If a woman does not want to become pregnant, she should continue using contraception until she has had:
- one year without a natural period if older than 50 years
- two years without a natural period if younger than 50 years.
For more information please visit our webpage ‘Contraception’.
It is important to note that bleeding after menopause is not normal and should be investigated. Postmenopausal bleeding is bleeding that occurs more than 12 months after your final period (the menopause). It can be bleeding like a period, spotting or staining.
The reason it is important to see your doctor about this abnormal bleeding is it that uterine or endometrial cancer must be excluded. These are the most serious but infrequent causes of this bleeding. In most women, the cause will be due to a very thin endometrial or uterine lining, but there can also be other causes, such as an endometrial polyp inside the uterus. See your doctor for further investigations.
Investigations your doctor might perform are:
- cervical screening
- vaginal or internal ultrasound.
You might also be referred to a gynaecologist for a biopsy or curettage, depending on the results of your other tests. Management of postmenopausal bleeding will depend on the cause of the bleeding.
Cervical screening (previously known as Pap smear)
After reaching menopause, you still need to have a cervical screening test every five years until the age of 74 years. This can be done at a visit to your doctor, and reminders are usually every five years. The test is only done every five years if your results are normal, otherwise you will need them more often.
You should get to know the normal look and feel of your own breasts, as this will help you notice if any changes occur. You should check your breasts while showering, dressing or looking in the mirror. Look for changes in the breast, nipple or the skin, such as a rash or dimpling, a lump, discharge or pain. If you find any of these changes, see your doctor.
If you are 50 years or older and have no breast changes, you should have a breast screen, or mammogram, every two years. A mammogram is the best way to detect breast cancer early and can detect changes you or your doctor cannot see. Contact BreastScreen Australia for information.
Before menopause, women have a lower risk of heart disease than men, but as women age and their oestrogen levels fall after menopause, their risk of cardiovascular disease increases.
Blood pressure can increase after menopuase, as can total cholesterol and LDL, or ‘bad cholesterol’. There can also be a decrease in HDL, or ‘good cholesterol’. Other blood fats such as triglycerides can also increase.
It is very important to try and to reduce the risk of cardiovascular disease, especially at this time of your life, with a healthy lifestyle that includes:
- a healthy and nutritious diet
- regular exercise for fitness
- maintaining a healthy weight
- not smoking
- minimising alcohol
Lifestyle changes might not be enough for some women with a higher risk of cardiovascular disease, so medication for high blood pressure and/or cholesterol may be required.
Bone health & osteoporosis
It is more common for women after menopause to develop osteoporosis than men. This is because of the low levels of oestrogen in a woman’s body after menopause, which affects her bone health. Most bone loss occurs in the first three years after menopause, and then the rate of bone loss slows. Osteoporosis is a condition in which a loss of bone mass and strength makes bones more fragile, which can lead to fractures in the bones.
Smoking, lack of exercise, alcohol and high caffeine intake (5-6 cups of coffee or caffeinated soft drinks per day) can increase the risk of osteoporosis.
Healthy eating that includes an adequate calcium intake is important for bone health. Your diet should include foods containing calcium such as dairy, canned fish with bones (eg, sardines), almonds, tofu, leafy green vegetables, and legumes such as chickpeas or kidney beans.
It is important for women to have bone health checks as part of their health screening. This may include the taking of a medical history, an examination checking risk factors for osteoporosis, and possibly bone density testing, but this is rebatable only for women with particular risk factors – such as a history of thyroid disease, or use of oral steroids (eg, prednisolone) – or those over 70 years of age.
Weight gain or redistribution
Many women experience changes to their weight during the perimenopause and after the menopause.
The main causes of weight gain at this time are likely to be:
- decreasing activity levels
- less muscle mass and slowing metabolism
- choosing cheaper, calorie-dense and processed foods instead of healthier food
- imbalance between the number of calories being eaten and energy being used.
Menopause doesn’t cause women to gain weight, but it can cause body fat to shift from the hips to the abdomen due to the decrease in oestrogen levels. Weight gain around the stomach is not healthy. It can increase blood pressure and blood fat, and can increase the risk of high blood pressure, diabetes, cardiovascular disease, dementia and some cancers. Maintaining a healthy weight and fitness at this time of life is very important to help reduce the risk of chronic disease. Visit our ‘Healthy living’ webpages for more information.
Menopause can result in difficulty controlling the bladder.
This can be caused by the loss of oestrogen, which can lead to a range of changes, including:
- weakness of the pelvic floor muscles
- the bladder being less elastic
- thinning of the urethral and bladder lining, leading to urinary tract infections
- vaginal dryness
- loss of elasticity in the pelvic tissues leading to prolapse
- weight gain.