October 18, 2026, 6:02 am | Read time: 8 minutes
Menopause is a process that can last up to ten years for some women, during which hormone production declines and fertility ends. Its final phase is postmenopause–lasting until the end of life. The various symptoms of menopause are often discussed. But what happens in postmenopause? What does this life stage mean for women, both physically and mentally? What can they do to stay healthy and satisfied for a long time? FITBOOK spoke with an expert on the topic.
Menopause Ends with Postmenopause
Most women enter perimenopause, the first phase of menopause, in their mid to late 40s. However, a recent study suggests that hormonal changes can begin significantly earlier.1 FITBOOK explains what women can expect in the different phases of menopause and what symptoms may occur in this article.
The terms menopause and climacteric are often used interchangeably. But this is not correct. “Menopause usually refers to the last natural menstrual period,” explains gynecologist Dr. Heidi Gößlinghoff. Whether it was indeed the last period can only be reliably determined later, when no further bleeding has occurred for twelve months. This is when postmenopause begins.
Postmenopause–Estrogen Levels Are Now Permanently Low
Postmenopause begins after the last menstrual period and encompasses the entire remaining life stage. The expert clarifies: “This is one-third to half of a woman’s lifetime!”
Unlike menopause, characterized by fluctuating estrogen levels and marking the hormonal transition around the last menstrual period, estrogen levels remain permanently low in postmenopause. This can have health consequences. Many of them are not felt, explains the gynecologist.
Possible Physical Consequences and Health Risks
Due to reduced estrogen supply, bone density decreases, especially rapidly in the first years after the last menstrual period. This can increase the likelihood of fractures. Women now have an increased risk of osteoporosis.
The risk of cardiovascular diseases also increases. “There is a significant increase in heart attacks, from which we are protected before postmenopause by higher estrogen levels,” says Dr. Gößlinghoff. FITBOOK delves deeper into the topic and sensible preventive measures in this article.2
Also interesting: The longer women have to live without estrogen, the worse it is for the heart and brain
Additionally, changes in cholesterol levels and a decline in muscle mass occur. The loss of muscle mass and metabolic changes can contribute to faster weight gain during this life stage. This is why physical activity is important now.
Menopause Symptoms That Persist in Postmenopause
Various menopause symptoms are favored by hormonal changes. Some of these complaints persist beyond the end of menopause. As Dr. Gößlinghoff explains, hot flashes and sleep disturbances can accompany women for years. However, they subside for many affected individuals sooner or later.
It is different with typical genital complaints, most of which are related to the thinning of mucous membranes due to the declining estrogen levels. These include vaginal dryness, pain during intercourse, more frequent bladder infections, and increasing bladder weakness. “These complaints tend to increase if not treated,” admits Dr. Gößlinghoff. Since they can significantly affect the quality of life and sexuality of those affected, it is all the more important not to simply accept them as an inevitable part of aging but to have them medically clarified and treated.
Possible Mental Effects–Positive and Negative
Mentally, women experience postmenopause very differently, the gynecologist describes.
At this point, it should be noted that menopause and, not least, the final postmenopause are associated with fears and negative perceptions for many women. It may be all the more relieving for them to hear that the new life phase, as Dr. Gößlinghoff emphasizes, can also be perceived as liberating. After all, cycle complaints are finally a thing of the past, as is the question of contraception. Some women feel more balanced and enjoy the new freedoms.
On the other hand, many affected individuals continue to struggle with sleep deprivation, mood swings, or concentration problems. This can also affect professional performance, as well as sexuality and partnership. But there is hope here too. “Not all of these complaints are automatically due to hormone deficiency,” explains the expert. If the complaints are clarified medically at an early stage, the cause can usually be easily determined, and there are often ways to treat the complaints specifically.
What You Can Do to Stay Fit for as Long as Possible
With the onset of postmenopause, bone health, muscle strength, and the cardiovascular system deserve special attention. The gynecologist therefore recommends two to three training sessions per week, combining strength and endurance training, as well as balance exercises. “Endurance training alone is not enough.”
Strength training helps maintain muscle mass. But nutrition also plays a major role. Dr. Gößlinghoff emphasizes the importance of adequate protein intake. Calcium and vitamin D, on the other hand, contribute to bone health. Women should avoid indulgences like nicotine and alcohol as much as possible.
Regular check-ups, especially in the internal medicine field, are also important. Blood pressure, blood lipids, and blood sugar can be monitored. Bone density measurements can also be useful in cases of family history or osteoporosis.
Pelvic floor training can help against bladder weakness. But not only physical prevention contributes to healthy aging. “In addition to these physical preventive measures, social contacts, good sleep, and a meaningful task also help to age healthily and happily.” Much can be done for quality of life in this way as well.
(When) Is Hormone Replacement Therapy Useful?
Hormone replacement therapy–the administration of sex hormones, whose production declines during menopause–was long controversial. Among other things, it is suspected to increase the risk of thrombosis.3
However, according to the gynecologist, the therapy is now being reassessed. “For women with complaints, it is the most effective treatment,” she says. If hormone treatment is started before age 60 or within the first ten years after menopause, the benefits generally outweigh the potential risks–at least for “suitable women.” There are situations where hormone treatment is not an option or must be carefully considered, such as certain breast cancer risks or an increased risk of thrombosis.
A special situation exists when menopause occurs prematurely, adds Dr. Gößlinghoff, “that is, before age 40. Here, hormone substitution is generally recommended, provided there is no contraindication.” It should be continued at least until the usual menopause age is reached.
How Menopause Changes the Vagina
Why Women Shouldn’t Settle for This Intimate Problem
What Hormone Treatment Can Do–and What It Can’t
Hormone therapy is considered the most effective treatment for hot flashes and night sweats, explains Dr. Gößlinghoff. It can also protect against osteoporosis.
However, the expert emphasizes that hormone replacement therapy is not a general remedy against age-related diseases. “Hormones alone do not help to completely prevent cardiovascular diseases or dementia.” Therefore, a healthy lifestyle also plays an important role in heart health and general well-being.
For vaginal dryness and pain during sex, the use of estrogen can help. But for this reason alone, systemic hormone therapy is not necessary, says the expert. “If only local complaints such as vaginal dryness or pain during intercourse are present, they can be treated well and safely with low-dose vaginal estrogen preparations.” The local treatment targets the affected area directly. Which therapy is suitable should be discussed individually with a doctor.
Different Types of Hormone Therapy
Depending on the preparation and individual situation, hormones can be administered as patches or tablets. Estrogen is also available as a gel. A pure estrogen therapy is only an option if there is no uterus. For certain complaints, a low-dose use of androgens like testosterone or DHEA can also be considered.
Again: This does not mean that every woman has to take hormones. Those without complaints do not automatically need hormone replacement therapy.
Conclusion: Postmenopause Is Not an End, but a New Chapter
This article highlights the various symptoms of postmenopause. However, it is generally important not to view this life stage solely from the perspective of potential health risks. Although the body changes and various complaints can occur, this does not mean that quality of life must necessarily suffer.
Consider postmenopause as a new stage of life that offers a good opportunity to pay more attention to your own health and well-being. Those who have complaints medically clarified and take time for what is good for them can do much for their own quality of life. And last but not least, this life stage also brings new freedoms. Postmenopause is a chance to give more space to your own needs, and with a bit of luck, for many more decades.