Menopause symptoms and long-term effects you should not ignore

When we think about menopause, it is easy to reduce it to hot flashes and mood swings. These are the most immediate signs, the ones that are noticed straight away and discussed most often.

However, this transition marks the beginning of significant changes in the body, some of which occur silently but can have a profound impact on long-term health.

In this article, we look at menopause symptoms and long-term effects and what you can do to take care of them consciously.

Menopause symptoms and long-term effects: the two sides of menopause

Hot flashes, mood swings and disturbed sleep are some of the most recognizable signs of the menopausal transition, the ones that often lead women to seek information or support. In most cases, these symptoms tend to ease or disappear over time, once the body settles into its new hormonal balance.

There is, however, another level of change that is less immediate to perceive but just as important: the one involving the bones, heart, metabolism and brain. These changes do not always present with a clear symptom in the short term, but develop over time, which is precisely why they are more easily ignored or underestimated. Learning about them is not meant to cause alarm, but to help you understand where to focus your attention today for your future wellbeing.

If you would like to learn more: Guide to all menopause symptoms

Estrogen and menopause: the long-term risks

It is impossible to talk about the long-term effects of menopause without talking about estrogen. Estrogens are not just “female” hormones but play a fundamental role in numerous physiological processes that go far beyond regulating the menstrual cycle.

They help maintain bones, take part in regulating blood pressure and lipid metabolism, support brain metabolism and keep skin and tissues elastic.

During menopause, their decline leads to a series of changes affecting different systems in the body, some apparent straight away and others developing more slowly over time. Let us look in detail at what happens when estrogen levels decline across different areas of interest.

1. Estrogen and bone health

Estrogens maintain the balance between bone tissue formation and resorption. As their levels decline**, bones can become more fragile and the risk of fractures increases,** especially in the hip, spine and wrist. In most cases, this change does not cause any obvious symptoms, which is why osteoporosis in menopause is described as a silent condition, often discovered only during a diagnostic examination or, unfortunately, following a fracture.

According to scientific literature, some women may lose up to 20% of their bone density in the first 5-7 years after menopause, a period in which bone loss is more rapid. It is no coincidence that the vast majority (80%)of people with osteoporosis are women.

2. Estrogen and cardiovascular health

Before menopause, estrogens have an important protective effect on the cardiovascular system. In particular, they:

• increase “good” cholesterol (HDL), which helps remove excess cholesterol from the arteries;

• help keep “bad” cholesterol (LDL) under control, limiting the build-up of plaque in blood vessels;

• support good arterial elasticity, improving blood circulation and blood pressure regulation;

• have a protective effect against inflammatory processes that, over time, contribute to the hardening of arterial walls.

After menopause, as estrogen levels decline, the risk of cardiovascular diseases such as heart attacks and strokes increases significantly. Postmenopausal women have a risk of cardiovascular disease that is twice as high as before menopause.

For this reason, regularly monitoring blood pressure, cholesterol and other cardiovascular markers becomes a particularly useful habit from the menopausal transition onwards, even when there are no obvious symptoms. We explored this topic in the dedicated article: Heart and menopause

3. Estrogen, muscles and joints

An often underestimated aspect involves muscle and joint pain, which many women begin to notice during the menopausal transition. Estrogens have an anti-inflammatory effect and help keep tendons, ligaments and cartilage elastic. As their levels decline, joints such as the knees, hands and shoulders can become stiffer and more painful, and widespread muscle discomfort is not uncommon, particularly in the morning.

This is accompanied by another change that is often less visible but equally important: the loss of muscle mass, known as sarcopenia, which accelerates from the menopausal transition onwards. Estrogens help maintain muscle mass and strength, and their decline makes it easier to lose muscle tissue over time. This does not only change the shape of the body but also affects metabolism, making it easier to accumulate fat.

These symptoms are often attributed solely to the natural ageing process, without considering the specific role of hormonal change.

