Menopause is the term used to describe the permanent end of menstruation, the inability of a woman to become pregnant, and the absence of menstruation for at least a year in a row. The diagnosis is made retro-actively following a menstrual period-free interval of 12 months. The majority of women experience meno-pause between the ages of 49 and 52, with 51 being the mean age for women (Soma Thakur, 2018). Meno-pause that commences before age 40 is referred to as premature menopause. The phrase Post menopause is used to denote the period of time following meno-pause. When women reach post menopause, the monthly cycle seems to have been absent for more than a year. The reproductive years are over at this point in the course of women life, as women are no longer ovulating. The menopausal symptoms pre-viously felt could get better or go entirely. A decade or over following menopause, some women, however, continue to have menopausal symptoms. Postmeno-pausal women live at this period for one-third of their lives. The loss of ovarian follicles, which are the main source of estrogen, signifies primary ovarian failure. The bulk of symptoms are brought on by a lack of estrogen (Ezeiruaku and Onitsha, 2022). 

However, it is challenging to distinguish it from other ageing-related symptoms (Soma Thakur, 2018). Vaso-motor disorders, urogenital atrophy, osteoporosis, cardiovascular disorder, cancer, mental ailments, cog-nitive impairment, and sexual issues are the top health concerns for menopausal women. For better patient care and health consequences for elder female patients, it is critical to comprehend the related risk factors, clinical manifestation, and therapy of typical meno-pausal symptoms. The term "postmenopausal syn-drome" refers to the four primary symptoms-hot flashes, sleep disturbances, genitourinary ailments / sexual problems, and mood changes-that are most frequently experienced by the menopausal women (Santoro, 2015). Premature/early menopause is linked to a greater chance of type 2 diabetes, cardiovascular disease, all-cause mortality, poorer cognitive function, osteoporosis, and fractures, according to a number of studies. On the other hand, endometrial and breast cancer risk are greater in late menopause (Meng Wang, 2021). Determining the elements that contribute to age at natural menopause may therefore provide insight into the causes, early detection, and potential pre-vention of these pertinent diseases in later life. The age at menopause varies significantly among and within populations. Menopause is brought on by a low thres-hold number of predefined follicles in the ovary, according to prior research; however, it is still unclear what influences the rate at which follicles deplete and how this affects the time when menopause begins. With the exception of the genetic influences for age at natural menopause variation, the other determinants which influences are reproductive and lifestyle factors (Meng Wang, 2021). The menopause has got three stages, which are perimenopause, menopause and post menopause.  Perimenopause is the period preceding menopause; menopause is the period that follows; and postmenopause is the final stage. Menstrual cycles become inconsistent and unpredictable throughout this time as hormonal changes begin to decline. Post-menopausal women are more susceptible to heart disease and osteoporosis than premenopausal women (NHS, 2021).

Predisposing factors the lower percentage of the circulating estrogen is the main cause of post-menopausal symptoms. The complicated changes that take place around menopause include hot flashes, vulvovaginal atrophy, and sexual dysfunction. There is a diminution in ovarian follicles, particularly the granulosa cells, at the level of the ovary. As a con-sequence, the ovary is unable to react to the hormones released by the pituitary. Due to a lack of feedback inhibition, the levels of luteinizing and follicle-stimulating hormones (FSH and LH) rise, and the production of ovarian estrogen, progesterone, and inhibin stops (Freeman, 2007). Nonetheless, the remaining adrenal gland and the ovarian theca cells continue to produce androgen, which is later converted to estrogen through peripheral aromatization (Kligman, 2010).  

According to cytological investigations, 90% of women are hypoestrogenic, and just 10% of them possess an estrogenic smear. The trigone of the bladder wall, the vaginal and urethral walls, as well as the pelvic muscles, all have estrogen receptors. Hence, the absence of estrogen stimulation results in atrophic alterations to the bladder and urethra in addition to the vagina. The depletion of lactobacilli and accom-panying drop in glycogen content cause the vaginal acidity to lose its protective natural barrier against infections (Soma Thakur, 2018). A propensity to a range of genitourinary problems and recurring infections, particularly those caused by low virulence organisms, are clinical consequences of these alter-ations. Enhoming et al. have shown that Proteus mirabilis would be competent to develop and move about in mid cycle cervical mucus. The genitourinary tracts mucosal immune system is under the hormonal modulation of the genitourinary tract, as demonstrated by a dip in estrogen levels during the mid cycle that facilitated the proliferation of the organisms (Soma Thakur, 2018).

Hot Flashes 

The causes of hot flashes are several. The thermo-regulatory system is speculated to reset and narrow as a consequence of changes in or inadequate estrogen production. Alterations in estrogen and FSH levels have also been associated to hot flashes. It can possibly be connected to the 5-hydroxytryptamine receptors (5-HT2A) up-regulation in the hypothalamus as a result of the decreased serotonin level. It is believed that lower estrogen levels are accountable for the drop (Kligman, 2010).  Hot flashes cause women to fail to attend work, interfere with daily tasks, and have trouble sleeping (Schiff, 1979). During the menopausal transformation, many women report having trouble focusing and being more vulnerable emotionally. Thyroid function tests should be done if there are any concerns because the prevalence of thyroid disease rises as women age. Therefore, if the symptoms are unusual or resistant to treatment, thyroid function tests should be carried out (Pronob K Dalal, 2015).

