“The most important long-term effect of reduced oestrogen involves the effects on the skeleton,” says Dr Heather Currie, founder of Menopause Matters and an associate specialist gynaecologist and obstetrician at Dumfries and Galloway Royal Infirmary.
“With age and reduced oestrogen levels, particularly when the menopause occurs before the age of 45, there is an increased risk of progressive loss of bone strength leading to bone thinning and fragility (osteoporosis),” she adds.
Osteoporosis literally means porous bones. Bone loss affects both men and women as they age but it occurs more rapidly in women, so that osteoporosis is more common in women than men. Osteoporosis is defined as low bone mass and deterioration of bone tissue, leading to an increase in bone fragility and susceptibility to fracture.
Fractures can significantly reduce quality of life, independence and, in the case of hip fracture, can shorten life. It has recently been estimated that by the age of 70, one in two of all women will have had a fracture related to osteoporosis.
“Development of osteoporosis in women is influenced by the strength of the bones before the menopause (peak bone mass being achieved in the 20s and being influenced by weight bearing exercise, diet adequate in calcium and vitamin D and by genetic influences), the age of menopause and the rate of bone loss with menopause and age,” explains Dr Currie.
The importance of weight-bearing exercise
A healthy diet and lifestyle are very important not only at menopause, but also in early years to build up peak bone mass. “The best thing for your bones is weight-bearing exercise,” says Dr Currie. Bones need to be used to keep them strong and healthy. Weight-bearing exercise, the type that involves putting force through your bones, includes activities such as walking, jogging, running, tennis and aerobics. Try and find an activity that you enjoy, and make simple changes to your daily routine, such as walking to the shops to buy a paper, rather than having it delivered, and taking the stairs, rather than a lift.
A well-balanced diet
Dr Currie also advocates that you: “Eat a well-balanced diet, with plenty of calcium and vitamin D.” Calcium is the main nutrient required for strong bones, so incorporating foods which are rich in calcium is essential. Aim for around 700mg calcium daily, which is the equivalent of a pint of semi-skimmed milk per day. Other sources are: oily fish, green leafy vegetables, bread, cereals, dried fruit, pulses, beans and seeds. With a balanced diet, you shouldn’t need to supplement calcium.
An adequate intake of vitamin D is also required for calcium to be absorbed properly. Good dietary sources of vitamin D include dairy products, oily fish, fortified margarine and eggs, however most of our vitamin D comes from the action of sunlight on the skin. “There is some debate around the need for vitamin D supplements in the UK, where we don't get enough sunshine over the winter months,” says Dr Currie.
Avoid caffeine and alcohol
“Avoid excess caffeine, by limiting tea, coffee and fizzy drinks, as caffeine affects the absorption of calcium,” says Dr Currie. “Also, reduce your intake of alcohol.”
Excessive alcohol is detrimental to bones; you shouldn’t exceed the government’s recommended limits, which is less than 14 units per week for women. One unit is the equivalent of a small glass of wine, one pub measure of spirit or half a pint of normal strength beer, lager or cider.
Smoking can also hasten bone loss, as well as cause an earlier menopause.
For more information on how to manage your symptoms visit Menopause Matters.