Post Menopause: What's It All About?

This week on Menopause Uprising, we’re diving into what happens after perimenopause. While there’s a lot of conversation around perimenopause right now, it’s just as important to understand what to expect in post-menopause.

Transcript -Automatically Generated

Welcome to Menopause Uprising with me, your host, Catherine O'Keefe. And today's episode is a solo episode and I wanted to talk about an aspect of menopause that I really feel we don't hear about enough. So if I was to hop onto social media now, if I was to hop onto any news platform and do a Google of menopause, I'll get plenty of responses and results.

The same when it comes to perimenopause, we're seeing a lot more happening and a lot more discussion in that area. But a really important part of the whole menopause timeline is postmenopause. And I really feel we're not discussing postmenopause enough. I do in my own little bubble and when I do talks and I'm in workplaces, postmenopause is a huge part of the conversations that I have.

So that's what I wanted to delve into today and just talk about this all important stage of the menopause timeline. So I guess, If we start and we look at the timeline of menopause, what does that look like? So we use menopause very much as an umbrella term. And, you know, it's, you're talking about perimenopause and postmenopause, menopause itself, you're wrapping it all together.

But if we look at the actual timeline, what comes first is perimenopause, and that's the kind of the early stages that's before menopause and menopause is the anniversary of. 12 months without a cycle. Your periods have gone and you know that you are finished, that fertile chapter in your life. That's when you hit menopause.

And then it's post menopause. Post menopause is the rest of your life. However, the initial few years of postmenopause are really important because if we think about the journey through menopause, just think about it like a mountain and in perimenopause, you're climbing up that mountain. The summit is when you get to menopause at the top, your period stop for 12 months, and then you're confirmed.

Um, you can back it up by a blood test showing that the FSH level, the follicle stimulating hormone has gone quite high. And there are your two tick boxes that yes, way, I've reached menopause. And then you still have to come down off the mountains. It doesn't mean the minute your period stops, unfortunately it doesn't mean that that means the symptoms stop.

And that's a really important aspect of menopause to be aware of and to understand why so many people connect with me and they talk to me and they're like, they're so excited because they've nearly hit the 12 months and you're thinking, okay, that's it, I'll be finished, whole new chapter. But unfortunately your body still has to calm down and adjust to a new status quo of hormones.

So that means the symptoms are still going to be there and you're going to have a period of years where everything has to calm down. The average age of menopause is 51. It will differ based on ethnic background. But if we think of that, let's use that for an example. So let's say a woman hits menopause at the age of 51.

Let's say she has many of the typical symptoms like hot flushes, sleep issues, brain fog, anxiety, urinary issues, et cetera. They're not going to disappear overnight. What's going to happen is that you still have to take that journey down off the mountain and the symptoms have to calm down. Generally for the majority of women.

The very last symptoms to go tend to be the vasomotor symptoms of menopause. So that is the hot flush and the night sweats. But again, it will be individual for everybody because some people can go through menopause. I'm talking, referring to myself here. I'm 54. I haven't had a hot flush yet. Maybe, maybe they'll start at some point.

I don't know, but it's not a foregone conclusion. You're going to get all of the symptoms of menopause and, you know, can be maybe many of the other symptoms. But what's really important to understand is there is that cooling off period where the body really has to go back to a new level. Hey, I'm happy now with my new hormones, my new level of hormones.

So there aren't any other symptoms to show or to throw out. And, you know, that can. I guess many people can get a bit disappointed, you know, they think they're nearly there and then of course the symptoms keep going. So just to bear that in mind. So it might be you hit menopause at 51, it might be 55, 56, as I said, before those symptoms will disappear.

And then the body just calms now into this whole new level of, this is my new level of hormones and that kind of tails on into the rest of your life. Any conversation we have around menopause, we have to talk about perimenopause and postmenopause and both of them have to have equal importance. That's my view on it and I think that's a really sensible approach to take because once you hit menopause, it's not all done and there still might be symptoms, you still might be looking, you still might be playing around with different management options to find what supports you.

