to ask yourself is, “How am I feeling, in terms of sleep, mood, libido, energy, and quality of relationships?” If you’ve noticed a decline since menopause, advocate for yourself and co-create a care plan with your healthcare provider that may include one or all of these components:
- Lifestyle
- Supplements
- Non-hormonal medications for symptoms
- Hormone replacement therapy
Where can I learn more?
Of course, speaking with your healthcare provider is a great place to start. If you’d like to know more about the medical science behind perimenopause and menopause and how you can best advocate for yourself, I highly recommend taking the mindbodygreen online Peri/menopause+ course.
Your turn
- Have you tried HRT? If so, what was your experience?
- Do you have additional questions about perimenopause or menopause? Do you have symptoms or treatments we haven’t yet discussed?
- What else is on your mind? Anything at all; I just love to hear from you.
Source: mindbodygreen Peri/menopause+ online course
Image by 🌸♡💙♡🌸 Julita 🌸♡💙♡🌸 from Pixabay
Strangely enough I had to start HRT about six years after menopause. It didn’t really alleviate my hot flashes, but it did take care of some other things. I think the important thing is to have a frank discussion with your doctor, letting them know what you do and don’t know about perimenopause, menopause, and postmenopause. Unfortunately, many doctors have had little to no training in discussing these. I am very fortunate in having a wonderful gynecologist. She’s probably younger than my daughter which is a little weird! Thanks for all the information, Christie. This is all so important for women these days.
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That’s interesting, Marsha. You were in the 10-year window for the best results, though. That’s too bad it didn’t help with your hot flashes. It sounds like you got other benefits though. I’m glad you have a doctor who is good to work with and well-educated on perimenopause and menopause. It is such a strange feeling when we reach a point where our healthcare providers are not only younger than us, but younger than our children as well!
Weirdly I’ve had 3 different doctors tell me that since I had a partial hysterectomy we’ll “never know” when I go into hormonal menopause as all 3 claimed hormone testing is very unreliable. So we’re taking a monitoring symptoms approach but after doing so much of my own research it’s amazing ALL the things that this hormone decline can trigger– like higher levels of anxiety, heart palpitations, acne, etc. on top of all the others you’ve mentioned.
It’s my understanding that because hormones fluctuate so wildly during perimenopause, it can be hard to know during that period, but if you reach a point where your hormones remain low for several months in a row, you are probably post-menopause. Of course, your symptoms really dictate the treatment anyway, so monitoring those is a good choice. It is pretty wild how every bodily system is affected by these few hormones.
Hi Christie – this was a great overview and summary. Thanks for all the info on HRT – I’ve found a low dose of combined hormone has worked really well for stopping my hot flashes that were very intrusive and annoying. I have a friend who is taking it for the long term heart and cognative benefits, so different reasons, but similar positive experiences.
Thank you, Leanne, and thank you for mentioning that I had not included HRT in my perimenopause post. That got me thinking that post-menopause deserved a discussion of its own, including HRT. There are so many different benefits. I started using a low-dose estrogen when I was plagued with UTIs. The estrogen prescription resolved the problem immediately. I had no idea the underlying cause was menopause.
I had a full hysterectomy induced menopause at the age of 64 and I can only say, after suffering from the impact of too much oestrogen for too long, it’s brilliant. At last my body feels my own. It now responds properly to exercise and nutrition rather than being held hostage by hormones; no more pre-menstrual acne/boils on the chin – imagine explaining those in your sixties; the end of stomach cramps etc.. Now I feel like one of the lucky ones in that I’ve avoided night sweats or the need for HRT but then I guess I’d already paid the price by continuing with a monthly cycle long after my sell by date.
Thanks for sharing your story, Caree. I hadn’t thought about the problems of an overabundance of hormones. And yes, you definitely “paid the price” as you say. You deserve an easy post-menopause.
You are always so thoughtful to state up front that readers all have different experiences and should consult a medical professional for what might ‘fit’ their needs best. I was on estrogen or some kind of HRT for about 5 minutes until I began growing breast masses that were associated with the hormones. They did help relieve some of my menopause symptoms but I had to discontinue the treatment. I am happily pretty much finished with hot flashes (I think!!). Still can be moody as heck but I think that is a lifelong affliction. If I can just have a little quiet time to start my day, a lot of my moodiness can be waylaid.
My nurse-daughter has learned that estradiol vaginal cream can help manage UTIs. So I have begun using that periodically as a preventative measure. So far, so good.
Wouldn’t it be easier, if all bodies reacted the same, Leslie! Of course, that isn’t the case, so we have to be open to experimenting for the best results. Personally, I have found estradiol tablets to be very effective at preventing UTIs. Thank goodness. Keep making time for that quiet start to the day. You are worth it.
I was surprised to hear a year or more without a menstrual cycle meant you are through menopause. I guess I thought that I was still menopausal because I still have occasional night sweats and need estradiol for symptoms. Now I realize some of the “fun” lasts post menopause! Still, it’s nice to know there are things we can do that help.
You’re not alone, Cindy. I think a lot of people use the term menopause to mean the whole journey through perimenopause to post-menopause. And then to realize that it’s not something that we “bounce back from” and return to “normal.”