Life After Menopause: Managing the Postmenopausal Period

After menopause, many individuals may continue to experience menopausal symptoms. The decrease in reproductive hormones, lifelong exposure to these same hormones, and genetic or environmental risk factors may increase the risk of developing bone diseases and gynecological cancers. Healthcare during this postmenopausal period includes screening for diseases that are common during this stage and may involve treatment to help address symptoms severely impacting quality of life.

Postmenopausal symptoms and disease risks

Menopause is a natural stage of life for all women and individuals assigned female at birth (AFABs). The postmenopausal stage lasts for life after menopause, and many women and AFABs will continue to experience ongoing symptoms. For some individuals whose quality of life becomes severely impacted, hormone replacement therapy (HRT) may be prescribed. Common symptoms experienced during postmenopause include:

• Vaginal dryness
• Hot flashes
• Night sweats
• Depression
• Sleep disturbance

The risk of certain diseases also increases during postmenopause. As estrogen levels decrease, rapid bone loss ensues, increasing the chances of developing bone diseases. In addition, in women and AFABs who started menstruating early or experienced late menopause, extended exposure to estrogen over their lifetime increases their risk of gynecological cancers. Common gynecological malignancies experienced after menopause include uterine, ovarian, and cervical cancers.

Healthcare during the postmenopausal period may include counseling and therapy for alleviating lingering menopausal symptoms, especially for those experiencing decreased quality of life. Screening for bone disease and certain cancers may be conducted to support early identification and treatment of these diseases. Hormonal testing may also be performed or recommended for individuals prescribed HRT.

Postmenopausal screening for diseases

Healthcare providers may use various technologies during postmenopause to screen for bone disease and gynecological cancers. Screening for osteoporosis may need to be considered for postmenopausal women and AFABs who are either 65 years and older or have risk factors for the disease. Standard gynecological exams and ultrasounds help with monitoring pelvic health and screening for cancers and other abnormalities.

Gynecological exams

Postmenopausal individuals are recommended to continue getting gynecological exams, which may include pelvic exams, mammograms, and pap smears. Pelvic exams are necessary for evaluating the health of your uterus, cervix, vagina, and other organs. Pelvic exams and pap smears will help healthcare providers discover signs of any abnormalities, including ovarian cysts, uterine fibroids, sexually transmitted diseases, and gynecological cancers. Mammograms are also used to screen for cancers of the breast. Your healthcare provider will help with determining which screenings are most appropriate for you to receive at your postmenopause follow-up visits.

Ultrasound imaging

Ultrasound imaging is used to evaluate reproductive organs, lesions in the uterus and ovaries, and reasons for abnormal bleeding, when present. Ultrasound imaging includes techniques such as transvaginal, color Doppler, and 3D ultrasounds. The technique uses sound waves to create images of the body to help with identifying abnormalities.

Bone density imaging

The loss of estrogen in addition to other factors such as aging, smoking, and genetics increases the risk of osteoporosis in postmenopausal individuals. Women and AFABs experience around 10% to 12% bone loss in 10 years after menopause. Dual-energy X-ray absorptiometry (DXA or DEXA) is the most common tool used to evaluate skeletal health. Other techniques that may be used include X-rays and CT scans. These tests use special imaging technology to measure bone density in the hip and spine, which can help identify early signs of bone loss and guide treatment decisions.

Hormonal testing during hormone replacement therapy (HRT)

The goal of HRT is to help resolve postmenopausal symptoms by supplementing the loss of estrogen and progesterone during menopause with compound mimics. While monitoring hormone levels while on HRT may not be necessary, hormone testing can be used to help confirm the effectiveness of the therapy. A few important hormones that may be measured to assess HRT results include estrogen, testosterone, progesterone, follicle-stimulating hormone (FSH), and thyroid-stimulating hormones (TSH).

The most accurate and standardized way to test your hormone will be through your healthcare provider's office or a clinic. However, at-home tests are also available for consumer purchase. Companies that provide various kits with either hormone panels or to test individual hormones include the following:

• Everlywell - Thyroid, postmenopause, and comprehensive test kits ranging $99 to $249
• LetsGetChecked - Thyroid, postmenopause, and comprehensive kits ranging from $99 to $139
• myLAB Box - Testosterone, thyroid, postmenopause, and comprehensive kits ranging $99 to $249
• Verisana - Estrogen, progesterone, testosterone, and comprehensive kits ranging from $49.49 to $219.95

Keep in mind that at-home hormone testing does not replace the advice and care of a licensed medical professional. Any concerns, testing options, and results related to postmenopausal symptoms and therapies should be discussed with your healthcare provider.

Reasons for postmenopausal screening

Women and AFABs who are experiencing any of the following symptoms after menopause should consult their healthcare providers:

• Postmenopausal bleeding. Common gynecological cancers, such as uterine and cervical cancers, may present with vaginal bleeding. Women experiencing bleeding after a year of non-bleeding period should be evaluated by a healthcare provider.

• Risk factors for osteoporosis. If you have a family history of osteoporosis, are thin, or have a history of smoking, you may be at higher risk for bone loss and fractures, and postmenopausal screening testing can help guide recommended preventive measures.

• Sexual pain and discomfort. If you are experiencing vaginal dryness, itching, or pain during sex, this may be a sign of vaginal atrophy, which occurs after menopause due to decreased estrogen levels.

• Severely impacted quality of life. If you are experiencing hot flashes, night sweats, mood changes, or other symptoms that are affecting your quality of life, menopausal testing can help determine whether hormonal changes are contributing to your symptoms and guide treatment decisions.

Postmenopause is a natural stage that every woman and AFAB will enter after menopause. However, these individuals are at an increased risk for certain conditions due to the decrease in reproductive hormone levels, lifelong exposure to estrogen, and other important risk factors. Screening during postmenopausal follow-ups for gynecological cancers, bone disorders, and other common diseases is important for monitoring your health status. By working closely with a healthcare provider, you can take proactive steps to maintain your health during postmenopause.