So again, I think. You know, having the knowledge to understand that it doesn't all disappear into the background once you hit menopause is really important because then you manage your expectations and you know and understand what the journey ahead looks like. Now, also just do bear in mind, you know, I always kind of like to remind people, there are 20 to 25 percent of women who do go through The whole menopause transition with no symptoms.

Bear in mind, there are women out there who don't get symptoms. They often kind of say to me, Catherine, I've gone through menopause. I have no symptoms. Is there something wrong with me? I'm like, no, you're very lucky. Just keep going, you know, because. We just do know not everyone gets symptoms. But when we come back to post menopause, I think another really important aspect of, and I am going to answer, there's questions that came in in relation to this on social media, so I will answer those as well.

But a really important part of this chapter now is, this is where, you know, the body is beginning to settle, and that's going to be over a period of months and years. But as that settling down is happening, This is where we still want to be very proactive. This is where we want to be bringing together what I talk about in my book, the six Ms of menopause.

And it's really about looking at your post menopause years and looking at, okay, maybe I'm still struggling with some symptoms or actually maybe I'm, I'm doing grand, you know, I'm on top of it. I'm feeling pretty good. But now it's like checking in with yourself. What do I need to be doing now so that I'm going to make sure I'm in optimum health when I hit my 70s, 80s, 90s, and if some of us live to 100 and beyond.

So it's kind of a bit like a call to action, a call to arms. It's, it's a stop moment where we should assess and we should look at, okay, you know, I've come through this. Now I'm at the other side. I'm managing my symptoms. What, what are the things now I need to start concentrating on and looking at? And there's three key aspects I would like to talk about today in relation to that.

One is your bone health. And certainly from our early forties and indeed throughout our whole life, we should be very conscious of our bone health. But if you come to the postmenopause, let's say you're 51, 52, you've come into postmenopause. If you've never had a DEXA scan done to measure, the, your bone density, then please do look at lining up a DEXA scan because it's really important we understand the health of our bones.

Unfortunately, what happens, many women in post menopause, it's when they have a fall, it's when they break a bone, which is called a fracture, and then maybe they're sent for scans that they realize, okay, I need to get a DEXA scan, then they might have a DEXA scan. It might. Discovered that they've osteoporosis or it might be osteopenia.

I would love to encourage everyone to be proactive in that, in that one and really look at getting a DEXA scan done earlier so that you actually know, okay, actually, look, my bones are in a good place. Now, what are the next steps that I should be doing to make sure I keep my bones in a good place? So I had a DEXA scan done probably about 18 months ago now.

And my bones were in a good place. That's exactly what I was hoping for. So I was thrilled with that. So I knew that I wasn't showing any signs of osteopenia, which is the precursor to osteoporosis. That meant I was like, okay, I know now my bones are in a good place. Now I'm going to start working on weight bearing exercise.

I'm going to use that information to build on my bones even further. So to make sure that my bones are getting stronger. The easiest, most impactful way to do that is weight bearing exercise. Now that can be doing exercises at home, it can be going to classes, it can be going to the gym, whatever works best for you.

But I would really encourage you, if you're not already doing it, Get that X ray scan done and then start to look at how can depending on the results, you know What steps forward can you take if everything is good? Then as I said start the weight bearing if something does come up if it's osteopenia or osteoporosis then obviously you're going to get guidance from your doctor or from a specialist and If if say for example is that it is osteopenia You can start to look at how can you get better results?

And then you're going to start exercise. Just make sure you do get a program. You do get guidance from someone who is working in this area from physiotherapists, et cetera, so that you're not going to do any damage. That's really, really important. So your bone health. It's vitally important and movement is a huge part of that.

So, you know, I'm talking there about the weight bearing, but it's also your everyday movement. It's going up and down the stairs. Try and use the stairs more than the lift. It's making sure you're taking movement breaks from your desk if you're in a sedentary, um, more office type static role. It's just getting breaks in throughout the day.

Another key part of that, obviously, on top of the bones, to help our bones, is the food that we're eating in our diet. And we talk a huge amount in Ireland about calcium, and we actually have very high intake of calcium in our diets, naturally. So, the chances are, you may already be getting enough of that.

