Does The Peri-menopause Affect Your Bones?

What Is Menopause?

Menopause is a transition that every woman goes through as they reach the end of their reproductive phase, and it marks the first anniversary of their last period. The lead up to menopause is known as peri-menopause, and just like adolescence, it can last a number of years.

Peri-menopause can bring huge changes on the physical, emotional and psychological levels. We all experience it differently, with around 20% of women barely noticing anything. Another 20% will suffer with very debilitating symptoms, and the rest of us sit somewhere in between.

We’re told that menopause leads to a drop in oestrogen, which in turn increases our risk of multiple health issues including osteoporosis. What actually happens is that there’s a swap in oestrogen, from a potent form needed for our menstrual cycles, to a less potent form needed to protect our health into old age. The narrative that we must take HRT if we’re going to avoid osteoporosis in most cases simply isn’t true. Archaeological specimens of post-menopausal women have found that most had very strong, healthy bones, suggesting that osteoporosis is more closely linked to our modern lifestyle.

How Does The Menopause Affect Your Bones?

Our bones are constantly renewing themselves by building up and breaking down. Ideally both happen in equal measure but during peri-menopause, the strong oestrogen which helps to slow the breakdown of bone declines. Levels of progesterone, which regulate the building of bone can also decline. As a result, the breakdown can happen faster than the rebuild, and the bones become more porous. This can be a particular problem where there’s a sudden drop in oestradiol, the strongest form of oestrogen, either naturally or in a surgical or medical menopause.

Of the two hormones, progesterone is four times more effective at protecting bone than oestrogen, so maintaining good progesterone levels is of prime importance. In the UK the NHS doesn’t prescribe progesterone only HRT, but we are able to lift progesterone levels with herbs if needed.

Caring for bones, and overall health, should ideally start long before peri-menopause. Each time a woman has a normal, natural menstrual cycle, she deposits some strong oestrogen in the bank which will help protect her bones in the long term. One problem is that many women use hormonal contraceptives, often from their late teens onwards, which prevent normal, natural cycles from happening. There’s also a good argument for holding menopause off as long as possible for the same reason.

Commonly prescribed medications such as SSRI antidepressants, and PPIs used to treat stomach acid reflux, can also reduce bone density. Whilst sometimes using these kinds of medications might be unavoidable, if there are any alternatives you could explore, even if you need to invest in working with a healthcare practitioner, it could be well worthwhile. If you’re in the UK, you’re welcome to book a quick chat to discuss this with me.

Early Menopause And Bone Density

Women who go through natural menopause early are recommended to use HRT until around the age of 50 when periods would usually come to a stop. Those who can’t use HRT still have a number of alternative options available, which we’ll discuss shortly.

Bone Density Testing and Early Warning Signs For Osteoporosis

Often osteoporosis goes undetected until there’s a fracture, by which time treatment options are usually quite limited. Prevention is definitely better than cure, and there are some early warning signs to look out for, including:

Dental problems like teeth becoming crooked or falling out, or receding gums.
A weaker grip than usual.
Muscle cramps, especially in the legs.
Unexpected fractures, eg, stress fractures from running which would normally be uncommon for someone of that age.
Back pain.
Losing height.

The mainstream testing for bone density is called a DEXA Scan, and some women are offered these scans on the NHS, particularly if they’re deemed high risk. However, some women prefer not to use them as they use high amounts of radiation, and only give a snapshot about what bone density looks like at a single point in time. As we know, bones are constantly breaking down and rebuilding, so only repeated DEXA scans, and repeated exposure to the radiation, will give an accurate picture of how density is changing over time. You can read more about DEXA scanning here.

Alternatives to DEXA scanning are currently only available privately in the UK, but they include ultrasound scans and urine testing for N Telopeptide. Your NHS GP is unlikely to take results of these tests into account or be able to interpret them appropriately, but they should help to give you a more accurate picture in the context of your symptoms. Repeated N Telopeptide testing also monitors how bone density is responding to HRT or other medications.

Does HRT Prevent Osteoporosis?

This is a really controversial topic, with a number of medics saying that HRT is key in protecting bone density, and a minority saying that there’s no good evidence to back its use in this way. We know that oestrogen helps to regulate the formation and breakdown of bone, so it makes sense, and there are some older studies cited in this article supporting the use of HRT.

However, oestrogen is just one small part of a much bigger bone density jigsaw, and some women can’t use HRT for medical reasons. Other factors including genetics, medications, gut health, thyroid health, nutritional status and exercise all need to be taken into consideration. Fortunately there’s a lot we can do besides taking HRT to help protect bone density during and after menopause.

How To Protect Yourself From Menopause Bone Density Loss (Without HRT)

There are 2 main aspects to keeping your bones strong and healthy: ensuring you have enough of the right building blocks, and ensuring that your build up and break down processes are correctly regulated.

Bones will only ever be as strong as they need to be, and that depends on the amount of weight bearing exercise they do. Strength training is vital for maintaining bone density especially as we reach peri-menopause, and the recommendation is to be able to lift 50-100% of your body weight, depending on the kind of lift you’re doing. Rebounding and vibration plates are also excellent for building bone strength because they cause the muscles to contract and pull on the bone more frequently than other forms of exercise.

Any movement is better than none, so if you’re unable to bear your own weight, swimming or walking in water would be a really good place to start.

Balance and core strength training is just as important post menopause, to help prevent falls and fractures.

In terms of diet, whilst it’s important to get a good amount of dietary protein in each day, too much protein can cause calcium to be lost from bone. Genetics also play a part here, and our protein requirements increase with age, but a good starting point is around 25% of the diet is made up of dense protein.

