October 18 is celebrated worldwide as International Menopause Day, a day dedicated to raising awareness about women’s health during and after menopause.
Throughout a woman’s reproductive life, menstrual cycles bring along many physical and emotional challenges such as abdominal cramps, bloating, and mood fluctuations. Many women assume that once menopause begins, these monthly troubles disappear and life becomes easier. However, menopause opens a new chapter that brings its own set of challenges.
This phase of life can be described as a period of “readjustment”, where a woman’s body adapts to major hormonal and physiological changes.
WHAT IS MENOPAUSE?
Menopause typically occurs between the ages of 45 and 55 years, marking the natural end of a woman’s reproductive years. It is defined as the permanent cessation of menstrual cycles due to the loss of ovarian follicular activity.
In the years leading up to menopause (the perimenopausal period), menstrual cycles become irregular and ovulation becomes less frequent. Eventually, estrogen and progesterone production from the ovaries declines significantly, leading to the complete cessation of menstruation, the hallmark of menopause.
WHY DOES MENOPAUSE HAPPEN?
Menopause occurs due to the “burning out” of the ovaries.
During a woman’s reproductive life, about 400 primordial follicles mature and ovulate, while hundreds of thousands degenerate naturally. By around age 45, very few primordial follicles remain to respond to the hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
As estrogen production from the ovaries declines, it can no longer suppress the production of FSH and LH. The body continues to release these hormones, but with no viable follicles left, estrogen levels drop to nearly zero.
This decline in estrogen is responsible for many of the symptoms and health changes associated with menopause.
RE ADJUSTMENT OF LIFE AFTER MENOPAUSE
After menopause, the body must adapt to the absence of estrogen and progesterone. The loss of these hormones can cause several physiological and emotional changes, including:
• Hot flashes and night sweats
• Shortness of breath or palpitations
• Irritability, fatigue, and anxiety
• Sleep disturbances and mood swings
• Vaginal dryness and reduced libido
• Increased risk of type 2 diabetes
• Higher chances of cardiovascular disease
• Decreased bone strength and mineralization, leading to osteoporosis
WHAT IS OSTEOPOROSIS?
Osteoporosis is the most common bone disorder in older adults, especially women after menopause. It is characterized by low bone mass and structural deterioration of bone tissue, leading to fragile bones that fracture easily.
Before osteoporosis develops, many women experience osteopenia, a stage of reduced bone mineral density. Over time, if untreated, osteopenia progresses into osteoporosis.
Unlike osteomalacia (softening of bones due to vitamin D deficiency), osteoporosis involves a loss of bone matrix, not just poor calcification. This occurs when osteoblastic activity (bone formation) is reduced and osteoclastic activity (bone resorption) increases.
CAUSES OF OSTEOPOROSIS OTHER THAN MENOPAUSE
1. Aging: Decline in growth hormone, insulin-like growth factors, and protein synthesis reduces bone formation.
2. Inactivity: Lack of physical stress on bones accelerates bone loss.
3. Malnutrition: Insufficient intake of protein, calcium, or vitamin D weakens bone structure.
4. Endocrine disorders: Conditions like Cushing’s syndrome can promote bone breakdown.
5. Medications: Long-term use of corticosteroids can impair bone metabolism.
ROLE OF ESTROGEN IN BONE HEALTH
Estrogen plays a vital role in maintaining bone strength by:
• Stimulating osteoblasts (bone forming cells)
• Inhibiting osteoclasts (bone resorbing cells)
• Enhancing calcium absorption and deposition in bones
• Supporting protein metabolism for bone matrix formation
When estrogen levels drop after menopause, bone resorption exceeds bone formation, leading to rapid bone loss, especially in the first 5 to 10 years post menopause.
LIFESTYLE MODIFICATIONS FOR POSTMENOPAUSAL HEALTH
Maintaining bone health after menopause requires a combination of lifestyle strategies and preventive care.
1. Regular Exercise
Weight-bearing and resistance exercises (like brisk walking, jogging, and light weight training) place healthy stress on bones, helping maintain bone density and strength.
2. Weight Management
Excess body weight adds unnecessary stress on the skeletal system, increasing fracture risk. Maintaining a healthy BMI supports both bone and cardiovascular health.
