Menopause does not end when the hot flushes do
· Citizen
Menopause has become a hot topic. Perimenopause even hotter.
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But the conversation seems to go cold once the hot flushes do.
And according to Pretoria-based healthcare practitioner Dr Juanri Jonck, that’s a challenge, because what comes afterwards could last another 30 or 40 years.
Dr Jonck said the very language used around menopause could create the impression that women eventually emerge from it, hormones restored and business as usual.
“I think we need to be careful with the phrase ‘the other side of menopause’, because it suggests that menopause eventually ends. It doesn’t,” she said.
“Your ovaries unfortunately don’t suddenly start producing their previous levels of oestrogen and progesterone again once your periods and hot flushes stop.”
Some of the obvious symptoms may improve, but Dr Jonck said the longer-term impact on bones, the heart, muscles, metabolism, skin and genitourinary health becomes increasingly important.
Postmenopause is not a short epilogue to menopause either. It is the life stage after the final menstrual period and, according to current International Menopause Society recommendations, its later phase stretches across the remainder of a woman’s life.
It lasts a new lifetime
For a woman reaching menopause at midlife, that could mean decades. “Menopause is not something you recover from.
The change in ovarian hormone production is permanent,” Dr Jonck said.
“A woman reaching menopause at around 50 may live for another 30 or 40 years in this hormonal environment, so this should be viewed as an important new stage of preventative health management rather than the finish line.”
Bone health is perhaps one of the best examples of what can get lost when the menopause conversation focuses primarily on symptoms, said Dr Jonck.
“Most people associate osteoporosis and bone loss with hips and spines. But the bones of the face are changing too,” she said.
Declining oestrogen means the protection it previously offered to bone does not simply return when hot flushes disappear.
“Our facial bones change as we age too. In aesthetic practice, we often see the face gradually lose some of its youthful feminine shape,” she said.
“The cheeks become flatter, the lower face can become heavier, jowls appear, and the face can start looking squarer and less defined.”
It is easy to blame ageing skin. But Dr Jonck said there was considerably more happening underneath it.
“This isn’t simply because the skin is sagging. The bone underneath is changing too.”
Facial fat, collagen and muscle are also lost or redistributed, while declining bone health can affect the structures supporting teeth and contribute to periodontal disease and eventually tooth loss.
Bones beneath the skin are changing
Even the familiar tired-looking eyes of ageing are more than skin deep.
Dr Jonck said the bony socket around the eye gradually becomes larger while the cheekbone underneath loses support. That can contribute to deeper hollows, tear troughs, more noticeable bags and a sunken appearance.
“So when a woman says that her face suddenly looks different, there is actually a lot happening underneath the skin.”
Dr Jonck said this made bone health something women should actively manage rather than only think about when osteoporosis becomes a concern.
“This is why women need to think proactively about resistance and weight-bearing exercise, adequate protein, calcium and vitamin D, avoiding smoking, dental health and appropriate bone-density screening,” she said.
Hormone therapy also prevents bone loss and fractures while it is being used, she added.