You’re Allowed to Mention the Part Nobody Asks About
Body · The Reading Room · 8 min read · Which symptoms fade after the final period, which ones quietly get worse, and the one most women never raise
Based on the published work of Margery L. S. Gass, MD, Executive Director Emerita of The North American Menopause Society, now The Menopause Society, and co-author of the consensus paper that named genitourinary syndrome of menopause. LinkedIn · MDedge author page · the paper on PubMed
You were told it would settle down after. Some of it does. One part of it was never going to.
Three years since the last period. You had, privately, filed the whole thing under finished. The night sweats had thinned out, the moods had steadied, and you had stopped carrying spare tights in your work bag.
Then the second urinary infection in six months. Getting up twice a night to pee. And a change in your sex life you have not mentioned to anyone, including, if we are honest, your husband in so many words.
None of it feels like menopause, because menopause was supposed to be over. So you search for post menopausal symptoms, half expecting to find nothing, and half expecting to find that this is simply what fifty-four looks like.
Neither is right. Informational, not medical advice, and worth taking to your clinician rather than instead of one. This is a reading of published research. We are not clinicians; the findings belong to the researchers and institutions named below, and the plain-English version is ours.
The short answer: after menopause, symptoms split into three groups. Some fade: hot flashes, for many women, though they continued an average of 4.5 years past the final period in the largest American study.¹ Some are silent: bone density falls fastest from about a year before the final period and for around three years after.² And one group tends to get worse: genitourinary syndrome of menopause, the dryness, pain with sex, urinary urgency and repeat infections that affect an estimated 27 to 84 percent of postmenopausal women.³ Unlike hot flashes, it follows a progressive course without treatment,4 and it is very treatable.³
The skim version
- Hot flashes lasted a median of 7.4 years in total in SWAN, about 4.5 of them after the final period.¹
- Bone: fast loss starts about a year before the final period, runs around three years at roughly 2 percent a year, and adds up to about 10 percent over ten years.²
- Genitourinary syndrome of menopause (GSM) affects an estimated 27 to 84 percent of postmenopausal women.³
- Unlike hot flashes, GSM progresses without treatment rather than easing with time.4
- More than half of affected women use no treatment, and about 70 percent never raise it with a clinician.4
- Treatments range from moisturizers and lubricants to low-dose vaginal estrogen, vaginal DHEA and oral ospemifene.³
In this article: The three groups · The one that gets worse · Every symptom, sorted · The silent one · The one move · FAQ
What are post menopausal symptoms, and do they go away?
The answer depends on which symptom, and the difference is not something most women are told.
The symptoms of the transition itself, the erratic cycles and the hormone-driven mood swings, mostly end with it. Hot flashes and night sweats usually taper, but on a longer clock than most people expect. In the Study of Women’s Health Across the Nation, Nancy Avis and colleagues found frequent hot flashes lasted a median of 7.4 years in total and continued an average of 4.5 years after the final period.¹
Other changes do not announce themselves at all, and bone is the main one. And a third group, centered on the vaginal and urinary tissues, behaves in the opposite way from hot flashes: rather than fading, it tends to build.
That is the part worth understanding properly, because it is the part women are most likely to put down to age and leave alone.
What is genitourinary syndrome of menopause?
It is the name, since 2014, for a set of changes that used to be called vulvovaginal atrophy, a term the consensus panel set out to replace.
Margery Gass, a former executive director of The North American Menopause Society, and David Portman wrote the paper from the consensus conference that proposed the new name, held jointly with the International Society for the Study of Women’s Sexual Health.5 The point of the change was to make it clear that this is not only about the vagina. The same falling estrogen affects the vulva, the vagina, the urethra and the bladder, so the syndrome covers dryness, burning and irritation, pain with sex, urinary urgency, pain on urination and repeat urinary infections.³5
The Menopause Society’s 2020 position statement puts the prevalence at roughly 27 to 84 percent of postmenopausal women, with a significant effect on health, sexual function and quality of life.³ The wide range partly reflects how differently studies ask the question, which is itself part of the problem: many women are never asked at all.
The clinical review on the NCBI Bookshelf makes the contrast with hot flashes explicit. Vasomotor symptoms often improve over time; GSM follows a progressive course without appropriate treatment. It also reports that more than half of affected women use no treatment, and that about 70 percent do not discuss it with a clinician, often from embarrassment or the belief that it is simply part of aging.4
What the research found
The statement. “The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society”, Menopause, 2020.
