Menopause

Menopause is the point when your periods stop and your ovaries sharply cut back how much estrogen they make. Estrogen's job in bone is to keep osteoclasts — the cells that break down old bone — in check, and to keep them short-lived. Once estrogen falls, osteoclasts live longer and work harder, while bone-building osteoblasts can't keep pace. The result is a stretch of faster bone loss, often around 2-3% of bone mineral density a year in the early transition, sometimes adding up to significant losses over the following 5-7 years.

This is why postmenopausal osteoporosis is so common, and why menopause is considered the single most skeletally significant event in most women's lives. The fastest loss happens early, which is also why timing matters: bone you keep is easier to hold onto than bone you have to rebuild later. If periods stop well before the average age (roughly 45), through surgery, cancer treatment, or ovarian insufficiency, that's treated as a distinct situation, because it means many extra years of low estrogen exposure, and guidelines generally support discussing hormone replacement until at least the typical age of natural menopause, unless there's a reason not to.

Hormone therapy is one option some women discuss with their prescriber, and large trial evidence has shown it reduces fractures, including hip fractures. But the balance of risks and benefits depends heavily on a woman's age and how long it's been since her last period, along with personal health history. Whether hormone therapy is right for you is a decision between you and your prescriber. Separately, the loading work you do is something within your own control, and it continues to matter whatever path you take with hormones.