4. Estrogen and the brain

Estrogens play a supporting role in the brain because they contribute to brain metabolism and memory. It is therefore not surprising that many women experience a sense of mental cloudiness, difficulty concentrating or small memory lapses during the menopausal transition, a phenomenon we explored in the article dedicated to brain fog in menopause.

In most cases, these symptoms are temporary. Over the long term, however, some studies observe a possible increase in the risk of cognitive decline linked to prolonged hormonal decline. When estrogen levels fall, the brain is forced to “function with less fuel”, increasing the risk of cognitive decline and affecting memory, concentration and the prevention of neurodegenerative diseases such as Alzheimer’s. It is no coincidence that two thirds of patients with Alzheimer’s are women.

In addition, the decline in estrogen can affect the production of serotonin, one of the neurotransmitters involved in regulating mood, contributing to emotional swings, irritability or moments of greater vulnerability, especially in women with a previous history of mood disorders.

In most cases, these are fluctuations that ease over time, but when they persist or become more intense, speaking with a specialist may be helpful

5. Estrogen and skin

The skin is also a tissue that is sensitive to estrogen, often more than people realize. Estrogen receptors are present in different layers of the skin, where these hormones help stimulate the production of collagen and elastin, maintain the skin’s natural hydration and support its ability to regenerate.

During menopause, as hormone levels decline, this balance changes: collagen production decreases significantly, especially in the first years after the final period, and the skin gradually loses thickness, tone and elasticity. The result is skin that is thinner, drier and more prone to wrinkles, but also more fragile and slower to heal after minor injuries. Hair and nails can also be affected, becoming more fragile or thinner.

This is a visible change, but one that is often dismissed as “only cosmetic”. Taking care of it does not mean pursuing an aesthetic ideal, but giving the right attention to skin in menopause.

6. Estrogen and genital health

Estrogens help keep vaginal tissue hydrated and elastic. As their levels decline, many women experience vaginal dryness, irritation and discomfort during sex, conditions that can significantly affect quality of life and intimacy. Unlike other symptoms of the menopausal transition, which tend to ease over time, these symptoms can persist or even worsen if they are not addressed, precisely because they are linked to a hormonal deficiency that does not resolve spontaneously.

If you have noticed changes and would like to explore them further, you can book an appointment with a Pausetiv gynecologist specializing in menopause.

6. Estrogen and metabolism

Finally, estrogens help regulate metabolism and the distribution of body fat. During menopause, fat tends to become more concentrated around the abdomen, a visible change that we explored in the article on menopause belly and bloating. Until menopause, these hormones promote fat storage mainly around the hips and thighs, a pattern that also provides relative metabolic protection.

During menopause, as hormone levels decline, this balance changes. Fat tends to be redistributed towards the abdominal area, even when overall body weight remains the same. This is often accompanied by a slowing of the basal metabolic rate, also linked to the natural loss of muscle mass that characterizes this phase and makes the body less efficient at burning energy at rest.

Over the long term, this redistribution of fat is not only a cosmetic issue but is associated with an altered metabolic profile, with a possible increase in insulin resistance and the likelihood of developing conditions such as diabetes. Here too, the change happens gradually and often silently, without obvious symptoms to signal how it is progressing over time.

How can you address the risks of the long-term effects of menopause?

Menopause is a time of change, but it can also be an opportunity to adopt habits that improve quality of life and support long-term health.

Here is what you can work on:

• Hormone replacement therapy (HRT): HRT may be a valid option for many women and can help slow the loss of bone density, support cardiovascular health and reduce some risks linked to cognitive decline. However, it is not suitable for everyone and must always be prescribed by a specialist doctor after a personalized assessment.

• .Targeted nutrition: a balanced diet can make a tangible difference. Foods rich in calcium and vitamin D support bone health; quality fats such as olive oil and avocado support the heart and brain; and a good amount of fibre helps metabolism. Flax seeds, soy and legumes, which are rich in phytoestrogens, can contribute to greater hormonal balance, while reducing sugar and alcohol remains one of the most useful habits during this phase.