The finding. GSM affects an estimated 27 to 84 percent of postmenopausal women and “remains underdiagnosed and undertreated, leaving many women to suffer silently.” Recommended first for mild symptoms: nonhormone lubricants and long-acting vaginal moisturizers. Prescription options include low-dose vaginal estrogens, vaginal DHEA and oral ospemifene, with systemic hormone therapy where hot flashes are also present.³
The limitation: the statement notes insufficient long-term data on endometrial safety for vaginal estrogen, DHEA and ospemifene, and found insufficient evidence to recommend energy-based treatments such as vaginal laser. The prevalence range is wide, in part because studies define and measure the condition differently.³
If you had quietly filed menopause under finished and this has reopened the file, it can help to see everything that is still changing in one place, rather than one embarrassing symptom at a time. Start here.
The source for this piece
Margery L. S. Gass, MD
Executive Director Emerita of The North American Menopause Society, now The Menopause Society, which she led as executive director. With David Portman, she co-authored the 2014 consensus paper, published jointly with the International Society for the Study of Women’s Sexual Health, that replaced the term vulvovaginal atrophy with genitourinary syndrome of menopause.
What we read: Portman, D. J., and Gass, M. L. S., Journal of Sexual Medicine, 2014,5 alongside The Menopause Society’s 2020 GSM position statement.³
Where to follow her work: MDedge author page · the GSM terminology paper, ISSWSH · PubMed · LinkedIn
Post menopausal symptoms, sorted: what fades, what stays, what grows
| Symptom | What usually happens after menopause | What that means for you |
|---|---|---|
| Hot flashes and night sweats | Usually fade, but on average continue about 4.5 years past the final period¹ | Worth treating rather than waiting out if they disrupt sleep or work |
| Erratic cycles and bleeding | End with the final period | Any bleeding after twelve months without a period needs checking |
| Vaginal dryness, pain with sex | Tend to progress without treatment4 | Treatable; not something to endure |
| Urinary urgency, repeat UTIs | Part of GSM; also tend to persist³4 | Worth naming as possibly menopause-related, not just bad luck |
| Bone loss | Fastest for about three years around the final period, then slower² | Silent; ask about bone health rather than waiting for a symptom |
The top two rows are the ones everyone talks about. The middle two are the ones nobody asks about, and they are the ones that get worse.
Who else has measured this
David J. Portman, MD, is first author, with Margery Gass, of the 2014 consensus paper that introduced the term genitourinary syndrome of menopause.5
the 2014 paper on PubMed · ISSWSH publication page
Stephanie S. Faubion, MD, MBA, Bill and Penny George Director of the Mayo Clinic Center for Women’s Health, spoke for The Menopause Society as its medical director when the 2020 statement was released, saying that despite new treatment options, GSM remains underdiagnosed and undertreated.³
Mayo Clinic biography · Mayo Clinic research profile · book: Mayo Clinic The Menopause Solution · X
Nancy E. Avis, PhD, Professor in the Department of Social Sciences and Health Policy at Wake Forest University School of Medicine, led the SWAN analysis showing hot flashes continue an average of 4.5 years after the final period.¹
Wake Forest profile · Wake Forest news release · PubMed · LinkedIn
The hot flashes get the attention. The part that grows gets the silence.
Which post menopausal change has no symptoms at all?
Bone. It does not hurt, it does not wake you, and it is changing fastest right around the time most women feel they have come out the other side.
The SWAN study’s summary for the public describes a period of fast bone loss that starts about a year before the final period and lasts around three years, with density falling by about 2 percent a year, more in the spine than the hip. Loss continues more slowly after that, adding up to roughly 10 percent over ten years.²
There is nothing to feel. Which is exactly why it belongs on the list of things to ask about, rather than things to wait for.
When this belongs with a doctor
See a clinician promptly for any vaginal bleeding after twelve months without a period, blood in the urine, fever or back pain with a urinary infection, or a new lump or sore in the vulval area. Book an appointment, without embarrassment, for dryness, pain with sex, urgency or repeat infections, since these respond to treatment and tend not to improve on their own.
The sentence to take with you: “Since my periods stopped I have had repeat urinary infections, some urgency, and dryness that makes sex painful. Could this be genitourinary syndrome of menopause, and what are my treatment options? Should we also talk about my bones?”
The one move: say the three words out loud
About seven in ten women with these symptoms never raise them.4 Most of them are not shy people. They are busy people who were never told these symptoms had a name, a cause and a treatment, so they sound like complaints about getting older rather than things a clinician would want to hear.
So the move is small and slightly uncomfortable. At your next appointment, use the name: genitourinary syndrome of menopause. Or its short form, GSM.