Calcium in your diet. If that's not the case, then certainly look to supplement. And if you are taking a calcium supplement, just be very mindful. There's some other key ingredients that work very beneficially with calcium. And that would be magnesium, good form of magnesium, either magnesium citrate, magnesium bioglycinate.

It's also called glycinate, and then also vitamin D and vitamin K. Vitamin D and vitamin K are very important when it comes to bone health. They're kind of like the, um, I always talk about them as being kind of the traffic masters when it comes to sending the nutrients. to where we want them to go in the body.

So sending the calcium to the right places in the body. So vitamin D and vitamin K are also really important. And if you are taking vitamin D supplement, which I would hope most people are, because generally most of us tend to be deficient and doctors don't test for vitamin D deficiency anymore. But You know, certainly when we're in our forties, do look for a vitamin D supplement that has vitamin K as well, because as we get older, it's really beneficial to have the two together.

So bone health is one key aspect. And the next is the cognitive side. So, you know, I'm in my fifties now. I'm very aware of, you know, being mindful of the fact two out of three dementia patients have are women. So what can we do to support our cognitive health in these years? And that's again, really looking at looking after ourselves.

Sleep is a huge part of managing stress, managing everyday life, making sure that we're going into the next day where we have energy, where we have resilience, that we're able to perform. To enjoy our lives. So sleep is a huge part of that. And that also feeds into our brain health as well. And there's many different aspects that feed into cognitive health.

This is something we really have to be conscious of in our forties. But again, in your fifties, if you're not already aware of it, this is an aspect you want to hone in on in those post menopause years where the good news is. We know Dr. Lisa Mosconi tells us for the majority of women, the brain recalibrates, it settles down when we come into the post menopause years.

So the brain fog won't feel as heightened as it did before. But what we want to do now, Is we want to nourish our brain. So we want to keep them healthy and active, but that's hard, right? Cause like, I can't see my brain. I can't see what's going on inside unless I go off and I have imaging done. So you don't know what's happening.

Well, what we want to think about is we want to start taking the steps that we know would be preventative. So, a key part of that is going to be movement. And we talked about, you know, the weight bearing exercise, which is also beneficial for your cognitive health. Also your cardiovascular exercise, which is hugely beneficial.

It's enhancing the oxygen flow. The blood flow to the brain. It's releasing the feel good hormones. The serotonin, the dopamine, these are all things that our brain will thrive on. So exercise is really important, the physical exercise. But I also like to talk about the exercise for the mind. And how do I promote my brain health?

what can I do? So it's it's it's It's for a good reason that many women take up bridge in their fifties, maybe earlier, maybe even later, because it's really challenging for the brain. And that's a fantastic hobby to take up. And, you know, also not only is it fantastic for your brain, but it's also a great community way of meeting other women and just socializing.

That bridge, chess, um, sudoku, anything that's problem solving is going to get the brain thinking. If we don't exercise our brain, it will just kind of lapse and it'll get a bit lazy and it's a bit like, I always use the example of sat nav, because, um, I know when I'm tired, if I'm driving home from somewhere I've been working, I put the sat nav on, I won't even think about where I'm going, I just follow the directions, because you're tired, right?

And I kind of think on that occasion, that's okay. But if I didn't have the sat nav, and if you think back to the days when we didn't have sat nav, we had to think about where we were going. We had to watch the road. We had to watch the directions. We had to take the turns, etc. We weren't being prompted. So your brain was actually What you weren't actively thinking about it, but your brain was being exercised.

So it's really understanding now as we become more reliant on technology and, you know, other aspects, which is brilliant, don't get me wrong. But it's also being conscious of the fact that we also have to think consciously now of how to proactively exercise the neural pathways and our beautiful brain.

So it is like, as I said, you know, bringing in challenges, um, uh, you know, problem solving, all of that will benefit. It can also be change. The brain loves change. So for many, it might be they take up a different hobby. When you get into your 40s and 50s, some people learn a language, maybe a musical instrument, just something different.

But the brain thrives on change and that change doesn't have to be big. It can be simply that you could walk a different route to work. You could cycle a different route to wherever you're going. You could cook a different recipe. You could read a different type of book. You could listen to a different type of music.