Weight gain 

Weight gain can happen to certain women before, during, or after menopause. During the menopausal progression, the follicular ovarian pool is continuously depleted, resulting in a decrease in estrogen production and a corresponding rise in androgen levels. By con-trolling lust and the satiety signals, this hormone imbalance changes energy homeostasis (Mauvais-Jarvis, 2013). Estrogen stops hunger signals from acting, reducing instances of excessive calorie eating. It is hypothesized that estrogens ability to regulate hunger hormones is diminished throughout the meno-pausal transition as a result of changing estrogen levels (Kozakowski, 2017). Women passing through meno-pause have stronger hunger cues, which encourage them to eat more and acquire weight. The increased deposition of belly fat is also encouraged by the hormonal imbalance that occurs during menopause. As a result of high androgen levels and low estrogen levels, the fat in the gluteal and femoral regions to abdominal regions of the body, that favors abdominal obesity (Lumsden, 2015).  Additionally, a higher level of abdominal obesity is a risk factor in and of itself for future metabolic issues (Lizcano, 2014). Hormonal dysregulation and its impact on energy balance are the main causes of menopausal obesity. These womens individual weight growth trajectories may differ due to a number of important factors, including bad eating habits, a sedentary lifestyle, and secondary reasons (hypothyroidism, cushing syndrome, and medication). Because of the hormonal diversity that occurs during menopause, the body may retain more fat and burn calories less effectively. The best technique to boost the bodys capacity to burn calories is through activity and exercise. Stress management can be beneficial. Excess weight gain can be prevented through exercise, stress management, limiting caffeine and alcohol intake, quitting smoking, and eating a balanced diet. However, it is crucial to make clear that the womens weight gain isnt due to something else, like an underactive thyroid, especially if the problem runs in the family.

Sexual Dysfunction 

Sexual dysfunction can result in diminished arousal or the inability to elicit an orgasm during sexual inter-course, as well as decreased interest or willingness to commence activities. Sexual dysfunction frequently has multiple contributing factors, which consists of psychological issues like depression or anxiety dis-orders, marital conflict, problems stemming from past physical or sexual abuse, drug use, or bodily issues that make sex uncomfortable, like endometriosis or atrophic vaginitis (Pronob K Dalal, 2015). After meno-pause, female sexual dysfunction is a complex issue with numerous etiologies. To maximize therapy, a thorough assessment of physiological, psychological, lifestyle, and relational factors is needed. Sexual function may be improved by anxiety and depression treatment, antidepressant drug adjustment, and rela-tionship counseling. Many women and couples who experience sexual dysfunction benefit from specific exercises and activities that are frequently carried out with sex therapist supervision. Dyspareunia is effectively reduced when genitourinary atrophy is treated specifically with vaginal lubricants, systemic vaginal estrogen therapy, or both. In a significant randomized, double-blind, placebo-controlled investi-gation of women with erectile dysfunction, the utilization of sildenafil citrate the proved ineffective (Basson, 2002). When menopausal women have low testosterone levels and no other known causes of their sexual dysfunction, androgen therapy may be an option for treatment (Bachmann, 2002). Patients who have a high risk of breast cancer, endometrial hyperplasia or cancer, cardiovascular illness, or hepatic disease should use androgen with caution. It may result in hirsutism and lower HDL levels. Since the body converts testosterone to estrogen, problems from estrogen therapy must be closely monitored. It also requires routine monitoring of the livers function and cholesterol levels (Jayasena, 2019).

Urinary incontinence and Urinary tract infections 

Menopausal women suffer sudden, strong desires to urinate, followed by an involuntary loss of urine, including the loss of urine when coughing, laughing, or raising. The tissues of the vagina & urethra also become less elastic. Urinary tract infections may also arise more frequently as a result of this. Pelvic floor exercises can help with incontinence problems. Dia-betes patients are more likely to develop asymp-tomatic bacteriuria, UTIs, & pyelonephritis (Kent, 2004).

Osteoporosis 

Since estrogen plays a significant role in hormone metabolism and affects certain bone cells called osteoclasts, osteoblasts, and osteocytes, women follo-wing menopause are more likely to develop weak bones that may break more easily. After menopause, women may lose up to 25% of their bone mass (or 1% to 2% annually). The possibility of osteoporosis and bone fractures rises when too much bone is lost. The most frequently affected bones are those of the hip, wrist, and spine. Hormone replacement therapy, consistent exercise, & calcium or vitamin D supple-ments can all help with this (Meng-Xia Ji, 2015).

