No one tells you how expensive it is to be in your 50s. Between protein shakes, omega-3s, vitamin D, magnesium, kettlebells, and my black weighted vest, I sometimes feel like I’m completely overwhelmed and swamped with too many things! My neighbors have, of course, told me in many polite ways how crazy I am, but here’s the truth – I’d rather look ridiculous now than feel helpless later.
Let me tell you about my mother and my mother-in-law. Two women from opposite corners of India, two very different diets, two very different lives. And yet, today in their 70s, both live with osteoporosis. Both have had joint replacements— one after a fall, one by choice. Both live with chronic pain. Both amble, carefully, with balance issues that shrink their world a little more each year.
Neither of them was told about the connection between menopause and bone health. Neither knew how deeply estrogen or the lack of it would shape their future.
Did you know menopause can reduce bone density by up to 25%? A direct result of estrogen loss means that 1 in 2 women above 50 will experience an osteoporotic fracture. In India, osteoporosis often arrives 10–20 years earlier than in the West, thanks to low-protein diets, lack of resistance training, and yo-yo dieting. A direct result of estrogen loss means that 1 in every 2 women above 50 will experience a hip, spine, or wrist-related osteoporosis.
Maximum bone density is built before the age of 30. As we grow older, physical activity alone can no longer increase overall bone mass dramatically. In adults, bone density may increase 1 to 2 %, but this increase occurs only in the area of the skeleton that is stressed. In extremely simple science, to build stronger bones, a much higher load or a greater compression and bending is needed to encourage our bodies to spend the necessary energy and resources. Also known as Osteogenetic loading.
This load put on the bone can be measured in terms of multiples of body weight. The higher the load, the better able the activity is to stimulate more bone growth. Most physical activity loads bone to a degree, but for strong osteogenic stimulation, the load needs to reach around 4 times body weight. As per research, Calculations of multiples of body weight look like this for common physical activities in relation to bone density.
After menopause, women’s risk for heart disease skyrockets. Estrogen normally improves insulin sensitivity and maintains favorable cholesterol. Without it, blood sugar regulation worsens, arteries stiffen, and inflammation rises. By age 60, heart disease is the #1 killer of women. Men tend to develop heart disease earlier than women, but by age 65, the risk of heart disease in females is equal to that of men. One main reason could be that estrogen is protective in women, and then the sudden catch-up is due to its decline.
Estrogen binds to receptor sites in your liver, affecting the genes involved in lipid metabolism. This metabolism controls the way your body breaks down, stores, and utilizes fats. It also plays a key role in the formation and removal of high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterols. Estrogen also helps in the increased production of Nitric Oxide, a vasodilator that relaxes and widens blood vessels. It helps regulate blood pressure and ensures proper blood flow to deliver oxygen and nutrients to tissues – many women will see a sudden spike in their blood pressure during perimenopause, and very few even connect the two.
Then there’s breast cancer. Estrogen is involved here, too, but the picture is more complex than “estrogen = bad.” The real story is about estrogen metabolism and how your liver and gut break it down. Poor detox pathways and chronic stress tip the balance toward harmful metabolites. Again, low NO production is critical in cellular renewal, production of antioxidants like glutathione and NADH, all having implications on aging and oxidative stress.
Here’s the truth that shocked me: Women are twice as likely as men to experience depression, and are 3 times more likely to be diagnosed with autoimmune disorders that attack the brain, such as multiple sclerosis. Women also carry a higher risk of Alzheimer’s Disease.
We aren’t just “moody” or “foggy,” our brains are literally changing.
It was as late as the mid-1990s that researchers discovered how deeply estrogen shapes other systems. Two brain regions are especially vulnerable when estrogen declines.
When estrogen drops, neurons literally slow down. Connections weaken. Amyloid plaques, one of the hallmarks of Alzheimer’s, may begin forming. What many women dismiss as “brain fog” or midlife depression could be their brain’s early warning signal.
A 2023 study in Nature Reviews Neurology showed that dementia-related changes often begin 10–20 years before symptoms appear, right around menopause for many women.
“Menopause is not just a reproductive transition; it is a neurological one.” Dr. Lisa Mosconi, a neuroscientist and author of The XX Brain.
Worldwide, a lot of research still needs to be done, and women are still underrepresented in many clinical trials. In fact, till as late as 1993, women were not even included in clinical trials,
Women shouldn’t be in a ‘special populations’ category,” says Martha Gulati, MD, a cardiologist at Cedars-Sinai Heart Institute & who specializes in women’s hearts & heart disease prevention.“It’s important to study women to find out how to care for [51%] of the population. We are the majority of the population. So, although women are special, we are not a ‘special population.’”
Though the discussion around menopause has started in India, it is still not enough and is still very vague and unclear. As with many women, we still tend to think of menopause as purely hormonal, a loss of estrogen, some hot flashes, some weight gain freedom and eventually freedom from periods. But in reality, estrogen is like Wi-Fi for the body, invisible, but connecting everything. By the time most women reach out for a doctor, they already live with osteoporosis, depression, or diabetes. And culturally, many of us accept this silently. We tell women- “adjust, ignore, endure.” But the cost of silence is staggering.
Hormone Replacement Therapy (HRT) is controversial, but the science has shifted in the last decade. The early 2000s Women’s Health Initiative study raised alarms about cancer risk, but re-analyses show that for many women, especially those under 60 and within 10 years of menopause, HRT can be protective for brain, bone, and heart health for certain women.
It’s not for everyone, but it’s worth an informed conversation with a doctor who understands the latest science.
So is everything bad – of course not. It can be for the better. Like everything else, the Japanese always have a beautiful word for menopause and call it. Kōnenki. This means “years of renewal, regeneration, and energy.” Imagine if we saw it not as an ending but as a beginning, an invitation to rebuild, reimagine, and reclaim strength.
So yes, I lift heavy things. Yes, I take my magnesium and omega-3s. Yes, I’ll keep choosing prevention over denial. Yes, some of the costs of a gym membership, trainer, and supplements may be high, but I’ve seen the cost of not investing -surgeries, medications, and a loss of independence.
So if you’re in your 40s or 50s and reading this, don’t adjust, ignore, or endure. Lift, learn, eat, and rest. Invest in your bones, your heart, your brain. Because estrogen may fade, but energy, strength, and clarity can be rebuilt.
Menopause is not a moment; it’s a transition. And like any transition, it’s easier when you have a map. Here are some essentials to discuss with your doctor and track for yourself:
Tests & Markers to Ask For
