Bone Health Through Your PeriMenopause

Understanding how your menopause transition will impact your bones has to be one of the greatest mysteries for the perimenopausal woman. Estrogen exposure, lack of estrogen and conditions which lead to estrogen deficiency or cumulative estrogen exposure clearly have impact on bone health, whether you are genetically predisposed or had a great diet, or exercised, or not! In women who have had abnormal cycles, like those with PCOS, prolonged cycles may impact our bones through estrogen differences, yet may be manifesting bone impact through alternative hormonal mechanisms (i.e. gonadotrophin differences, differences in the amount of circulating testosterone, or progesterone or even adrenal hormones or the liver production of SHBG etc). It is also important to differentiate between short and long term cycle changes, some women during their life may have been high estrogen and others may have been chronically low. And others of you, just to confuse your gynos may have fluctuated as often as hemlines as you gained weight, or changed your diet, or changed your contraceptive method or had children!  When discussing what factors impact on bone health that relate to estrogen deficiencies: lactation, prolonged DMPA use to name two, should be discussed with your gyno, and in fact, those are so important that you may want to consider getting your bones tested if you’ve done either for long stretches. We know in fact that some women who have irregular cycles are estrogen dominant. Would these women have better bone health? Needless to say your chronic vitamin D levels also would impact your bones, and whether this would fluctuate with estrogen use or disuse, we don’t really know. We do know that women in menopause will loose 2-4% of bone per year, so that the impact of estrogen loss is probably, of all the factors mentioned, the most important when you consider what is affecting your bones the most.As you age bone loss slows to about 1% per year. But you will not naturally gain bone as you age, to hold your bone calcium mass as you age, it is most likely you are going to need therapy. First a test of your bone mass and then have a discussion as to what medication, for how long, and then how to evaluate your bone as you age.