By Dr. Sunny Ramchandani, President, Flagship Medical Group

As women transition into their mid-60s and beyond, hormonal health continues to play a pivotal role in overall well-being. While menopause marks a significant shift in hormonal balance, the postmenopausal years bring their own set of changes and challenges that deserve attention.

As women age, their bodies continue to change—often in ways that are less talked about. These changes can influence everything from bone health and memory to sleep, mood, and weight. At Flagship Health, we take a holistic approach to senior care, recognizing that physical, emotional, and lifestyle factors are deeply connected.

This guide covers what women need to know after menopause: how hormonal changes can affect health, the most common symptoms to watch for, when to talk to your doctor, and lifestyle habits that can help you feel your best for years to come.

The Postmenopausal Hormonal Landscape

Menopause—defined as 12 consecutive months without a menstrual period—typically occurs between ages 45 and 55. By their mid-60s, most women are well into the postmenopausal stage, when estrogen and progesterone levels stay consistently low. While this marks the end of fertility, hormonal influence continues. The endocrine system still affects bone density, heart function, cognitive health, skin elasticity, mood, and fat distribution.

In addition to estrogen and progesterone, hormones like testosterone, cortisol, insulin, and thyroid hormones also shift with age. These changes can influence how women feel and function each day. About 90% of women over 70 develop thyroid nodules—many of which can contribute to hormonal imbalances. Insulin resistance also becomes more common after menopause, raising the risk of type 2 diabetes.

Declining estrogen also impacts bone health. According to the CDC, nearly 27% of women over 65 have osteoporosis, increasing fracture risk. These hormonal shifts often build over time, contributing to fatigue, weight gain, memory changes, and reduced mobility. That’s why regular checkups and healthy habits are especially important in this stage of life.

Common Hormonal Changes in Women Aged 65+

Understanding the most common hormonal shifts can help women recognize symptoms early, seek care when needed, and take steps to protect their long-term health. These changes don’t all happen at once—different hormones affect different systems and can show up in a variety of ways.

1. Estrogen and Progesterone

Postmenopausal women experience persistently low levels of estrogen and progesterone, which may lead to:

  • Bone health concerns: Increased risk of osteoporosis and fractures.
  • Genitourinary issues: Vaginal dryness, discomfort, and increased susceptibility to urinary tract infections.
  • Skin and hair changes: Reduced collagen production causing skin thinning and hair loss.
  • Persistent vasomotor symptoms: Some women continue to experience hot flashes and night sweats.

Treatments vary depending on which symptoms you’re experiencing. Hormone therapy may be one option, along with other medical or lifestyle approaches. If you’re noticing changes that affect your comfort, energy, or quality of life, consult with your healthcare provider to discuss what treatments may be right for you.

2. Testosterone

Although it’s often thought of as a male hormone, testosterone also plays an important role in women’s health—especially in maintaining energy, strength, and sexual function. In older women, testosterone levels gradually decline with age, which may lead to:

  • Reduced interest in sexual activity
  • Fatigue or lower energy
  • Loss of muscle mass and strength

Testosterone replacement therapy may be considered for some women, but it’s not appropriate for everyone. If you’re noticing symptoms that affect your strength, energy, or sexual health, consult with your healthcare provider to determine if treatment is right for you.

3. Thyroid Hormones

Aging can affect how well the thyroid functions, and women are more likely than men to experience thyroid disorders in later life. These hormonal imbalances can impact metabolism, mood, and overall energy which may lead to:

  • Hyperthyroidism: An overactive thyroid that can cause anxiety, heart palpitations, trouble sleeping, sensitivity to heat, and unintentional weight loss
  • Hypothyroidism: An underactive thyroid that may lead to fatigue, weight gain, cold intolerance, constipation, and slowed thinking

Regular screening is advised to catch problems early. Treatment options may include daily medication to restore hormone balance and relieve symptoms.

4. Insulin and Glucose Regulation

Insulin resistance tends to increase with age, particularly in postmenopausal women. When this occurs, the body becomes less efficient at managing blood sugar, which can raise the risk of:

Lifestyle modifications and medications can improve insulin sensitivity and help prevent complications. Treatment often includes a combination of dietary changes, regular physical activity, weight management, and, when necessary, glucose-lowering medications.

5. Cortisol and Stress Hormones

Chronic low-level stress is common in older adults, often stemming from factors like social isolation, caregiving responsibilities, or ongoing health concerns. This can lead to elevated cortisol levels, which may result in:

  • Disrupted sleep
  • Increased abdominal fat
  • Weakened immune function
  • Memory and concentration difficulties

Lifestyle strategies such as meditation, counseling, exercise, and structured routines can help regulate cortisol and support overall well-being.

