Menopause is associated with a reduction in bone density due to falling levels of estrogen. Estrogen helps to protect bone strength. Therefore, estrogen replacement therapy (ERT) is used in those with premature menopause to maintain bone density and reduce the risk of osteoporosis.

What level of ERT (Estrogen Replacement Therapy) do I need to maintain bone health? 

In surgical menopause, the current recommendation is to maintain the level of ERT that keeps vasomotor symptoms (hot flashes, night sweats) at bay.  At the present time, there is no evidence supporting a “correct” or “optimal” level of ERT dosing (or blood level of estrogen) that protects bones in everyone; it appears that the optimal dosing of ERT is unique to each individual.  Therefore, experts recommend that ERT dose be adjusted on an individual basis to (1) achieve remission of menopausal symptoms (especially hot flashes and night sweats) while also (2) minimizing any risks of ERT (taking into consideration each woman’s individual risk profile).

There are lots of additional ways to protect your bone health, including staying active, weight bearing & high impact exercise, resistance exercise, and a healthy balanced diet rich in calcium and vitamin D. Quitting smoking and reducing alcohol intake are also important for reducing risk of osteoporosis. 

Should I have my bone mineral density tested? How often? 

Assessment of bone mineral density (DEXA scan) should be considered at the time of surgical treatment (start of surgical menopause) to evaluate your individual risk level for osteoporosis. The frequency of repeated bone density assessment should be guided by your individualized risk (e.g., not taking HRT, family history, smoking) for developing osteoporosis. Talk to your doctor about whether and how frequently your bone mineral density should be monitored.

More Information: 

https://thebms.org.uk/publications/consensus-statements

https://www.nhs.uk/live-well/healthy-body/menopause-and-your-bone-health/


Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.

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