That's kind of pushing your brain out of, Oh, okay, this is something new. I haven't kind of thought about this before, or I haven't listened to this type of music before. And that is all exercise for the brain. And again, it's hugely beneficial. So when you think about these post menopause years and what else you need to be doing, just be mindful of these additional steps.

So for your bones, for your brain, and then finally your heart. A lot of what we've talked about already is is going to benefit your heart and we've talked about exercise. We've talked about, you know, um, the, the, the benefit of looking after our brain and another part of that is going to be stress management, which will benefit your heart, would benefit all aspects of your health.

And that is really looking at, you know, what are the stresses in my life? Am I asking for help? We're brutal. The majority of women, we tend to be really bad to ask for help. So it's just kind of, you know, whether it's at work or at home, it's putting your hand up and just kind of, you know, asking for help, asking for support.

And that will help in relation to managing stress. Mindfulness, meditation, hugely beneficial for your heart health, but also for your cognitive health as well. When we talk about heart health, what we eat and our food is a big aspect of this. And this is why we know of all the diets that are out there.

It's the Mediterranean lifestyle and diet is one. that has great affinity with heart health. And one of the key reasons for that is because of the high portion of fiber in that diet. And it's also the heavy use of omega 3. So That is your extra virgin olive oil. It is your nuts and seeds, all of that hugely beneficial for your heart.

So it's being conscious of looking at the food that you're eating. And is it supporting this aspect of your health? And really fiber is so important. I often think we can't talk about fiber enough because what I guess one thing that I see a lot and it was a symptom I experienced myself in the early perimenopause years was chronic constipation.

And initially you're kind of thinking, oh yeah, a day or two goes by, you might have a bowel movement. Don't even think about it. You mightn't even register that you didn't have a bowel movement today. But as that builds and as that goes on, it's going to make you feel more tired. You're not going to eliminate excess toxins as efficiently as you might have done before.

So it's really important to have fiber in your diet and particularly in postmenopause. You really want to make sure your bowel health is your number one priority. So that means loads of fruit and vegetables and whole grains. It also means don't keep eating the same fruit and vegetables every week. Add diversity.

I always kind of say, look, every time you go shopping, put a new, one new fruit or vegetable into the trolley so that it means you've got diversity coming into the gut microbiome, which is going to benefit your overall health, but it's also going to benefit your brain health as well, because we know of gut brain connection.

But that diversity of fiber will all will mean that your microbiome, it's going to flourish. It's going to have loads of different bacteria. It's going to have a good variety of prebiotics in there, which are really beneficial for supporting your overall immune health. and of course your bowel health as well and which will indirectly are all going to support your heart health.

So there's some of the key aspects that I would just love you to consider in relation to your perimenopause years. I'm just going to touch on now some of the questions that that were sent in, in relation to, um, menopause, um, and post menopause. What's normal to expect at this stage as most info on perimenopause?

So, when we look at post menopause, as I said, we're still going to have symptoms. Generally, what you find, the most common symptoms that people might still be experiencing, would be brain fog, Would be anxiety, would be hot flushes and night sweats. And it might also be that urinary issues start to come in.

The post menopause years, if you haven't done it already, this is a time when it is hugely beneficial to make an appointment with a women's health physio. That's a person, that's a specialist physio who will, Check you out internally, talk to you about your symptoms, and just ensure that your pelvic health and your core health is where we want it to be at.

Let's be very clear here. It is not normal that women use sanitary products. and pads as they get older. That's not normal. That's simply marketing. If you can be proactive and engage with a women's health physio, you will be saving yourself so much money, so much hassle, and so much time down the line. I never needed HRT.

I did, I did, sorry, I never needed HRT, did I do myself an injustice or harm? Have I missed out in some way? If you never needed HRT, no. Remember it's all about looking at your symptoms, mild, moderate or severe, and if your symptoms are mild, then really it's looking at enhance everything through lifestyle.

If they're moderate and severe, then that's a different conversation. But if you haven't, if you didn't need HRT and you didn't use HRT, that's totally fine. Now you still want to be conscious whatever age you're at in these years, now you want to do What I've just mentioned, you want to look after your bones.

