Bone health in perimenopause and menopause: What women should know early

Often, bone health declines silently during midlife with the passing of the years. Perimenopause and menopause are key transition periods for bone loss. Understanding risks early helps prevent fractures and long-term complications. In this article you will learn about bone health in perimenopause and menopause, and what to do early. Doctify offers experienced gynaecologists that can help through the process as well.

Why bone health matters during perimenopause and menopause

In every stage of life, bones are constantly remodeling and changing. Oestrogen plays a major role in maintaining bone density through the years. But, when perimenopause starts, osestrogen levels begin to fluctuate. The bones need oestrogen in order to maintain their bone health. The hormonal changes experienced during perimenopause can accelerate bone loss before menopause is diagnosed.

What happens to bones as hormones change

Oestrogen levels start to decline when the perimenopause begins, having some effects on bone health. This hormonal decline causes a sharp increase in bone turnover by accelerating bone resorption (breakdown) and decreasing the formation of new bone, leading to rapid bone loss. The first years after menopause (the first 5-7 years) are especially important because the rapid decline of oestrogen causes an accelerated loss of up to 10%–20% of bone density, significantly increasing fracture risk.

Who is at higher risk of bone loss and osteoporosis

Listed are some examples of people that are at higher risk of experiencing bone loss and osteoporosis:

• Family history of osteoporosis or fractures
• Early menopause or surgical menopause
• Low body weight
• Smoking or high alcohol intake
• Long-term steroid use
• Low calcium or vitamin D intake
• Sedentary lifestyle

Signs of bone loss women often miss

Usually, women miss the first signs of bone loss or osteoporosis, since bone loss usually has no symptoms in early stages. Some warning signs include: loss of height, posture changes, or decreased grip strength. Also, other signs are receding gums (indicating jawbone loss), and having weak or brittle fingernails. For many, fractures are often the first noticeable sign, but in order to have a fracture, many years of bone loss have already passed.

Bone density screening and when it’s recommended

Bone density screening starts with a DEXA (Dual-energy X-ray Absorptiometry) scan, it is a rapid and non-invasive imaging test that measures bone mineral density (BMD) to assess bone strength, diagnose osteoporosis, and determine fracture risk.

Screening should be considered in women in perimenopausal women (typically ages 40–55). As well, screening should continue after menopause and follow-up intervals. Results of the screening are very util and help guide prevention or treatment decisions.

Daily habits that protect bone strength

Here are some tips that you can incorporate on your daily habits in order to protect your bone strength:

• Weight-bearing and resistance exercise
• The role of muscle strength in fall prevention
• Nutrition basics for bone health
• Calcium-rich foods
• Vitamin D and sunlight exposure
• Protein intake and overall dietary balance

Lifestyle factors that weaken bones

As there are good factors that strengthen your bones, there are also bad factors that weaken your bones. Starting with smoking, smoking is one of the worst because it reduces bone mineral density by 5–10%. Followed by, excess alcohol consumption, very restrictive diets, and prolonged inactivity or sedentarism. All of those impact significantly in bone formation and are considered negative lifestyle factors that weaken bones.

Hormone therapy and medications

Hormonal replacement therapy can help bone health by increasing bone density and reducing fracture risk in postmenopausal women, by supplementing the declining estrogen, which slows bone breakdown (resorption). On the other hand, medication for osteoporosis may be considered when bone density is low (T-score < -2.5), a fragility fracture occurs, or when high-risk factors exist. Nevertheless, the individualised risk-benefit should be discussed with your clinician.

Practical steps women can take now

Here are some practical steps women can take now that will drastically help your bone health. First, reviewing lifestyle habits early and tracking risk factors over time. Continued by discussing bone health during routine health checks with your healthcare professional. Lastly, staying consistent with exercise and nutrition is fundamental because it strengthens your body and your bones.

When to speak to a healthcare professional

If you experience any of the following please consult with a gynaecologist for professional healthcare:

• Personal or family history of fractures
• Early menopause or concerning symptoms
• Questions about screening or treatment options
• Uncertainty about individual bone health risk

Conclusion

Bone health protection starts earlier than many women realise. Small, consistent actions during perimenopause can significantly reduce fracture risk later in life. Doctify helps women connect with trusted Women’s Health specialists to assess bone health, access screening, and receive personalised prevention advice.

Feel free to consult a gynaecologist through Doctify for personalised advice whenever you want, we will be happy to help you! Find the best gynaecologyists in the United Kingdom or search for the best specialists globally:

• Gynaecologists in the United Arab Emirates
• Gynaecologists in Germany
• Gynaecologists in Austria
• Gynaecologists in Ireland
• Gynaecologists in Australia

Medically Reviewed
Last reviewed on 03/02/2026