Hey there, menopause warriors! Let’s talk bones.
Whether you’re cruising through natural menopause or were fast-tracked into the surgical version
(hello, uterus and ovaries vacating the premises!),
your skeleton might be waving a tiny white flag.
Why?
Because oestrogen, that unsung hero of our hormonal symphony,
does so much more than just keep our skin glowing and moods (mostly) balanced.
It’s also the backbone of, well, our bones!
When oestrogen levels dip during menopause, your risk of osteoporosis
aka the brittle bone brigade—skyrockets.
So, grab a coffee (but let’s not overdo it; calcium still matters),
and let’s dive into why oestrogen is your bone’s bestie, backed by science and plenty of sass.
Let’s set the stage:
Bone remodelling is a constant cycle of breakdown and rebuilding.
It keeps your skeleton fresh and functional. Here’s how it works:
Osteoclasts: These are the “demo team” cells that break down old bone. Think of them as the wrecking ball.
Osteoblasts: These are the “construction crew” cells that build new bone.
Here’s the problem: when oestrogen levels drop,
the wrecking ball goes berserk, and the construction crew can’t keep up.
The result? Thinner, weaker bones.
Without enough oestrogen, it’s like running a LEGO factory without a blueprint—chaos and no structural integrity.
The science is clear:
oestrogen inhibits osteoclast activity,
keeping bone breakdown in check.
When it’s gone? Osteoclasts party like it’s 1999, and the osteoblasts can’t clean up the mess.
How Much Oestrogen Do You Need for Bone Protection?
Here’s the golden number: 250–300 pmol/L of oestradiol in your blood.
That’s the sweet spot for protecting your skeleton. Don’t just take my word for it—here’s what the experts say:
1. Chelsea & Westminster NHS Foundation Trust
Their HRT guidance is crystal clear:
A serum oestradiol level of 250 pmol/L or higher is essential to support bone metabolism and prevent bone loss.
If your levels don’t hit this target, you might need to adjust your HRT dose or brand.
2. Professor John Studd
The late, great menopause maestro didn’t mince words:
“Osteoporosis can usually be prevented by oestradiol therapy, and the bone density can be increased in established osteoporosis by the use of oestrogens producing plasma oestradiol levels of at least 300 pmol/L.”
He also argued that oestrogen is more effective than bisphosphonates (those fancy osteoporosis meds) for protecting and building bone mass.
Pro Tip: If your consultant hasn’t mentioned these targets, it might be time to start a conversation—or find someone who understands how critical bone health is during menopause.
Why Oestrogen Is Better Than the Alternatives
Yes, there are other treatments for osteoporosis—like bisphosphonates or SERMs (Selective Estrogen Receptor Modulators). But let’s be real:
These meds slow bone breakdown, but they don’t encourage the growth of new, healthy bone like oestrogen does.
Oestrogen doesn’t just put a stop to the wrecking crew; it also helps the builders get back to work.
For women in menopause, oestrogen isn’t just a hormone—it’s a structural engineer for your skeleton.
The UK vs. USA Testing Debate
Here’s the tea:
In the USA, they can test free oestradiol (the active, unbound stuff). Jealous? Same.
Over here in the UK, we have to rely on SHBG levels to estimate how much oestradiol is bioavailable.
A good consultant will test your SHBG alongside total oestradiol to get the full picture.
If yours doesn’t? Demand it.
High SHBG can bind up your oestrogen and make it less effective, even if your total levels look fine on paper.
DEXA Scans: Your Skeleton’s Report Card
If you’re worried about osteoporosis, a DEXA scan (Dual-Energy X-ray Absorptiometry) is a must.
It’s quick, painless, and gives you a precise measure of your bone density.
Think of it as your skeleton’s annual performance review.
Tip: If you’ve had surgical menopause or early menopause, you’re at higher risk for osteoporosis.
Advocate for a scan early, even if you’re not showing symptoms yet.
Final Thoughts: Love Your Bones
Menopause might feel like Mother Nature flipping the script, but oestrogen can help you rewrite it.
Aim for that 250–300 pmol/L sweet spot, keep an eye on your SHBG,
and don’t let anyone tell you “normal” levels are good enough if you’re still symptomatic.
Fuel Your Bones with Nutrition
Aim for 700mg of calcium a day to keep your bones strong.
Think leafy green veg, dried fruit, and dairy products as your calcium-rich go-to’s.
Vitamin D is your bone’s BFF because it helps your body absorb calcium like a pro.
A vitamin D supplement is often a good idea, especially if:
It’s autumn or winter (goodbye, sunshine!).
Your diet lacks vitamin D-rich foods.
Your skin isn’t regularly exposed to sunlight (hello, cloudy skies or SPF enthusiasts!)
This is the brand I use from Amazon.
Pro Tip: Smoking and excessive alcohol can wreak havoc on your bones—cutting back on these is another step toward long-term bone health.
Your bones are your foundation—so let’s keep them strong, sassy, and ready for whatever life throws your way.
Because life isn’t just about avoiding falls; it’s about dancing through them like the fabulous queens we are. 💃
Got questions or need more info? Drop them in the comments—I’m here to help!
Further reading –
Hormone replacement therapy and the prevention of postmenopausal osteoporosis
Oestrogens and Osteoporosis (1)
