The Surprising Health Conditions That Strike After Menopause

When estrogen production decreases, the hormone’s protective benefits do too.

Medically reviewed in July 2022

Hot flashes, irregular periods, sleep disturbances, mood changes—these symptoms can combine to make menopause an uncomfortable experience. But once it’s over, it’s over, right? Not exactly. Some of the symptoms may be gone, but after menopause, the protective effects of estrogen, the primary female sex hormone, drop off, putting women at risk for a variety of conditions.

Estrogen and menopause
Estrogen is mostly produced in the ovaries, but other places in the body create small amounts, as well. It affects many other systems of the body besides the reproductive system, such as the circulatory system, the urinary tract, the musculoskeletal system, mucus membranes and the brain.

During the menstrual cycle, estrogen increases, thickening the lining of uterus, and an egg, produced by the ovaries, matures. During months where the egg does not meet sperm (and thus, result in a pregnancy), the uterine lining and the egg are expelled. A woman is born with a finite number of eggs, and as the eggs run out and hormone levels decline, the woman enters menopause and stops having periods.

Once menopause hits, on average, around age 51, the ovaries stop producing estrogen and another female hormone called progesterone.

The negative effects of estrogen decline
Estrogen not only helps to keep a woman fertile, but it also has a number of protective effects that women largely lose when they hit menopause. Here are some of the ways a menopause-related estrogen decline can have a negative effect on your health:

Greater risk of heart issues: “Before menopause, estrogen protects the heart,” says Sudha Purohit, MD, an internal medicine doctor with Saint Joseph Mercy Health System in Ann Arbor, Michigan.

Estrogen is believed to help keep the walls of the arteries flexible, and when the hormone production decreases, it leaves women prone to stiffening of the arteries. After menopause—but not necessarily due to the decrease in estrogen—heart disease risk factors like blood pressure and cholesterol increase. Other factors, like obesity and smoking, contribute to the risk.

A January 2017 study published in the Journal of the American Heart Association suggests that estrogen also helps keep a certain type of fat, known as paracardial fat, off the heart. An increase in paracardial fat is often seen post-menopause and raises the risk of heart disease.

Increased risk of osteoporosis: Estrogen also protects the bones, so menopause raises the risk for osteoporosis, says Dr. Purohit. One study found that women had lost more than 9 percent of their bone mass in their hip and more than 10 percent in their lower back by 10 years after menopause. “People with early menopause—age 40 or before—are at an even higher risk,” says Purohit.

Painful sex: Sex can be difficult after menopause. “When estrogen levels go down, the vagina can atrophy, and sex becomes more painful,” says Purohit. Painful sex may lead to a less than desirable sex life, which Purohit says can be a contributor to post-menopause depression. “Sex is a great stress reliever,” she says. “I always advise my patients to lead a normal, healthy sex life.”

What you can do about these side effects of menopause
Menopausal hormone therapy (MHT) is available to women experiencing menopause. The most bothersome symptom for most women is hot flashes and MHT is an effective option. But because of the risks—which can include breast cancer, endometrial cancer and other problems, depending on what form of MHT a patient takes—experts advise women take it for the shortest time possible and at the lowest dose needed.

It’s important to get plenty of exercise and keep the weight off post-menopause, says Purohit. “After menopause, women tend to gain weight,” says Purohit. “One pound per year is not uncommon. To maintain a healthy weight, get enough exercise and practice portion control.”

The Centers for Disease Control and Prevention recommends that most adults get 150 minutes of moderate exercise per week or 75 minutes of vigorous exercise per week. About 20 percent of women become depressed some time during menopause, and exercise can help with that as well. “When people are physically fit, they’re mentally fit as well,” says Purohit.

It's no surprise that menopause is going to bring many changes, but with the proper treatment plan, the side effects can definitely be controlled. You and your OBGYN can discuss what’s best for you, based on a variety of factors, so you can get some relief.

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