If there is one thing to take seriously and early in perimenopause, it is your bones. Bone loss accelerates sharply during the perimenopausal transition and the first few years after menopause — and unlike many symptoms, it happens silently, with no warning signs until a fracture occurs.
The good news is that this is one of the most preventable parts of the transition. What you do in your 40s, before and during perimenopause, has a larger effect on your bones for the rest of your life than almost anything you do later.
Why Perimenopause Is the Critical Window
Oestrogen does not just regulate your cycle. It is one of the main protectors of bone in the female body. It slows the activity of cells that break bone down (osteoclasts) and supports the cells that build bone up (osteoblasts). As long as oestrogen is steady, bone is constantly renewed in balance.
When oestrogen begins to fall and fluctuate in perimenopause, that balance tips. Bone is broken down faster than it is rebuilt. Women can lose a meaningful percentage of their bone density in the few years surrounding the final period. This is the single fastest phase of bone loss in a woman’s life.
In India this matters even more. Bone density is on average lower in Indian women than in many Western populations, vitamin D deficiency is extremely common despite the sunshine, and calcium intake in many traditional diets falls short of what bones need. The combination means osteoporosis often arrives earlier and is underdiagnosed.
What Actually Protects Bone
Weight-bearing and resistance exercise. This is the most powerful thing you can do, and it is often the most neglected. Bone responds to load. When muscles pull on bone and when bone bears your body weight, it signals the body to build and maintain density. Walking is good but not enough on its own. What bones respond to most is resistance training — lifting weights, using resistance bands, bodyweight exercises like squats and push-ups — and impact, such as brisk walking, stair climbing, or dancing. Aim for strength work two to three times a week. It is never too late to start, and the benefit is real at any age.
Calcium from food first. Adult women need a substantial daily amount of calcium, and the need does not drop in perimenopause. Food sources are better absorbed and safer than relying on supplements alone. Indian diets offer many good sources: milk, curd, paneer, ragi (finger millet, exceptionally high in calcium), sesame seeds (til), almonds, green leafy vegetables like methi and amaranth, and small fish eaten with bones. If you eat dairy and ragi regularly, you may already be close to your target.
Vitamin D, which most Indians lack. Calcium cannot be absorbed without vitamin D, and deficiency is the rule rather than the exception in India — including in sunny cities, because of indoor lifestyles, clothing, and skin pigmentation. This is one situation where testing and, if needed, supplementing under medical guidance makes a real difference. Ask your doctor for a vitamin D blood test.
Protein. Bone is not just minerals — about half of bone is protein. Many Indian women, especially vegetarians, eat less protein than they need. Include dals, beans, paneer, curd, eggs, soya, and nuts across the day.
Stopping smoking and limiting alcohol. Both accelerate bone loss directly. If you smoke, this is one more strong reason to stop.
What Quietly Harms Bone
Crash dieting and being significantly underweight reduce bone density — body fat is not the enemy of bone that diet culture suggests. Excessive caffeine in very large amounts can slightly reduce calcium absorption. A completely sedentary routine, even in a slim person, allows bone to weaken because it is never loaded. And very high salt intake increases calcium loss through urine — relevant for many Indian diets high in pickles, papad, and processed snacks.
Should You Get a Bone Density Test?
A bone density scan (DEXA) measures bone strength painlessly. It is worth discussing with your doctor if you have risk factors: a family history of osteoporosis or hip fracture, early menopause, a small or thin frame, a history of low body weight or eating disorders, long-term steroid medication use, or a previous fracture from a minor fall. For women with these risks, a baseline scan during perimenopause is reasonable. Your doctor can advise on timing.
Where HRT Fits
Hormone replacement therapy is one of the most effective treatments for preventing bone loss, because it replaces the oestrogen that was protecting bone in the first place. For women who are also managing other perimenopausal symptoms, bone protection is one of its well-established benefits. Whether HRT is right for you is a personal decision to make with your gynaecologist, weighing your full health picture. It is worth asking about specifically if bone health is a concern.
When to See a Doctor
Routine appointment to ask about a vitamin D test, your calcium and protein intake, and whether a bone density scan is appropriate for you. This is a good conversation to have early in perimenopause rather than after a problem appears.
Promptly if you experience a fracture from a minor fall or knock, a noticeable loss of height, or a new stooping of the upper back — these can be signs that bone loss has already advanced and needs assessment.
Bones give no warning. The work you do for them now is invisible until the day it quietly protects you. Start before you can feel the difference.
The Second Spring is an information resource, not a medical provider. For personal advice, speak with your doctor or gynaecologist. Write to us at thesecondspringofficial@gmail.com