Naming it does two things. It tells the clinician you already know this is a recognized medical condition, which changes the tone of the conversation. And it moves the urinary infections, the urgency and the pain from three separate awkward topics into one treatable thing, which is how the research describes them.³5
Common questions
What are the most common post menopausal symptoms?
Continuing hot flashes and night sweats for some women, and the symptoms of genitourinary syndrome of menopause, including vaginal dryness, pain with sex, urinary urgency and repeat infections, which affect an estimated 27 to 84 percent of postmenopausal women.¹³
How long do symptoms last after menopause?
It depends on the symptom. In SWAN, hot flashes continued an average of 4.5 years after the final period.¹ GSM symptoms, by contrast, tend to progress without treatment rather than resolve.4
Why do I keep getting UTIs after menopause?
Repeat urinary infections are part of genitourinary syndrome of menopause, which results from lower estrogen affecting the urethra and bladder as well as the vagina.³5 It is worth raising with a clinician, since treatment options exist.
Does vaginal dryness after menopause go away?
Usually not on its own. Unlike hot flashes, GSM follows a progressive course without appropriate treatment.4 Moisturizers, lubricants and prescription options including low-dose vaginal estrogen can help.³
Do I need to worry about my bones after menopause?
Bone loss is fastest for around three years around the final period, at about 2 percent a year, and continues more slowly afterward.² It has no symptoms, so it is worth asking a clinician about your bone health.
The one move
At your next appointment, name it: genitourinary syndrome of menopause. Then list the dryness, the urgency and the infections as one thing, and ask about your bones while you are there.
If this has reopened a chapter you thought was closed, seeing everything still in motion on one page tends to make it feel smaller. Start here.
You did finish the transition. This is simply the part that nobody put on the list.
Related reading: the bladder changes that do not settle on their own, the bone timetable nobody is shown, and how long each stage of menopause lasts.
On the researchers. Margery Gass and David Portman are cited for the consensus paper that defined genitourinary syndrome of menopause; neither is your clinician. Stephanie Faubion is cited for The Menopause Society’s 2020 statement. Nancy Avis is cited for the SWAN analysis of hot flash duration. The findings describe groups of women and cannot predict any individual’s symptoms.
Sourcing, disclosure and disclaimers
This is not medical advice. Blue Leaf Journal publishes general information for a general readership. Nothing here is a diagnosis, a treatment recommendation, or a substitute for care from a clinician who knows your history. Informational, not medical advice: see your clinician.
We are not clinicians. Blue Leaf Journal is an independent publication and its bylines carry no medical or academic credential. We read published research and translate it. The findings belong to the researchers and institutions named and linked above; the plain-English rendering is ours, and so is any error in it.
No affiliation and no endorsement. Blue Leaf Journal is not affiliated with Margery L. S. Gass, David J. Portman, Stephanie S. Faubion, Nancy E. Avis, The Menopause Society, the International Society for the Study of Women’s Sexual Health, Mayo Clinic, Wake Forest University School of Medicine or the Study of Women’s Health Across the Nation. None of them has reviewed, approved or endorsed this article, and none of them is responsible for it.
No commercial relationship. Nobody named above paid for or was paid for this coverage. There are no affiliate links, no sponsored placements and no product recommendations in this article.
How this was checked. Every figure above was checked against the cited source on 16 September 2026, and each source is linked below. If you find something we have got wrong, write to norawhitfield@blueleafjournal.com and we will correct it and say that we did.
References
1. Avis, N. E., Crawford, S. L., Greendale, G., et al. “Duration of menopausal vasomotor symptoms over the menopause transition.” JAMA Internal Medicine, 2015. PubMed · free full text via PubMed Central
2. Study of Women’s Health Across the Nation, “SWAN Fact Sheet: Bone Health over the Menopause Transition”.
3. “The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society.” Menopause, 2020. PubMed · free full text via ISSWSH · release summary
4. “Genitourinary Syndrome of Menopause.” StatPearls, NCBI Bookshelf, updated 2026. ncbi.nlm.nih.gov
5. Portman, D. J., Gass, M. L. S., and the Vulvovaginal Atrophy Terminology Consensus Conference Panel. “Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society.” Journal of Sexual Medicine, 2014, 11(12):2865–2872. PubMed
Keep reading
Nora Whitfield writes for Blue Leaf Journal, where the working rule is that a mechanism you can name is easier to live with than one you cannot. She reads the limitations section before the conclusion, and passes on what she finds there.
Written by Nora Whitfield for Blue Leaf Journal. Updated: 16 September 2026.
