Menopause, the natural stage marking the end of a woman’s reproductive years, can significantly affect bone health and increase the risk of osteoporosis and fractures due to declining oestrogen levels, a medical expert has said.

Although menopause has important health implications, it remains a frequently overlooked issue within Nigeria’s sexual and reproductive health and rights framework.

According to the World Health Organisation (WHO), menopause occurs when a woman’s menstrual periods stop permanently because of declining levels of oestrogen and the loss of ovarian follicular function. As a result, the ovaries stop releasing eggs for fertilisation, making natural conception no longer possible.

Common symptoms associated with menopause include hot flushes, night sweats, irregular menstrual flow, vaginal dryness, pain during sexual intercourse, urinary incontinence, sleep disturbances, mood changes, anxiety and depression.

Perimenopause refers to the transition period leading to menopause and extends until one year after the final menstrual period, while postmenopause begins after a woman has gone 12 consecutive months without menstruation.

In Nigeria, women generally attain menopause around the age of 48 and above as part of the natural ageing process.

Menopause and bone health

Speaking with PT Health Watch, Qudus Lawal, an obstetrician and gynaecologist, said menopause disrupts hormonal balance, leading to increased bone breakdown and reduced bone formation.

According to him, while nearly all women experience some degree of bone loss after menopause because of declining oestrogen levels, not all will develop osteoporosis or sustain fractures.

He explained that bone density before menopause plays a major role in determining a woman’s risk of osteoporosis later in life.

Using a financial analogy, Mr Lawal described bone health as a balance between deposits and withdrawals.

“The stronger the bone density a woman builds before menopause, the better protected she is against the accelerated loss that occurs afterwards,” he said.

Why bone loss increases after menopause

Mr Lawal explained that oestrogen normally suppresses osteoclasts, the cells responsible for breaking down bone tissue.

However, when oestrogen levels fall after menopause, these cells become more active, while osteoblasts, the cells responsible for building new bone, are unable to replace bone at the same rate.

This imbalance gradually weakens bones and increases the risk of osteoporosis and fractures.

Maintaining healthy bones after menopause

Mr Lawal recommended a combination of proper nutrition, regular exercise and preventive healthcare measures to maintain bone health after menopause.

He advised women to consume balanced diets rich in calcium and vitamin D, engage in weight-bearing and muscle-strengthening exercises, and take steps to prevent falls.

“When you take foods and supplements that are rich in those essential nutrients, it helps build the bone,” he said.

He stressed the importance of early intervention, noting that bone density loss is often silent and may not produce symptoms until complications occur.

“One of the ways people present is that they grow shorter. Normally, once you get to a certain age after puberty, you are not supposed to grow shorter.

“But many of our mothers begin to lose height over time, which may result from age-related spinal degeneration and bone loss,” he said.

According to him, many women only become aware of significant bone loss after suffering fractures.

“The fracture can be due to a fall, sometimes a little push that you normally have without having symptoms. Just a little trip in the bathroom could lead to a major fracture,” he added.

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Mr Lawal noted that in some countries, bone density screening forms part of routine wellness checks for postmenopausal women, helping identify individuals at high risk and allowing for early intervention.

He urged women to adopt healthy lifestyles and prioritise bone health long before menopause.

According to him, the goal is to ensure women build and maintain strong bone density before menopause to minimise the impact of hormonal changes later in life.