Menopause: what changes after your last period

Menopause is the point when you have had no periods for twelve months in a row. Everything after that is postmenopause. Oestrogen is now steadily low, and the body adjusts to this new reality. Some changes are felt straight away; others are "silent" and only show up years later. It is worth knowing about the second kind in advance: the first years after menopause are exactly when you can do the most for the decades ahead.

What you feel

When oestrogen is low, a recognisable picture forms: hot flashes, night sweats, broken sleep, dryness and discomfort during intimacy, aching joints and muscles, "brain fog". This is one story, not a set of separate problems, and it is best tackled as a whole.

A separate word about dryness and discomfort during intimacy. It is a very common change — in half of women or more — yet it is rarely talked about. Unlike hot flashes, it does not go away on its own and tends to get worse over time. The good news is that it responds well to help: a regular moisturiser, a lubricant for intimacy, pelvic floor exercises — and a conversation with your doctor. There is no need to put up with it.

What you don't feel, but matters

Heart and blood vessels. Before menopause, women's risk of heart disease is roughly half that of men; as oestrogen falls, the gap closes quickly. The sharpest acceleration happens in the year or two around the last period: "bad" cholesterol rises, and blood vessels become stiffer. This is not a verdict but a window for prevention.

Bones. Bone is lost fastest from about a year before the last period to two years after — up to 2% a year in the spine. There are no symptoms until a fracture. If you had early menopause before 45, a fracture from a minor injury, long-term steroid use, or a parent with a hip fracture — it is worth discussing a bone density scan with your doctor now, without waiting until 65.

Muscles and metabolism. Fat shifts towards the belly, the body handles sugar less well, and muscle responds less to protein and exercise. Sugar cravings, "fog" and a changing figure are one chain.

What to do

Strength training twice a week. This is a lever for everything at once: hot flashes, mood, bones, muscles and metabolism. The basics are squats, pulls and presses, without pain.

Protein at every meal, starting with breakfast. After 40, muscle needs more protein than before, and breakfast is usually where there is least.

A walk after meals. 10–15 minutes after eating helps the body cope with sugar.

A Mediterranean way of eating. Olive oil, fish, nuts, vegetables and fibre — the best-studied way to support the heart and blood vessels.

Know your numbers. Blood pressure, sugar, cholesterol — and, if possible, ask your doctor for ApoB and Lp(a): they show the risk to blood vessels more precisely, and Lp(a) only needs to be tested once in a lifetime.

When to see a doctor without delay

Any bleeding after twelve months without periods is always a reason to see a gynaecologist promptly.

What to try this week

• Two strength sessions of 30–40 minutes on different days.
• A source of protein at every meal; start with breakfast.
• 10–15 minutes of walking after your main meal.

This is general information, not a prescription. Tests and treatment are chosen by a doctor.