Cardiovascular disease 

Compared to premenopausal women of roughly the same age, postmenopausal women appear to be more susceptible to cardiovascular disorders. The reduction in estrogen, particularly 17-oestradiol, is the most significant hormonal alteration that occurs after menopause. Heart disease, heart attack, and stroke are only a few of the cardiovascular disorders that estrogen helps to defend against (Miriam, 1999). The shift in cardiovascular determinants and the risk of cardio-vascular morbidity are thought to be caused by this hormone. Regardless of the subjects age, it has been linked to a 2-20% increase in total serum cholesterol through a reduction in HDL cholesterol levels and a rise in LDL cholesterol, as well as a 2–35% increase in triglycerides and the high blood pressure (Sindhu Prabakaran, 2021). As per the studies, the hormone replacement treatment reduced the amount of athero-sclerosis in human coronary arteries (Miriam, 1999). Diet, quitting smoking, and regular exercise are the main contenders for the preventing heart disease. Lowering the risk could also be accomplished by managing cholesterol levels, diabetes, and an increase in blood pressure (Sindhu Prabakaran, 2021). Cardio-vascular disease Compared to premenopausal women of roughly the same age, postmenopausal women appear to be more susceptible to the cardiovascular disorders. The reduction in estrogen, particularly 17-oestradiol, is the most significant hormonal alteration that occurs after menopause. Heart disease, heart attack, and stroke are only a few of the cardiovascular disorders that estrogen helps to the defend against (Miriam, 1999). The shift in cardiovascular deter-minants and the risk of cardiovascular morbidity are thought to be caused by this hormone. Regardless of the subjects age, it has been linked to a 2-20% increase in total serum cholesterol through a reduction in HDL cholesterol levels and a rise in the LDL cholesterol, as well as a 2–35% increase in trigly-cerides and high blood pressure (Sindhu Prabakaran, 2021). 

As per the studies, hormone replacement treatment reduced the amount of atherosclerosis in human coronary arteries (Miriam, 1999). Diet, quitting smoking, and regular exercise are the main contenders for preventing heart disease. Lowering the risk could also be accomplished by managing cholesterol levels, diabetes, and an increase in blood pressure (Sindhu Prabakaran, 2021).

Vulvovaginal Atrophy 

Reduced estrogen levels could leads the tissues in the vagina to become thin and degenerate, making it to dry and cause atrophy, itching, burning, discharge, shortening of the vagina, uterine prolapse, & dyspar-eunia (Iuliia Naumova, 2018). Urogenital tissues are extremely sensitive to estrogen. Vaginal dryness can persist in postmenopausal women for long time after their last menstruation. Vaginal lubricants can aid in reducing any discomfort brought on by sex (Iuliia Naumova, 2018). Reduced estrogen levels may also affect the bladder and urine system, and many people experience urinary incontinence. By utilizing lubri-cation, topical lotions, or laser therapy, recurring dryness and painful intercourse can be prevented (Acog, 2021).

Mental health issues 

Post-menopausal women frequently feel irritability, anxiety, and depression (Gita D. Mishra, 2003). Sexual tension, stress, or other difficulties in life that arise at this time could be the cause of this. Some people find it upsetting that they are past the reproductive years. Reduced hormone levels might also result in mood symptoms (Masakazu Terauchi, 2012).

Vaginal bleeding 

Its not a typical after effect of declining hormone levels to experience modest, self-controlled vaginal bleeding which occurs during post menopause. Your vagina may occasionally get dry, which could result in some minor bleeding or spotting after intercourse. In other instances, it might be an indication of malignancy, an infection like endometritis, a disease like endometrial hyperplasia or uterine fibroids, or both (Shaikh Zinnat Ara, 2021).

A Plenty of postmenopausal womens health issues due to the population of postmenopausal women growing along with life expectancy. Thus the, postmenopausal health should indeed be given the attention it deserves in the present circumstances. It is important to make an effort to dispel the worries and fears of the ladies who are less informed of the numerous symptoms. The onset of symptoms in conjunction to menopause varies. While some women go through perimenopause with earlier symptoms, others go through it with later symptoms. Debatable is the timing of the initiation of treatment. It has been challenging to discern between symptoms brought on by ovarian function decline and those brought on by ageing or the strains of midlife society. Hormone replacement therapy is supposed to help symptoms brought on by ovarian function loss go away, however this hasnt been observed. 

In this area, more study is necessary. The onset of symptoms in regards to menopause varies. While some women go through perimenopause with the earlier symptoms, others go through it with later symptoms.

There is no conflict of interest.

I would like to express my sincere gratitude to Professors Shashidhar Kotian and (Dr.) Sukesh for their knowledge and assistance in all areas of our study as well as for their assistance in writing the manu-script. I also want to express my gratitude to Dr. Shalini Kuruvila and Professor Bibin Scaria for their tremendous assistance in reviewing and providing insightful feedback to ensure that the manuscript was properly edited.