The window we should not miss

Tomorrow, I turn a year older. After last year’s milestone birthday, the subsequent ones are still joyous occasions, but they also oblige us to think about how we are aging and what we hope to keep doing in the years ahead. For me, that includes staying strong and healthy to enjoy life with my family, to serve patients, to teach, and to travel. It also means paying attention to changes we cannot see, including those happening inside our bodies.

In my article earlier this month, “Before the Bones Grow Old,” I wrote about building strong bones in childhood and adolescence. Good nutrition and physical activity help establish the foundation we carry into adulthood. As women my age navigate through perimenopause, this brings another opportunity to act: preserving that strength as our hormones change.

We often associate perimenopause brings irregular periods, hot flashes, disrupted sleep, and mental or emotional changes. Some women experience irritability, anxiety, mood changes, difficulty concentrating, or “brain fog.” Bone loss receives less attention because it is silent. You can’t feel your bones getting weaker as estrogen levels decline.

This process can accelerate before menstruation stops completely. The Study of Women’s Health Across the Nation found that bone loss was greatest from about one year before the final menstrual period until two years afterward. Waiting until we feel “old enough” to worry about osteoporosis may mean missing an important opportunity for prevention.

This is why I encourage women to discuss hormone replacement therapy, also called menopausal hormone therapy, with their doctors. Treatment with estrogen prevents bone loss and reduces fracture risk, while also treating hot flashes and night sweats. For appropriately selected women, these benefits can make treatment a valuable part of care.