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.

Nigeria is intensifying efforts to expand access to Multiple Micronutrient Supplements (MMS) for pregnant women, with health authorities pushing for increased local production and sustainable financing to reduce dependence on donor support.

The move was highlighted on Thursday in Abuja during a validation meeting on findings from the 2025 Market Landscaping and Segmentation Analysis.

Speaking at the event, Olufunmilola Adegbite, Director and Head of the Nutrition Department at the Federal Ministry of Health and Social Welfare, said strengthening domestic manufacturing would be crucial to achieving the country’s maternal health targets.

“Local production will be critical in achieving the country’s ambition for reaching pregnant women with MMS and ensuring long-term sustainability,” she said.

According to Ms Adegbite, local manufacturing would improve the availability of supplements, reduce dependence on imports, and protect supply chains from global disruptions.

Six-state study

The 2025 market landscape analysis covered Lagos, Kano, Bauchi, Imo, Niger and Bayelsa, selected to reflect Nigeria’s diverse geographical zones and market segments.

Commissioned by the Federal Ministry of Health and Social Welfare in collaboration with Sight and Life and the development Research and Projects Centre (dRPC), the study examined financing systems and broader implementation requirements needed to support nationwide MMS scale-up.

Researchers assessed existing health financing mechanisms alongside key implementation enablers, including supply chains, regulatory frameworks and stakeholder engagement.

Why MMS matters

MMS are daily antenatal supplements containing iron, folic acid and other essential vitamins and minerals needed to support maternal nutrition and healthier birth outcomes.

Unlike conventional iron-folic acid supplements, MMS provide a broader range of micronutrients.

Evidence suggests the intervention can further reduce the risks of low birth weight, preterm delivery and other adverse pregnancy outcomes.

Ms Adegbite said Nigeria has made significant progress in aligning with global maternal nutrition standards.

According to her, MMS was approved for use in 2021, incorporated into the National Essential Medicines List and integrated into national guidelines on micronutrient deficiency control and antenatal care management.

“These achievements demonstrate Nigeria’s commitment to improving maternal and newborn nutritional outcomes,” she said.

Financing remains critical

Despite these policy gains, Ms Adegbite said considerable work remains to ensure effective implementation and wider access.

She identified sustainable financing as a major requirement for expansion, noting that mechanisms such as the National Health Insurance Authority (NHIA), the Basic Healthcare Provision Fund (BHCPF) and dedicated federal and state budget allocations could help support broader coverage.

She added that findings from the market analysis would provide evidence to guide policy decisions, investment priorities and implementation strategies.

Although progress has been made in institutionalising MMS, she said challenges persist in supply systems, regulation, financing and stakeholder coordination.

Concerns over donor dependence

In her remarks, the Country Manager of Sight and Life, Zainab Abubakar, said the study sought to identify sustainable pathways for financing MMS within Nigeria’s health system.

Ms Abubakar noted that inadequate funding, limited insurance coverage and heavy reliance on out-of-pocket spending continue to restrict access to maternal nutrition services.

“The research assessed the health financing landscape in Nigeria to identify viable pathways for sustainable domestic financing,” she said.

“It explored opportunities for resource mobilisation, evaluated potential funding mechanisms, highlighted implementation bottlenecks and developed context-specific recommendations.”

‘Women’s issues need funding’

Also speaking, the Special Adviser to the President on Health and dRPC board member, Salma Anas, called for stronger political commitment to maternal nutrition programmes.

Ms Anas said anaemia in pregnancy remains a major public health challenge and urged leaders to prioritise investments that benefit women and children.

According to her, programmes targeting women and children often struggle to attract adequate funding because they are incorrectly viewed as issues affecting only women.

“Every woman’s issue is a man’s business,” she said.

“Let us do away with the woman’s issue. Let’s budget it. Let’s release it and let it be used for the intended purpose.”

Background

Nigeria adopted MMS following global recommendations and growing evidence that the intervention provides greater nutritional benefits than traditional iron-folic acid supplements.

According to UNICEF, MMS contains 15 essential vitamins and minerals and has become the global reference standard for maternal micronutrient supplementation.

READ ALSO: Study ranks Lagos and Kano as the most ready for maternal supplement rollout

PREMIUM TIMES reported in 2024 that the federal government distributed about 1.3 million bottles of MMS to pregnant women across 12 states during the early phase of implementation.

UNICEF later announced that Nigeria would receive an additional 3 million bottles in 2025 through the Child Nutrition Fund, following the delivery of 3 million bottles in 2024.

However, with an estimated 12 million pregnancies recorded annually, stakeholders say existing supplies remain insufficient, highlighting the need for expanded coverage and stronger domestic investment.

They argue that shifting from donor-dependent supply chains to local manufacturing and market-based financing mechanisms will be essential to ensuring the long-term sustainability of MMS scale-up.