A Year Since the Last Egg: What Happens After Menopause?

Menopause is often talked about like it’s a long, drawn-out process, but in reality, it’s just one day—yes, one! It’s the day your last period happens, but you only know it in hindsight, 12 months later, when you haven’t had a period for a full year. That day marks the start of postmenopause. Understanding what happens after menopause is crucial, because it’s not just about the end of periods—it’s about the beginning of a new phase in your life.

Many people use “menopause” and “postmenopause” interchangeably. Technically, menopause is just that single day, while postmenopause is the rest of your life.

What happens after menopause?
After menopause, your body enters postmenopause, marked by low estrogen and progesterone levels. You may experience symptoms like hot flashes, vaginal dryness, and changes in bone and heart health.

Now, Let’s Get Into the Science Behind It

Menopause happens because your ovarian follicles, the little sacs that hold your eggs, are depleted. When that happens, your brain starts sending out higher levels of follicle-stimulating hormone (FSH) to signal the follicles (small nests in the ovaries that house eggs) to mature eggs. But it doesn’t work anymore. There are no eggs to mature, so the follicles cannot respond to the brain by producing more estrogen. FSH keeps rising because the ovaries have run out of eggs, and that leads to the significant hormonal changes that define menopause. 

The main ones? A big drop in estrogen, especially the most important form estradiol, and progesterone. There are other hormonal shifts too, like an increase in Luteinizing Hormone (LH) and a decrease in testosterone and inhibins A and B, but these are a bit more subtle1 2 3.

Navigating Early and Late Postmenopause

This journey doesn’t happen overnight and doesn’t always happen naturally. It can also start early if your ovaries are removed, or due to cancer treatments, autoimmune conditions like oophoritis (where your immune system attacks your ovaries), or genetic conditions like Turner syndrome or Fragile X syndrome4, 5, 6.Postmenopause can be broken into two stages13:

Early Postmenopause

This is where FSH keeps climbing, and your estradiol keeps falling until both hit a stable level. This stage lasts around 5 to 8 years. It is the time when you’re most likely to experience those dreaded hot flashes and night sweats—classic vasomotor symptoms (VMS).

Late Postmenopause

This stage lasts the rest of your life. While the hot flashes might fade, other symptoms become more common, like vaginal dryness and thinning of the genital tissues. Your body has fully transitioned into its new phase.

The Menopause Countdown

While menopause is a universal experience, the timing of it can vary quite a bit from woman to woman and certain factors can even speed up the process.
Premature menopause begins before age 40, and early menopause occurs between ages 40 and 45.

Studies show that the earlier menopause starts, the higher the risk of certain health issues like cardiovascular disease, osteoporosis, and cognitive decline12. That’s why it’s important to be aware of these timelines if menopause happens sooner than expected.

Most women will go through spontaneous menopause somewhere between ages 45 and 55, but the average age can depend on where in the world you live9, 10:

• In Europe, the average age is between 50 and 53.
• In North America, it typically starts between 50 and 51.
• In Latin America, it varies more, ranging from 44 to 53 years old.
• In Asia, menopause can start earlier, usually between 42 and 49.

Curious Facts

• In 2021, it was estimated that 1.02 billion women globally were postmenopausal, and that number is expected to reach 1.65 billion by 205011. That’s a lot of us going through this together!
• Here’s another interesting fact: smoking can actually cause menopause to start earlier. Why? Smoking lowers estrogen levels and speeds up the loss of eggs in your ovaries, effectively bringing menopause closer. Just another reason to kick that habit if you haven’t already7, 8.

Menopausal Symptoms: What to Expect

Menopausal symptoms can vary greatly in both intensity and duration. 70% to 95% of us will experience menopausal symptoms at some point14, 15, 16. Let’s focus on the key groups of symptoms that many women experience. You might recognize some of these in yourself, or maybe they haven’t hit you yet. It’s good to know what could come up.

Vasomotor Symptoms (VMS)

These are the famous menopause symptoms! Hot flashes, night sweats, palpitations… Have you ever felt your body suddenly heat up out of nowhere, right in the middle of a normal day? Or how about waking up drenched in sweat despite a chilly room? If so, you’re in good company—60–80% of women experience hot flashes or night sweats. Unfortunately, VMS can last an average of 10 years.

Mood Disturbances

Have you ever found yourself snapping at someone or feeling extra irritable for no clear reason? Or maybe there’s a sense of worry that just won’t go away, even if nothing specific is stressing you out. Mood changes can be one of the most frustrating parts of menopause, leaving you feeling like you’re on an emotional rollercoaster that you never signed up for.

Cognitive Disfunction

Ever walk into a room and completely forget why you’re there? Or struggle to find a word that’s right on the tip of your tongue? These moments of brain fog are common during menopause. You might find yourself wondering, “Is it just stress or is my brain slowing down?” In my opinion, cognitive changes are the least talked about, but could be the most frustrating of the symptoms. They are very hard to identify and label.

Symptoms Affecting Your Bladder and Vagina

Have you ever felt vaginal discomfort? Maybe dryness or even pain during intimacy? This is a common, often overlooked symptom of menopause. If you’ve noticed needing to pee more frequently, especially at night, or dealing with repeated UTIs, that’s part of this package too. It can be frustrating and a little embarrassing, but it’s more common than you’d think.

Bone and Joint Problems

Are your knees feeling stiffer than usual? Or maybe you’ve noticed your back aching more often? During postmenopause, your bones lose density faster, which can lead to more fractures or persistent joint pain. It might even explain those nagging aches you didn’t have before.

Heart Health

You may not notice this immediately, but menopause can impact your heart health. Have you been paying attention to your cholesterol levels or blood pressure? Changes in estrogen levels can increase your risk of heart disease, so it’s a good idea to keep an eye on your heart health during this time.

Skin Changes

Has your skin been feeling more dry or itchy? Maybe you’ve noticed a few new facial hairs popping up, or your nails breaking more easily. These changes are common as estrogen levels drop, and personal care becomes of paramount importance.

Muscle Loss and Increased Body Fat

Do your muscles feel weaker? This could be sarcopenia, a gradual loss of muscle mass and strength that often comes with menopause. Have you noticed weight gathering more around your middle? Shifts in hormones during this time can cause changes in how your body stores fat, even if your routine hasn’t changed.