If menopause had a social media profile, its relationship status with women’s health would be… “complicated”. Sure, the hot flashes and mood swings grab most of the headlines, but lurking quietly in the background is another issue: bone loss. Oestrogen is important when it comes to keeping bones strong. Once its levels dip during menopause, women become much more prone to osteoporosis.”Why Oestrogen Is Crucial Bone is a living tissue that constantly rebuilds and repairs itself. Oestrogen is what keeps this construction site running smoothly. “When oestrogen drops, the balance between bone building and bone breakdown collapses,” explains Dr. Pramila Kalra, Consultant, Department of Endocrinology, Ramaiah Memorial Hospital. This leads to bones that weaken faster than they can repair.And it’s not just an invisible problem on a scan. Weakened bones translate into fractures from the most minor of falls. Hips, spines, and wrists are the usual casualties. “To put it into perspective, women over 50 face a 15% lifetime risk of hip fracture, and recovering from one can seriously affect independence,” says Dr. Kalra.Understanding Hormone Replacement Therapy (HRT)“HRT replaces the hormones your body no longer produces enough of after menopause, and this can significantly slow down bone loss,” says Dr. Kalra. Not only does it help bones maintain their density, but in some cases, it can even nudge bone strength upwards.HRT isn’t a one-size-fits-all pill. It comes in forms that suit different lifestyles: tablets, patches, gels, and even sprays. For women with a uterus, progesterone usually joins the prescription party to protect the uterine lining. And along with stronger bones, many women also notice relief from hot flashes, night sweats, and that infamous menopause brain fog.Is HRT Right for You?Before you rush to the pharmacy, there are questions worth asking. “HRT works best for women who have severe menopausal symptoms or are at a high risk of osteoporosis,” says Dr. Kalra. Women who experience early menopause, particularly before age 45, are often strong candidates for HRT because their bones face years of oestrogen shortfall.Safety concerns around HRT have caused plenty of headlines in the past. But newer research has changed the conversation. “When HRT is started within 10 years of menopause and before age 60, the benefits outweigh the risks for most women,” explains Dr. Kalra.Still, the risks are not zero. There may be a slight increase in the chance of blood clots or breast cancer depending on personal health, the type of HRT, and how long it’s used. “That’s why an individualised discussion with your doctor is crucial. It’s about weighing your personal benefits against possible risks,” she stresses.A Bigger Bone Health PlanDr. Kalra recommends thinking beyond medication. A diet rich in calcium and vitamin D, regular exercise—particularly weight-bearing workouts—and avoiding smoking and excessive alcohol are all essential. “HRT is most effective as part of a holistic bone health plan,” she says.The Need for Personalised CareThere’s no “universal prescription” for menopause management. “The decision to start HRT must be highly individualised,” advises Dr. Kalra. Your doctor will consider your family history, existing health conditions, and results from a bone density scan. Together, you can discuss the type, dose, and duration of therapy that best fits your needs.The conversation should cover not just symptoms but also your future risks. “It’s not about erasing menopause—it’s about empowering women to make informed choices so they can stay active and independent for years to come,” says Dr. Kalra.Menopause may be inevitable, but brittle bones don’t have to be. With the right support, including HRT where appropriate, women can safeguard their bone health and dramatically reduce their risk of fractures. “Think of it as investing in your future mobility and independence,” Dr. Kalra concludes.