How Hormonal Changes Most Commonly Affect Daily Life

1. Physical Comfort and Mobility

Changes in estrogen and progesterone after menopause can affect how women feel and function throughout the day. These hormonal shifts may interfere with:

  • Mobility and balance: may be affected by weakened bones or joint discomfort—making it harder to walk, climb stairs, or stand for long periods.
  • Sleep quality: may be disrupted by hot flashes and night sweats—leading to fatigue and lower energy during the day.
  • Intimacy and daily comfort: may be affected by vaginal dryness or urinary discomfort—causing distress during activities like sitting, exercising, or using the bathroom.

When these issues go unaddressed, they can subtly erode comfort, routine, and emotional well-being—making proactive care especially important.

2. Strength, Energy, and Sexual Health

As testosterone declines with age, the resulting shifts in sexual interest, energy, and strength can influence how women feel and function day to day:

  • Less desire for intimacy, which may affect connection and communication in relationships
  • Fatigue that makes it harder to keep up with routines, errands, or social plans
  • Reduced physical strength that can impact tasks like carrying groceries, climbing stairs, or staying active

Over time, these changes can chip away at motivation, confidence, and overall well-being—making it important to address them before they start to limit your daily life.

3. Mental Clarity and Heart Function

When thyroid hormones become unbalanced, the effects can ripple through both cognitive function and heart rhythm—making daily life feel less steady or predictable. These shifts may show up as:

  • Trouble following conversations, managing tasks, or staying mentally organized
  • Feeling unusually forgetful, distracted, or mentally worn out by routine decisions
  • Moments of restlessness, racing heartbeat, or dizziness during simple activities

These disruptions can affect everything from confidence to concentration, making it harder to move through the day with ease and focus.

4. Blood Sugar and Weight Stability

As insulin resistance increases, postmenopausal women may experience changes that affect how they feel and function each day. These may include:

  • Stable energy levels throughout the day, leading to fatigue or difficulty following through on tasks
  • Physical ease or comfort, especially with increased abdominal weight
  • Motivation and confidence, when healthy habits don’t yield expected results

These effects can influence how women move through daily routines, manage meals, and stay motivated—highlighting the importance of early awareness and support.

5. Stress Resilience and Emotional Balance

When cortisol levels remain elevated over time, the body’s ability to recover from stress or maintain steady energy and focus can start to decline. These shifts may show up as:

  • Difficulty falling or staying asleep, leading to daytime fatigue or irritability
  • Greater susceptibility to illness, making it harder to stay active or social
  • Trouble concentrating or remembering tasks, which can disrupt daily routines

Together, these effects can chip away at emotional balance and make it harder to handle responsibilities with ease and confidence.

Hormone Therapy Considerations for Women Over 65

Hormone therapy (HRT) is used to relieve a variety of menopausal symptoms caused by declining estrogen and other hormone levels. These can include hot flashes, night sweats, vaginal dryness, and urinary discomfort. HRT is most commonly prescribed during perimenopause or within the first 10 years after menopause—typically between ages 50 and 60—when symptoms are often most noticeable. The type of hormone therapy recommended can vary based on a woman's age, overall health, and the specific symptoms she’s experiencing.

Systemic hormone therapy—taken as a pill, patch, or injection—is a type of HRT that may be considered for healthy postmenopausal women beyond this window if symptoms remain moderate to severe and other health risks are low. It is generally not recommended for women with a history of blood clots, stroke, or hormone-sensitive cancers, and it tends to be less effective when started more than 10 years after menopause.

For women over 65, some of the most common ongoing menopausal symptoms tend to be vaginal or urinary—such as dryness, irritation, or discomfort. At this stage, the type of hormone therapy most commonly considered is localized treatment, which delivers hormones directly to the affected tissues. Clinical guidelines typically recommend options like topical low-dose vaginal estrogen or vaginal DHEA to manage these symptoms. These therapies are effective and generally considered safe when appropriately monitored. Because they act locally rather than circulating throughout the body, they carry a lower risk of systemic effects compared to hormone therapies that are absorbed into the bloodstream, such as pills, patches, or injections.

Potential benefits include:

  • Relief from hot flashes and night sweats
  • Improved vaginal dryness or urinary discomfort
  • Reduced risk of bone loss in some women 

Risks may include:

  • Increased chance of blood clots or stroke
  • Higher risk of certain breast cancers
  • Potential effects on heart health

If you're experiencing postmenopausal symptoms, talk to your healthcare provider to see if hormone therapy could be a safe and appropriate option for you. 

