It's been more than a year since your last period. You'd assumed that would be the end of it. But you're still waking up hot in the night, your joints ache in the morning, and some days your brain feels full of cotton wool. You might be 55, or 60, or older, and wondering why it hasn't stopped.
Post menopause symptoms are common, and they're not a sign that something has gone wrong. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer, and that some, such as joint pain and vaginal dryness, can carry on after menopause.
This guide covers what tends to carry on, what's new, what often gets better, and what's worth getting checked.
See your GP if:
What does post menopause mean?
Menopause is the point when you haven't had a period for 12 months in a row, Women's Health Concern explains. It's the patient arm of the British Menopause Society. Post menopause is simply the time after that point: the rest of your life.
For most women, menopause happens between 45 and 55. The average age of the final period is 51. Women spend roughly a third of their lives after the menopause, so it's worth knowing what to expect (Women's Health Concern).
Before that point is perimenopause, when hormone levels rise and fall and symptoms come and go. One practical point: if you're 50 or over, Women's Health Concern says you can usually stop contraception once you've gone a year without a period. If you're under 50, it's two years.
If you're not sure which stage you're in, our guide to the signs perimenopause is ending may help.
Common post menopause symptoms
After menopause, your ovaries make very little oestrogen. Some symptoms fade as your body gets used to that. Others carry on for years, and a few can start or get worse. The most common are:
- Hot flushes and night sweats. These often carry on for several years after your last period.
- Poor sleep. This is often linked to night sweats, but not always.
- Joint and muscle aches.
- Vaginal dryness and bladder changes. These often carry on, and can increase after the menopause.
- Low mood, anxiety and brain fog.
- Skin and hair changes. The NHS lists dry, itchy skin and thinning hair among menopause symptoms.
What often gets better
It's not all bad news. Once your periods have stopped, there are no more heavy or unpredictable periods. And if you get migraines, the NHS says they often get better after the menopause.
Hot flushes after menopause
Many women are told hot flushes (hot flashes) only last a year or two. For lots of women, that isn't true.
A large US study called SWAN followed women through the menopause. It found that frequent hot flushes and night sweats lasted a median of 7.4 years in total. They carried on for a median of 4.5 years after the final period (Avis and others, 2015).
Women whose flushes started early, while their periods were still regular or only just changing, tended to have them the longest. For them, flushes carried on for a median of 9.4 years after their last period. So it's quite normal to still be having hot flushes in your late 50s or at 60.
Things to try:
- Wear light layers, and keep your bedroom cool at night (NHS).
- Have a fan, a cool shower or a cold drink to hand.
- Notice your triggers. The NHS mentions spicy food, caffeine, hot drinks, smoking and alcohol.
- If you smoke, Women's Health Concern says smoking is known to trigger more frequent and severe flushes.
Things to talk to your GP about:
- HRT. NICE's menopause guideline says doctors should offer HRT for hot flushes and night sweats.
- Menopause-specific CBT. NICE says this can be used alongside HRT, or instead of it if HRT isn't suitable or you'd rather not take it.
- Non-hormonal medicines. NICE recommends a newer medicine called fezolinetant as an option for moderate to severe hot flushes.
Our articles on night sweats and why hot flushes are worse at night go into more detail.
Sleep after menopause
Sleep problems are very common around menopause, affecting around 40 to 56% of women during the transition, says Women's Health Concern. Low oestrogen affects sleep directly. It also affects it through night sweats, mood changes, aching joints and needing the loo in the night.
Two sleep problems become more common from menopause onwards:
- Sleep apnoea, where your breathing stops and starts while you sleep. It can cause loud snoring, morning headaches and tiredness, but not everyone with it snores.
- Restless legs, an uncomfortable urge to move your legs in the evening or at night. Women's Health Concern suggests asking your GP for a blood test to check your iron levels.
Simple habits help: get up at the same time every day, avoid caffeine after lunchtime, keep your bedroom cool, dark and quiet, and build a relaxing wind-down routine. If you can't sleep, get up after 20 minutes and do something calm until you feel sleepy.
CBT for insomnia is the most effective treatment for long-term insomnia, Women's Health Concern says. Your GP can tell you how to get it. If you'd like something gentle to listen to at bedtime as well, menopause sleep hypnosis is a recording to help you relax and drift off. There's more in our article on menopause insomnia.
Joint pain, mood and brain fog
The NHS lists muscle aches and joint pain among menopause symptoms, and says joint pain can carry on after menopause. Keeping active matters here too. NICE asks doctors to explain the importance of keeping up muscle strength through physical activity. See our page on menopause joint pain.
Low mood, anxiety and trouble concentrating are common menopause symptoms, says Women's Health Concern. It points out that poor sleep can make them feel worse. HRT and CBT can both help, and it's always worth telling your GP if your mood is low most of the time.
Vaginal dryness and bladder changes
These are some of the most common symptoms after menopause, and some of the least talked about.
Without oestrogen, the skin of the vulva and vagina becomes thinner, drier and less stretchy. Women's Health Concern says about half of women experience vaginal dryness after the menopause, and that problems with dryness and painful sex increase after it. Yet only about a quarter of women affected seek treatment.
Low oestrogen can also affect the bladder. The NHS says vaginal dryness can come with needing to wee more often, and repeated urine infections.
There's a lot that can help:
- From a pharmacy: vaginal moisturisers and water-based lubricants, without a prescription. You can ask the pharmacist for advice in private.
- From your GP: vaginal oestrogen, as a cream, gel, tablet, pessary or ring. NICE says serious side effects are very rare, and very little gets into the rest of your body. Symptoms often come back when you stop, but you can start again.
- Avoid perfumed soaps and washes.
Our page on vaginal dryness has more, and so does our page on UTIs after menopause.
When to see a GP after menopause
Please see your GP if:
- you have any bleeding from your vagina, a year or more after your last period (see the box at the top)
- symptoms such as hot flushes, poor sleep or low mood are making daily life hard
- vaginal dryness lasts more than a few weeks or is affecting your life
- you've noticed any new symptom that worries you
You don't have to put up with symptoms just because your periods have stopped. Treatment is still available after menopause.
Looking after your health after menopause
Lower oestrogen affects more than symptoms. It also affects your bones and your heart.
Your bones. The NHS says women lose bone quickly in the first few years after the menopause. Osteoporosis usually causes no pain until a bone breaks, so it's easy to miss. To keep your bones strong:
- do regular weight-bearing and strength exercise, such as walking and resistance work
- eat a healthy diet with enough calcium and vitamin D
- stop smoking, and cut down on alcohol
Your heart. After the menopause, rates of heart disease in women rise and eventually catch up with men's, Women's Health Concern says. In England, if you're 40 to 74 and don't already have a heart condition, you can have a free NHS Health Check every 5 years. It looks at things like your cholesterol and gives you a score for your risk of heart disease and stroke.
Women's Health Concern also suggests aiming for 150 minutes of exercise a week, eating a balanced diet low in saturated fat and salt, and keeping alcohol under 14 units a week.
For a full list of what can happen before and after the menopause, see our guide to perimenopause symptoms. And if you'd like to know more about how long it all lasts, read how long does menopause last.
Where relaxation fits in
Hot flushes and poor sleep are two of the symptoms most likely to carry on after menopause. Some women like to have something calming ready for the moment the heat starts to rise. Our recording hypnosis for menopause hot flushes, Cool and Calm, is just under half an hour of deep relaxation and cooling imagery, with a simple technique to practise when you feel the heat begin. It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.
If you'd like to try our style first, our free Ten-Minute Calm Reset is a good place to start.
This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