You want to look after your heart. You want to look after your cognitive health. You want to ensure that you're thriving through the post menopause years and that you really are enjoying this chapter in your life. How long should you stay on HRT? I'm 61. Is this post menopause? At 61, the chances are you are post menopause.

Your doctor can confirm that with your FSH level. In relation to staying on HRT, there's no hard and fast rule to this now. It's very much sitting down with your doctor and they will always be looking at ensuring the benefits of HRT are outweighing the risks. So it could be, depending on your state, symptoms, you know, it might be that maybe you don't need HRT anymore.

It's really to sit down and have a conversation with your doctor and just see, because you might be well through, you might be on the other side, you might come off HRT and you might find actually it's fine. Um, you don't have any symptoms, but definitely I would recommend, you don't have a chat with your doctor and discuss where you're at in relation to symptoms and how you're feeling.

59. Not on HRT. Will my body suffer more from the lack of oestrogen? Feeling okay at present? Again, go back to how are you doing? So if you're doing great, if you're feeling good, you're okay, then great. You know, keep, you know, keep enjoying your life. Um, this is something that comes up a lot where people kind of feel nearly they've missed out because they haven't taken HRT.

But the end goal is not that every woman should be on HRT. And I think it's really important we keep that in our minds. So I would go back, you know, your body, Won't have suffered, but what you do want to be conscious of, we know that estrogen has a protective role to play when it comes to bone health and there's a lot of studies around that.

But that protection stops the minute you stop taking estrogen. So what you want to do is, as I said earlier, you want to be focusing now on your bones and all of those crucial aspects of, um, of your overall health. Advice, opinion and coming off HRT postmenopause. I am five years postmenopause now, nearly four years on HRT.

Yeah, I would simply have a conversation with your doctor because, you know, it was not advised to go cold turkey and it would be much more beneficial and easy for you if you gradually come off your HRT and your doctor should sit down with you and just explain, depending on whatever dose you're on, how you're going to do a gradual reduction.

Can hot flushes get worse? in postmenopause. Oh, hot flushes. Oh, hot flushes are, um, they're always a tricky one, and they generally are the last symptom to go, um, for so many. Can they get worse in postmenopause? Not for the majority of women, but I will put a huge but here. Because I have spoken to many women who never had hot flushes in the perimenopause years, and then they came on in the post menopause years.

So remember what I was saying earlier about coming down off the mountain. So again, it can be the hot flushes, they can be just making their last little entrance and saying, Bye bye. I'm here to show you that I'm, I'm leaving the building. So it can happen. Um, but for the majority of people, it tends to be as they get closer to menopause itself, that's where the symptoms tend to get more intense.

One other symptom just to be mindful of that, if you're not treating it, will not improve in post menopause. And that is vaginal dryness, vaginal atrophy. If you have vaginal atrophy and you are not treating it with local oestrogen, that can become a chronic condition. It can lead to recurrent UTIs. And it's so easily treated with many different forms of local oestrogen that it really is.

so important that any woman who has any of the symptoms talks to their doctor and sets up a treatment plan. The key symptoms you look at when it comes to vaginal dryness would be inflammation around the vulva area, which is external. It might be a feeling of heat. It might be thrush like symptoms. It might be painful sex, painful penetration, might be spotting or bleeding after sex.

Could also be that you can have a slight watery discharge. They would be some of the common symptoms. But again, that's another aspect of your health, hugely important to be mindful of. And it would be something. If you did go and visit a women's health physio, they might, would also be able to give you some insights in terms of what they're seeing.

Does the internal vagina walls, do they look like there's dryness there? Can they see some of the symptoms, etc. They will also be looking for, you know, is there any signs of prolapse, etc. That's why that's such an important appointment to make or to have at some stage. You know, I would ideally, I would love if the government brought in a free women's health check at the age of 45 and one key part of that would be visits to a women's health physio just to check how everything is because we can't see what's happening internally.

So really important. So I hope you enjoyed today's session. If you have any questions or comments, please do let me know. And as always, I would love if you would comment on the podcast, share the episode, and just read it on whatever platform you're listening to. That's really helpful and will be a great support to me.

Thanks everyone for listening.