• Physical activity: exercise is not just about fitness: it supports cardiovascular health, keeps bones strong and can help protect cognitive functions over time. The most effective combination brings together:

  • resistance exercises, such as weightlifting, to strengthen bones and muscles;

  • aerobic activity, such as walking or swimming, for heart health;

  • yoga or Pilates, for balance, flexibility and stress management, which are also useful for stiffer joints.

• Social life and relationships: mental wellbeing is as much a pillar of health during this phase as physical wellbeing. Cultivating social relationships and taking part in groups or shared activities helps reduce stress and can also support cognitive wellbeing over time.

• Sleep and stress management: sleeping well is essential for regenerating the body and mind. If hot flashes disturb sleep, relaxation techniques such as meditation or deep breathing can be helpful. Reducing daily stress through practices such as mindfulness or spending time outdoors helps stabilize mood and support cardiovascular health.

Recommended reading to learn more about menopause symptoms

If you would like to explore these topics further, here are some books and resources that may be useful:

1. Lisa Mosconi, The Menopause Brain: a neuroscientist’s exploration of the link between hormonal decline and brain function

2. Avrum Bluming, Carol Tavris, Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives: a book that presents a critical reading of the risks and benefits of hormone replacement therapy; a useful perspective that should always be considered alongside advice from your specialist, since some of its positions are the subject of debate within the scientific community

3. Harvard Health Publishing, Heart Disease in Women: an educational resource on the link between menopause and cardiovascular health

4. Mayo Clinic*, Osteoporosis Prevention*: an in-depth look at bone health after menopause

PauseTest: a guidance tool for you

We have seen how many of these changes during perimenopause and the menopausal transition happen silently, without a clear symptom that prompts you to stop and ask yourself, “what is happening to my body?”.

This is precisely the most delicate point: it is not that these signs are not there, but that they often go unregistered. Between work, family and the countless things to do every day, it is easy to keep going without paying attention to joint discomfort, a different kind of fatigue than usual or a change in weight

The PauseTest was created for precisely this reason. It is a test that analyzes four areas — hormonal health, nutrition, mental health and sleep, physical activity — and it is also useful for those who are already in the transition or went through it some time ago. Answering its questions is a practical way to stop for a moment and observe signs of menopause that might otherwise remain in the background, bringing order to what you feel but do not name.

The result is not a diagnosis, but an overall picture from which to start. It is useful for guiding you towards the most suitable specialist, even when the question is no longer understanding “what stage you are in”, but consciously managing the long-term changes discussed in this article, from bone and cardiovascular health to metabolism and the cognitive and emotional sphere.

Take the PauseTest

Disclaimer: the information contained in this article is for informational and educational purposes only. It is not a substitute in any way for the advice, diagnosis or recommendations of a doctor or healthcare professional. If you have concerns or symptoms that worry you, always seek advice from a qualified specialist.

Frequently asked questions about the effects of menopause

• Is it true that all women develop osteoarthritis during menopause?

  No, it is not automatic. The decline in estrogen increases the likelihood of inflammation and joint wear, but this does not mean that osteoarthritis will develop in every woman. Factors such as physical activity, body weight and family predisposition can have as much influence as hormonal change. This is why staying active remains one of the most important habits during this phase.

• Why can muscle pain appear during menopause even without physical exertion?

  Because the decline in estrogen reduces the body’s natural anti-inflammatory action and accelerates the loss of muscle mass. This can lead to a feeling of widespread soreness, especially upon waking, even without having exercised the day before. This is one of the reasons why these aches and pains are often mistaken for a simple sign of ageing, when they actually have a specific hormonal cause.

• Why are menopause symptoms not the same for all women?

  Because the decline in estrogen interacts with individual factors such as genetics, lifestyle, medical history, and even the way the body has already responded to other hormonal changes in life, such as pregnancy. This is why two women of the same age can experience the menopausal transition very differently, both in the intensity of visible symptoms and in the long-term risks that deserve close attention. It is precisely because of this variability that a tool such as the PauseTest can be helpful: it helps you understand your specific situation and guides you towards a pathway to regain your balance during this delicate phase.