Alternatives to Hormone Therapy

Hormone therapy isn’t right for everyone—especially women with certain health conditions or risk factors. Fortunately, there are several non-hormonal options that can help manage symptoms:

  • Selective estrogen receptor modulators (SERMs): Medications that mimic some effects of estrogen without raising certain risks
  • Vaginal moisturizers and lubricants: Over-the-counter options for dryness and discomfort
  • Low-dose antidepressants: Sometimes used to reduce hot flashes and improve mood
  • Lifestyle adjustments: Sleep routines, regular physical activity, and weight management can all support hormone balance

These alternatives can be effective on their own or used in combination. They may come with fewer risks than hormone therapy and are often used to treat more specific symptoms. A healthcare provider familiar with menopause and senior care can help tailor the best approach for your needs.

Lifestyle Strategies for Hormonal Balance

While some hormonal changes are a natural part of aging, others can be influenced by daily habits. Focusing on a few key areas can help support overall well-being and ease the effects of hormone shifts.

1. Nutrition

Food is one of the most powerful tools for supporting hormonal balance, especially after menopause. A well-rounded diet can reduce inflammation, protect bones, and help sustain steady energy throughout the day.

  • Anti-inflammatory foods (daily): Leafy greens, berries, fish, and whole grains can reduce inflammation and support overall health
  • Limit processed items: Cutting back on sugars, refined carbs, and trans fats helps stabilize blood sugar and reduce fatigue
  • Protein intake (each meal): Prioritizing high-quality protein helps preserve muscle and strength with age
  • Smart supplementation (as needed): Vitamin D, calcium, magnesium, and omega-3s may help fill gaps and support bone and brain health

Making thoughtful choices at mealtime can strengthen your foundation for better health, resilience, and overall well-being.

2. Physical Activity

Movement supports nearly every system affected by hormonal change—from metabolism and bone strength to heart health and emotional well-being. The key is consistency, not intensity.

  • Strength training (2x/week): Builds muscle, maintains bone density, and supports balance
  • Low-impact cardio (most days): Walking, swimming, or cycling can boost heart health and energy
  • Balance and flexibility work: Yoga, tai chi, or stretching helps improve mobility and prevent falls

Staying active makes daily tasks easier and helps you feel stronger, steadier, and more in control of your body. 

3. Sleep

Sleep plays a critical role in maintaining hormonal balance, memory, metabolism, and mood. While sleep patterns can shift with age, small adjustments can lead to more restful nights.

  • Aim for 7–8 hours of quality sleep: Supports brain function, emotional balance, and energy
  • Address disruptions: Insomnia and sleep apnea become more common and may need attention
  • Establish a steady routine: Consistent sleep and wake times, plus limited screen time, support deeper rest

Improving sleep can restore mental clarity, reduce fatigue, and make daily life feel more manageable.

4. Mental and Emotional Health

Hormonal changes can influence mood, stress tolerance, and mental clarity. Nurturing emotional well-being is key to feeling grounded, engaged, and resilient throughout the day.

  • Stay socially connected: Regular contact with friends, family, or community helps reduce isolation and boost mood
  • Practice relaxation techniques: Meditation, deep breathing, or tai chi can support calm and reduce stress
  • Seek support when needed: Depression and anxiety are common—and treatable—at any age
  • Keep your mind active: Reading, puzzles, and learning new skills help maintain focus and purpose

Caring for your emotional well-being can help regulate stress hormones, improve mood stability, and support better overall hormonal balance as you age.

When to Consult a Healthcare Provider

Don’t wait for symptoms to disrupt your daily life before reaching out. Many hormone-related changes happen gradually and may be easy to overlook at first. If you notice any of the following, it may be time to schedule a check-up:

  • Persistent fatigue
  • Unexplained weight changes
  • Mood swings or emotional shifts
  • Memory issues or difficulty concentrating

These symptoms are common in postmenopausal women and can have a range of causes—including hormonal shifts, thyroid changes, or aging-related transitions. While they may not always signal a serious problem, checking in with your healthcare provider can help you better understand what’s going on and explore options for feeling your best.

Final Thoughts

Hormonal health remains an important part of aging well. While many hormonal changes are expected after menopause, they can still affect energy, mobility, mood, and overall quality of life. Understanding how hormones continue to influence the body, staying informed, and working closely with your healthcare provider can help you stay strong, independent, and well-supported through every stage of aging.

At Flagship Health, we’re here to support you at every stage of your journey. Our providers take the time to listen, answer your questions, and work with you to create a care plan that fits your unique goals and needs.

Want to learn more about hormonal health or schedule a wellness visit? Contact our team today to take the next step toward feeling your best.

About Dr. Ramchandani

Dr. Sunny Ramchandani is the President of Flagship Medical Group with over 20 years of experience caring for patients, including extensive work with the senior population. A former White House Fellow and Navy physician, he previously served as Chief Population Health Officer at Naval Medical Center San Diego and helped lead national health reforms in Afghanistan. Dr. Ramchandani holds degrees from the U.S. Naval Academy, Yale School of Medicine, and Harvard School of Public Health.