For generations, women have been told that menopause is a temporary phase — something to “get through.” Yet for many, the story doesn’t end when the hot flashes fade. Menopause is not a single moment in time but a permanent biological state with long-term implications for our bones, hearts, brains, and overall vitality. On this World Menopause Day, as we focus on bone health, it’s worth reframing how we talk about life after our ovaries retire — and why estrogen plays a far greater role in lifelong health than many realize.

The Myth of “Getting Through”

Menopause marks the end of ovarian estrogen production — not the end of its importance.
Once estrogen levels decline, a new hormonal baseline is established. The symptoms that dominate early menopause (night sweats, mood changes, disrupted sleep) may ease, but the physiologic effects of low estrogen persist. The quiet shifts that follow — in bone density, vascular function, metabolism, and cognition — often unfold silently over years or decades.

Telling women they simply “get through” menopause is like telling someone they “got through” aging. It minimizes the biological transformation and ignores the preventive opportunities available when we understand and can better address the long-term consequences.

Estrogen and the Skeleton: The Hidden Half-Life of Menopause

Bone is not static — it’s living tissue constantly remodeled by cells that build and break it down. Estrogen acts as a powerful regulator of this balance. When estrogen falls, bone resorption outpaces bone formation, leading to an accelerated decline in bone density that is most rapid in the first five years after the final menstrual period.

By the time most women reach their mid-60s, one in two will have experienced a fracture related to osteoporosis. These fractures are not just inconvenient; hip and vertebral fractures carry significant morbidity, loss of independence, and even increased mortality.

The tragedy is that this is largely preventable. Early recognition of bone loss and appropriate use of lifestyle strategies, calcium and vitamin D optimization, resistance training, and — for many women — hormone therapy can preserve bone strength and reduce fracture risk.

The Heart’s Estrogen Connection

Cardiovascular disease remains the leading cause of death for women, yet risk is often underestimated. Before menopause, women have a natural advantage: estrogen supports the flexibility of blood vessels, improves lipid profiles, and helps maintain glucose balance.

After menopause, this protection diminishes. LDL cholesterol rises, arteries stiffen, and inflammatory pathways activate — all contributing to a higher risk of atherosclerosis and heart disease.

While hormone therapy is not prescribed primarily for cardiovascular prevention, evidence shows that initiating estrogen therapy in early menopause (typically within 10 years of the final menstrual period) may support vascular health and reduce long-term risk when individualized to a woman’s profile. The key is timing and tailoring.

When Bone and Arteries Speak the Same Language

Bone loss and arterial calcification — two seemingly opposite processes — are biologically intertwined. Both are influenced by estrogen deficiency and share similar molecular pathways involving calcium, phosphate, and regulatory proteins that govern mineralization.

In healthy bone, estrogen suppresses osteoclast activity and supports the proteins that keep calcium in the skeleton where it belongs. When estrogen declines, bone resorption releases calcium and phosphate into circulation, while vascular smooth muscle cells can begin to behave like bone-forming cells, depositing calcium into arterial walls. The result: weaker bones and stiffer arteries.

Women with low bone mineral density are more likely to have elevated coronary artery calcium scores, reflecting this shared biology. Supporting skeletal health through hormonal balance, weight-bearing activity, and adequate micronutrients can, in turn, support vascular resilience — another reason why comprehensive menopause care must address both systems together.

The Bigger Picture: Thriving, Not Just Surviving

Women today can expect to live more than a third of their lives in the postmenopausal state. This longevity brings both opportunity and responsibility — to approach midlife as a pivot point rather than a decline.

Bone density scans, lipid and glucose assessments, and thoughtful hormone discussions are not indulgences — they’re preventive medicine. The more we understand about estrogen’s role in maintaining musculoskeletal and cardiovascular integrity, the better we can support vibrant, active, independent aging.

Reclaiming Menopause

At Reclaim Menopause, we believe menopause care should not end with symptom control. It should empower women with knowledge, data, and choices — to preserve bone, protect the heart, and optimize quality of life for decades to come.

Menopause is not something you “get through.” It’s something you learn to live well within.

Call to Action

October is World Menopause Month, take one step toward your long-term health:

• Ask your provider about a DEXA scan to understand your bone health baseline.
• Review your lipid profile, glucose metabolism, and blood pressure.
• Revisit whether hormone therapy might be appropriate for you — especially if you’re within 10 years of menopause.

Let’s move beyond endurance and toward empowerment. Our bones, hearts, and futures depend on it.

About the Author

Dr. Laura Duncan is a physician and founder of Reclaim Menopause, PLLC, a membership-based medical practice devoted to thoughtful, evidence-based care for women in perimenopause and menopause. Dr. Duncan partners with women to navigate midlife with clarity, confidence, and prevention — without the barriers of traditional healthcare models.

Learn more or schedule a consultation at ReclaimMenopause.com.