Oxalates and phytates found in certain plant foods can also hinder absorption of calcium in the gut. The foods that contain these substances have multiple health benefits, so we don’t want to be avoiding them completely. However, it’s important to cook them before eating, and ensure we eat plenty of good sources of calcium alongside.

Foods which support bone health would include:

Mushrooms exposed to sunlight, fish, and free-range eggs for Vitamin D.
Natto, cheeses, and fermented foods like kefir and sauerkraut for Vitamin K2.
Dairy products, leafy greens like kale, bok choi, spring greens lightly cooked. Nuts, seeds and fish for the calcium.
Nuts, peas and beans for the magnesium.

Vitamin D and K2

Parathyroid hormone, which is made by the parathyroid glands in your neck, helps to regulate calcium absorption into your bones. It can’t do its job properly without adequate levels of Vitamin D and K2.

In recent years we’ve been conditioned to be afraid of the sun, and not expose our skin to it without plenty of sunblock. Although too much exposure to stong sunlight isn’t great, neither is too little. Humans have always lived under the sun, and we’ve always depended on sunlight to make our Vitamin D, as well as regulate our biological rhythms, fertility, and mood. Traditionally we’d have started spending more time outside in early spring, allowing Vitamin D levels to increase slowly, which has a protective effect against UV damage. We’d also have foraged fresh herbs, which are packed with protective antioxidants. Nowadays we don’t tend to expose our skin to the sun until we’re in summer, and most of us don’t get enough antioxidants from our plant foods either. Not surprisingly, by doing that we increase our risk of burning and turn to chemical sunblocks for protection.

I advocate gradual, sensible exposure to sunlight, along with a diet rich in antioxidants. Vitamin D has multiple health benefits besides building bone strength, and we were never designed to get it solely from supplements. Mushrooms, which nature gives us as the light levels drop in autumn, are the richest food source of Vitamin D, and our ancestors would have dried them to keep a constant supply going in over winter. Vitamin D is made from cholesterol, and you need adequate levels of that and magnesium in your diet, besides the sun exposure, to be able to produce it.

Vitamin K2 (which is different to Vitamin K for blood clotting) works alongside Vitamin D in herding calcium into the bones. If you’re going to supplement Vitamin D, make sure it also contains K2, and monitor your levels every 3 months to make sure you’re on the correct dose as any excess is stored in your body fat.

Supplements For Osteoporosis

Bone mineral complexes

We’re still being told to supplement calcium to maintain healthy bone, but that’s only part of the story. If you think of your bones as being made like a brick wall, the calcium would be the bricks, but you also need cement to hold them in place. The ‘cement’ is a whole range of other minerals, including magnesium, boron and phosporous. Magnesium is a very common mineral deficiency, and if you have bone spurs or calcification anywhere else in the body, it’s usually a sign of low magnesium levels. Around 99% of your body’s calcium should be locked safely in your bones. A good bone mineral complex should include:

Calcium and Magnesium at a ratio of 2:1 respectively.
Vitamin C
Vitamin D
Vitamin K2
Zinc
Boron

In addition, fish, starflower and evening primrose oils help to maintain bone density.

Bone broth

If you’re an omnivore, the best way to ensure you’re getting all of the right nutrients for your bones in the right proportions, is to drink bone broth. Generally speaking, when we want to strengthen a particular organ or part of the body, ingesting food made from the corresponding part of the animal is a good way to do it. Shop bought bone broth is expensive but home-made is free or very cheap to make. Not only does it help to nourish your bones, but it heals the gut lining and provides nutrients for skin and connective tissue as well.

You can find out more about the health benefits of bone broth, and how to make it, on my YouTube channel here.

Herbal Remedies For Osteoporosis

I often get asked how herbs compare to HRT when it comes to protecting bone density. To the best of my knowledge, there are no studies comparing the two, but we do know that certain phyto-oestrogenic herbs and foods can make a significant difference.

There is some evidence backing the use of herbs like Red Clover, which has been shown to have a potentially protective effect on the lumbar spine. A number of plants from the Yam family have also been found to improve bone density in a number of ways.

As a Herbalist I always treat the person rather than the condition they present with. In a patient with osteoporosis, I’d be looking at things like:

Family history of osteoporosis or osteopenia (mild bone loss)
Hyperthyroidism
Insulin resistance – as this can influence bone strength in both positive and negative ways
Menstrual health – to assess trends in oestrogen and progesterone levels since periods started.
Use of Proton Pump Inhibitors, SSRI’s, hormonal contraception and other medications which may contribute.
Gut health – how well the gut is able to absorb nutrients both from diet and supplements.
History of unexpected injuries, loss of height, changes in posture.
Diet & exercise – both too little and too much exercise can lead to bone loss.
Chronic stress, inflammation, and burnout patterns.

With this in mind, each patient’s herbal prescription will be unique to them, considering bone density in the context of their overall health. Protecting the bones during peri-menopause requires the regulatory hormones to be very finely tuned, gut health to be good, nutritional status to be good, and physical exercise. In terms of hormones, it’s not just about oestrogen and progesterone. The bones themselves also make a hormone called osteocalcin which speaks to the brain and pancreas, feeding into the system which regulates blood sugar levels. Sometimes it’s a very complex web, with multiple factors impacting bone health. Where this happens I might focus on gut health to start with, before moving on to normalising reproductive hormone levels, and perhaps giving herbs like Elder leaf which specifically work on bone strength.

Where To Get More Help

If you’re concerned about developing osteoporosis after menopause, book a free call with me to talk about it.