Most menopause advice concerns symptoms. This page concerns two things that are largely silent at the time and matter considerably later.
Neither is a reason for alarm. Both are reasons that the years around menopause are worth treating as a period for active health management rather than just getting through.
Bone
What happens
Bone is living tissue, constantly broken down and rebuilt. The hormones that fall at menopause have a role in restraining the breakdown side of that balance.
As they decline, the balance tips. Bone loss accelerates in the years immediately around the final period — this is the steepest period of loss most women will experience — before settling to a slower ongoing rate.
Which is why the years either side of menopause are the ones that matter most. Bone you keep is easier than bone you rebuild.
What actually builds bone
This is where most general advice is unhelpful, because bone responds to specific things.
Bone adapts to load and impact. It responds to forces that are meaningfully greater than daily life. That means:
Impact. Jumping, skipping, hopping, running, bounding. Even small amounts count — the evidence suggests brief, frequent bouts are effective. Stair climbing taken two at a time qualifies.
Progressive resistance training. Lifting weights heavy enough to be genuinely challenging, and increasing the load over time. This is the piece most commonly missing, and "progressive" is the operative word — the same light weights for two years stop providing a stimulus.
What does comparatively little for bone, despite being good for you in other ways:
- Swimming and cycling, because the load is supported
- Walking on flat ground, which is barely more load than daily life
- Yoga and Pilates, which help balance and strength but provide limited bone stimulus
The other inputs
Calcium. Adequate intake matters, and food sources are generally preferred over supplements. Dairy, tinned fish with bones, fortified alternatives, tofu, leafy greens.
Vitamin D. Needed to absorb calcium. Australia has more deficiency than you would expect given the sunshine, particularly in southern states in winter, and in women who cover up or work indoors. A simple blood test.
Not smoking. Smoking is directly harmful to bone.
Moderate alcohol. Heavy intake impairs bone formation.
Enough food. Under-eating, particularly with heavy training, is harmful to bone.
Testing
Bone density is measured by a DXA scan. Medicare covers it in defined circumstances — including from age 70, and at any age with certain risk factors or a minimal-trauma fracture.
Worth asking your doctor whether you qualify, particularly with early menopause, a family history of osteoporosis, long-term steroid use, a previous fracture from a minor fall, or a low body weight.
Heart
What happens
Cardiovascular risk rises after menopause. Heart disease is a leading cause of death in Australian women — considerably more so than is generally appreciated, including by women themselves.
Several things contribute: changes in cholesterol profile, in how the body handles blood sugar, in blood pressure, and in the distribution of body fat.
Why it is under-recognised
Two reasons worth knowing.
Perception. Heart disease is widely regarded as a men's problem. Women consistently underestimate their own risk, and so do some clinicians.
Presentation. Women more often experience symptoms other than the classic crushing chest pain — breathlessness, nausea, jaw or back pain, unusual fatigue. These are more easily dismissed, by the woman experiencing them and by the system.
What helps
The list is unglamorous and well evidenced:
- Know your numbers. Blood pressure, cholesterol, blood glucose. Ask at your next appointment
- Move regularly. Aim toward the general guidance of 150 minutes of moderate activity a week, plus strength work twice a week
- Do not smoke. The single largest modifiable factor
- Limit alcohol
- Eat mostly whole foods, with attention to fibre and unsaturated fats
- Sleep. Poor sleep is independently associated with cardiovascular risk, which is one more reason to treat it seriously
A practical starting point
If you do nothing else, two resistance sessions a week is the highest-value change at this stage of life. It addresses bone, muscle mass, joint pain, metabolic health and mood simultaneously, and nothing else covers that range.
Getting started:
- Start lighter than you think. The first month is about learning movements, not testing limits
- Learn the basics properly. A few sessions with an exercise physiologist or a good trainer prevents months of unproductive or injurious training. An exercise physiologist may attract Medicare rebates under a chronic disease management plan
- Progress gradually. Slightly more weight, or one more repetition, over weeks
- Include impact if your joints tolerate it — even a minute of skipping counts
- Keep walking, for your heart and your head
- Expect it to take months. Bone remodels slowly. Consistency over years is what counts
If you have existing conditions, a previous fracture, or have not exercised in a long time, talk to your doctor before starting. That is a reason to get guidance, not a reason to skip it.
Related
Joint pain covers why movement helps rather than harms aching joints. Early menopause covers why bone health matters more, and earlier, for women whose menopause came before 45.