Detailed definition
Postmenopause, in STRAW+10 terminology, refers to all the years following the final menstrual period. It is divided into early postmenopause (the first ~6 years, when vasomotor symptoms are typically most active and bone loss is fastest) and late postmenopause (years thereafter). In early postmenopause, FSH continues to rise to a plateau around 60–80 mIU/mL, estradiol falls below 20 pg/mL, and inhibin B and AMH become undetectable. Bone mineral density declines at 1–2% per year for the first several years post-FMP. Genitourinary syndrome of menopause develops or worsens. Cardiovascular risk begins to rise toward male levels. The "timing hypothesis" suggests that initiation of HRT during early postmenopause (or within 10 years of the FMP, whichever is later) provides the most favorable risk-benefit profile, while starting HRT in late postmenopause for the first time after age 60 has a less favorable profile.
Why it matters in menopause
Postmenopause is where long-term HRT decisions become consequential. Continuing HRT into the 60s or beyond is increasingly common in evidence-based menopause practice when the symptom and bone benefits clearly outweigh risks for a given woman. The blanket rule of "stop HRT at 60 or after 5 years" is not in current NAMS guidance — it is an outdated artifact of the post-WHI panic.
Related terms
Sources
External references: Wikipedia.