DEAR MAYO CLINIC: My older sister recently went through menopause and was surprised to learn it could affect more than periods and cause hot flashes. What should women know about these changes to heart, brain and bone health as we get older?

ANSWER: Menopause is a natural transition that marks the end of a woman's reproductive years. It's defined as 12 consecutive months without a menstrual period. However, there are exceptions. Procedures that affect the uterus or certain types of hormonal birth control can stop monthly bleeding, even if menopause has not yet occurred.

While many people associate menopause with hot flashes and changes in periods, it can also influence several aspects of long-term health. These effects can vary from person to person, but they also are a common part of aging.

Hormones

A key reason for these changes is the decline in estrogen and progesterone — hormones that play a role in many systems throughout the body. As levels decrease, these changes don't happen overnight; rather, they develop gradually over time.

Estrogen helps support healthy blood vessels and cholesterol levels. As levels decline during menopause, blood vessels may become less flexible and cholesterol levels may rise, which can lead to plaque buildup in blood vessels. These changes may increase the risk of heart disease after menopause, especially in people who have other risk factors.

Many women notice changes in memory, focus or mood during menopause. Symptoms such as "brain fog," difficulty finding words or forgetfulness are common and can be linked to hormonal changes, sleep disruption and stress.

In most cases, these changes are mild and may come and go. However, symptoms that are persistent, worsening or noticeable to others may need further evaluation. These can include difficulty following conversations, getting lost in familiar places or changes in thinking or behavior.

Bone health is another important consideration. Estrogen helps maintain bone density and strength, and as levels decline, the body loses bone more quickly than it can rebuild it. Over time, this can lead to lower bone density and an increased risk of fractures.

Bone loss often begins around menopause and can continue for several years. Risk factors include older age, a smaller body frame, smoking, inactivity, certain medical conditions and use of some medications. Screening can help identify changes early, since bone loss often occurs without noticeable symptoms.

Menopause can affect daily life in ways that aren't always immediately recognized. Some women experience fatigue, joint aches, weight or skin changes, or shifts in sex drive. There may also be an increased risk of metabolic conditions or urinary tract infections.

Treatment and care

Healthy habits can make a meaningful difference before, during and after menopause. Regular physical activity, including cardiovascular and weight-bearing exercise, and a balanced diet can help support overall health. Prioritizing sleep, avoiding tobacco and limiting alcohol also are important. Small, consistent lifestyle changes can have a lasting effect over time, so it's best to start making them before transitioning to menopause.

Routine checkups are an opportunity to share your symptoms and concerns. Your healthcare team can help guide next steps, including monitoring risk factors and deciding when screenings or treatments are appropriate.

Hormone therapy may help manage symptoms and support bone and heart health. This therapy is most effective when started near the time of menopause and may be appropriate for certain people after discussing the risks and benefits with their healthcare professional.

Nonhormonal options also are available for those who are at risk of hormone-related complications or prefer not taking hormones. Medications and lifestyle approaches are available to address symptoms like hot flashes, vaginal dryness and sleep disturbances.

Menopause is more than a change in menstrual cycles. It's a shift that affects multiple aspects of your health. With education and discussions with a healthcare professional, women can make informed decisions about preventive care and treatment options to support their health during menopause.

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Amy Hagen, C.N.P., Obstetrics & Gynecology, Mayo Clinic Health System, Mankato, Minnesota

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