Beyond the cycle. Still understood.

Once you've gone 12 full months without a period, you've reached menopause — and any bleeding after that point is medically abnormal and must be evaluated by a doctor. Most causes are benign (vaginal atrophy, polyps, or HRT side effects), but roughly 10% of postmenopausal bleeding is endometrial cancer, and Stage I has a 5-year survival rate above 90% when caught early.

Women lose up to 20% of their bone density in the first 5–7 years after menopause due to estrogen withdrawal. One in two postmenopausal women will experience an osteoporotic fracture in their lifetime. The good news: bone loss is preventable and treatable with a combination of weight-bearing exercise, adequate calcium and vitamin D, and — when indicated — medications like bisphosphonates or HRT. A DEXA scan establishes your baseline and guides treatment decisions.

Cognitive changes during menopause are real, measurable, and — for most women — temporary. The SWAN study documented declines in verbal memory and processing speed during the menopausal transition that stabilize in postmenopause. However, women carry two-thirds of Alzheimer's diagnoses, and the estrogen withdrawal of menopause is increasingly recognized as a contributing factor. Proactive brain health strategies — including cardiovascular exercise, sleep optimization, social engagement, and managing cardiometabolic risk factors — can meaningfully reduce long-term dementia risk.

The median duration of hot flashes is about 7 years, though some women experience them for a decade or more, and 10–15% still have them into their 70s. The honest answer is that they do generally become milder over time, but they may not disappear entirely — and you absolutely do not have to just endure them, because treatments like HRT, SSRIs, gabapentin, and newer options like fezolinetant can reduce frequency and severity by 45–75%.