You've heard about the hot flushes and mood swings, but the end of your periods could also mean the beginning of some surprising health issues. Read on and learn how to protect yourself.

Pelvic Organ Prolapse

When you're younger, your pelvic muscles do a pretty good job of contracting and keeping everything in place. But after menopause those muscles can weaken, causing the bladder, uterus, rectum or vagina to droop downward. In severe cases, one or more of those organs can hang out of your body like a ball, which can rub on your clothes and cause bleeding, pain, and other discomfort. "It can also make it very hard to empty your bladder or bowels," says Dr Beri Ridgeway.

Women who've had a kid via vaginal childbirth are the most susceptible, says Ridgeway. (Menopausal changes add further insult to injury.) Many women also gain weight around menopause, which puts extra pressure on the pelvic organs.

What you can do: Speak up. Many women delay treatment because they're confused and embarrassed, says Ridgeway. But you're far from alone: About 41 to 50% of women may have some degree of prolapse. If you feel a bulge between your legs or have trouble emptying your bladder or bowels completely, see your doctor, stat. For the best care, seek out a urogynaecologist who specialises in pelvic floor disorders. For a mild case, your doctor may simply recommend pelvic floor exercises like Kegels. More advanced cases may merit surgery or a pessary, a device that you wear internally to support your pelvic organs.

Liver Disease

When you're young and healthy, the liver tends to easily repair damage from things like alcohol, infections or excess fat. However, sometimes the organ lays down scar tissue instead of healthy cells. Oestrogen seems to interfere with this process, so when this hormone drops at menopause scar tissue can start building up. "Over time that may lead to advanced chronic liver disease," says Dr Carla Brady. 
Oestrogen may also protect the mitochondria, or powerhouses in your liver cells. As levels of this hormone decline, damage can ensue, further accelerating liver ageing.

What you can do: The next time your doctor orders a routine blood screen, ask him or her to check the box for a liver enzyme test. Elevated levels are often the first sign that something's wrong in this critical organ. "For many people, liver disease is fairly silent until it gets to more advanced stages," says Brady. 

Autoimmune Disorders

Feeling tired, moody or experiencing hot flashes? Those are all normal menopausal symptoms—but they could also be signs of an autoimmune disorder such as multiple sclerosis, lupus, or rheumatoid arthritis, says Dr Mindy S. Christianson. While a new immune problem could crop up at menopause, this change of life might very well cause a condition you already had to worsen.   

Again, blame oestrogen: Shifts in this hormone may lead to excess inflammation in your body and cause certain body systems to turn on themselves.

What you can do: Keep track of any symptoms you experience during menopause and discuss them with your doctor. If you already know you have an autoimmune issue, be sure to explain what you're going through to your rheumatologist and/or endocrinologist, in addition to your gynaecologist. They can help you keep tabs on your disease and tweak your treatment as necessary.

Dry Eye

Oestrogen isn't the only hormone that's going awry. Levels of testosterone—yes, women make it too!—also fall during menopause, and they can mess with your eyes. This "male" hormone plays a critical role in the function of your meibomian glands, which produce an oily layer that preserves moisture on the surface of your eyes, explains Dr Austin Mircheff.

When testosterone declines, that oily layer can thin out. As a result, more water evaporates from your eyes, leaving behind irritating salt. Hello, dryness, discomfort and inflammation! Meanwhile, the cells of your lacrimal glands—which make antibodies that protect the surface of your peepers—seem to die off more quickly after menopause. That may explain why, according to a recent study, older women report more frequent and severe dry eye than older men. 

What you can do: Even people with perfect vision should get routine eye exams starting at age 40. If you haven't been seeing an eye doc, start now—and tell him or her if your eyes feel very dry. Using over-the-counter lubricating eye drops are sometimes enough, but you might need an Rx or tear duct plugs to prevent moisture from draining too quickly.

Hearing Loss

Everyone's sense of hearing tends to decline with age, but women may experience problems more rapidly after menopause, says Dr Kevin Ohlemiller. That's because oestrogen plays a role in your cochleas, the snail-shaped organs in your inner ears that convert vibrations into electrical signals your brain can process.

What you can do: Step one: limit your exposure to loud noises. Then focus on eating well and exercising.  It may sound strange, but following overall healthy lifestyle can help protect just about every part of your body—including your ears—says Ohlemiller. Need proof? One recent study found that women who got the most exercise had a 17% reduced risk of hearing loss. And other research, revealed that women who consumed the most beta-carotene (in carrots and other orange-coloured produce) were 12% less likely to report hearing loss.

Sleep Apnoea

Sure, night sweats (which are hot flushes that occur while you're snoozing) can keep you up, but that's not the only way menopause affects your slumber. Research suggests that women have a 3.5 times higher risk of sleep apnoea after menopause than they do before the transition, says Dr Sara Nowakowski. This condition—in which you stop breathing for several seconds at a time while you're asleep—makes it difficult to feel well-rested. It also raises your risk for diabetes, stroke, and more.

There are a few things happening at menopause that make you more prone to sleep apnoea. First, progesterone, a hormone that helps protect your respiratory system, declines. The skin in your neck also thins, which could impinge on your airway and obstruct nighttime breathing. Menopausal weight gain can obstruct your respiratory system as well. 

What you can do: Seek out a sleep specialist if you have any symptoms of sleep apnoea. Although snoring is the most famous sign (ask your partner), it's not the only one. Many women who suspect they have insomnia eventually find out that sleep apnoea is the culprit, says Nowakowski. Excessive daytime sleepiness is another reason to head to the doctor's office. You may need positive airway pressure (CPAP) or a dental appliance to keep your airways open while you sleep.