3. Balanced Diet
A nutrient rich diet is essential.
Include foods high in calcium (milk, cheese, yogurt, spinach, okra, and fortified cereals) and vitamin D (egg yolks, fish, liver, and fortified orange juice).
4. Avoid Alcohol and Smoking
Both alcohol and smoking reduce bone formation and calcium absorption, accelerating bone loss.
5. Sunlight Exposure
Vitamin D, often called the “sunshine vitamin,” is synthesized in the skin when exposed to sunlight. It helps the body absorb calcium effectively and strengthens bones.
MEDICATIONS FOR POSTMENOPAUSAL OSTEOPOROSIS
Several treatments are available to prevent fractures and improve bone density in postmenopausal women:
• Bisphosphonates (Alendronate, Risedronate, Pamidronate, Etidronate): Slow down bone resorption and increase bone mass.
• Denosumab: A monoclonal antibody given by injection to prevent bone loss and reduce fracture risk.
• Abaloparatide: A self-administered daily injection that stimulates bone formation (used for up to 2 years).
• Teriparatide: A recombinant parathyroid hormone that promotes new bone growth.
• Romosozumab: A sclerostin inhibitor that both increases bone formation and decreases resorption (administered under medical supervision).
• Calcitonin: Available as a nasal spray; helps regulate calcium and slow bone loss.
• Calcium and Vitamin D supplements: Essential for bone mineralization and maintenance.
• Hormone Replacement Therapy (HRT): Can relieve menopausal symptoms and slow bone loss, though it carries potential risks such as blood clots, stroke, and certain cancers — so it must be prescribed cautiously.
AWARENESS AND PREVENTION
The purpose of celebrating World Menopause Day is to spread awareness about the health challenges women face after menopause, and to empower them to take proactive steps toward lifelong wellness.
Menopause is not an end but a natural transition. With the right lifestyle, nutrition, and medical support, women can continue to live vibrant, active, and fulfilling lives.
FAQs ABOUT MENOPAUSE AND OSTEOPOROSIS
1. Why does the risk of osteoporosis increase after menopause?
After menopause, estrogen levels drop sharply. Estrogen protects bones by slowing bone breakdown, so its decline accelerates bone loss and increases fracture risk.
2. How can I tell if I have osteoporosis?
Osteoporosis is often called a “silent disease” because it develops without symptoms. A bone mineral density (BMD) test or DEXA scan is the most reliable way to diagnose it.
3. Can exercise really help strengthen bones after menopause?
Yes. Weight-bearing and resistance exercises stimulate bone formation and improve balance, reducing the risk of falls and fractures.
4. What are the best dietary sources of calcium and vitamin D?
Calcium: milk, yogurt, cheese, leafy greens, and fortified foods.
Vitamin D: egg yolks, fatty fish, beef liver, and sunlight exposure.
5. Is hormone replacement therapy (HRT) safe for everyone?
HRT can reduce menopausal symptoms and slow bone loss, but it’s not suitable for everyone. Women with a history of breast cancer, blood clots, or liver disease should discuss alternatives with their healthcare provider.
6. Can osteoporosis be reversed?
While bone loss cannot be completely reversed, treatment and lifestyle changes can significantly improve bone density and prevent fractures.
7. How much sun exposure is needed for vitamin D?
About 10–20 minutes of sunlight exposure to the arms and legs, several times a week, is usually sufficient, depending on skin tone, climate, and geographic location.
DISCLAIMER
This article is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider before making decisions about your health, medication, or treatment plan.
CALL TO ACTION
Menopause marks a new phase of life, one that deserves strength, awareness, and proactive care.
Prioritize your bone health today: eat balanced, move daily, and get your vitamin D checked.
If you’re approaching or going through menopause, speak to your doctor about bone density screening and preventive options. Early action means stronger bones and a healthier future.REFERENCES:
1. Journal of Clinical Endocrinology & Metabolism (2020)
2. Nutrients (2021)
3. Osteoporosis International (2022)
4. Frontiers in Endocrinology (2020)
5. The Lancet Diabetes & Endocrinology (2019)
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