How to maintain bone health

by Etsuko Ueda 

Now that we identified the primary culprits in menopausal bone erosion (see Menopause Bone Series Articles), the strategy is self-evident in most part, which is no different from what we already know for improving general health.
First of all, it is not inevitable to develop osteoporosis or osteopenia in your 50s and 60s. It is only 1 in 3 women over 50 who will experience osteoporotic fractures. 2 in 3 will either die before it, or survive without. There was an interesting study that demonstrated that healthy women can maintain  bone mineral density in thier 50s and 60s by taking daily multivitamins and 1200 mg of calcium, even when suffering menopausal symptoms (Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. H B Leonetti, S Longo, J N Anasti, 1999).
However, we don't know if the same thing can be said about bone quality. In any case, weakening of bone is largely preventable, and it is best to avoid the things that may increase the risk.
Even if your bones have eroded substantially, it is still not too late to act. You can strengthen your bones at any age. The well known factors that tip the bone remodeling balance in favor of healthy bone formation are

  •  Overall nutrition:
  • Hormones: smart management of estrogen dominance and menopausal transition
    • Women can use low dose transdermal progesterone as needed bases throughout her adult life to keep the maximum bone building activity. By early 40's, you may find it necessary to stay on it to augment the declining progesterone secretion in order to protect your uterus, ovaries, breasts, brain, bone, etc. from elevated estrogen and cortisol. When you start to see the indications of declining estrogen, such as hot flashes and foggy brain, along with skipped periods, it is time to start ultra low dose of transdermal estradiol (provided you are already on progesterone see Safe & Effective Natural HRT) to minimize the stress (cortisol and norepinephrine) of menopausal symptoms. 
    • To ensure maximum bone build up before you reach the age when bone erosion seems unavoidable (whether bone erosion in old age is unavoidable or not is far from certain, though). If you lead a stressful life and prone to have periods with low progesterone, you will lose the opportunities to build up your bones that much more. Taking low dose transdermal progesterone as needed bases will help you get back on track. 
    • To ensure good circulation: Estrogen and progesterone are big part of healthy cardiovascular system and circulation as I reviewed in Menopausal Symptoms And Cardiovascular Health. Estrogen and progesterone are also important in controlling hot flashes as well as stress, tension, and anxiety, all of which raise cortisol, adrenalin, and sympathetic nerve activity (norepinephrine) that create a restricted blood flow pattern. Hypertension is an indication of such blood flow pattern and ultralow dose transdermal Estrogen and real Progesterone can help (Transdermal Delivery of Estrogen and Progesterone Improves Blood Pressure in Menopausal Women with High Stress). 
    • To eliminate menopausal symptoms:  Suffering severe and prolonged menopausal symptoms is the number one culprit of menopause bone erosion for most people. The root cause of menopausal symptoms is low estradiol and low progesterone, and nothing else can completely eliminate the symptom effectively and safely. If you think hormones are dangerous, you don't know the whole story. As I explained in Hormones: Dos and Don'ts and Safe Use of Hormones: the Hard Evidence,  there is a well established way to use them safely and effectively.
Cortisol and Stress management:
Relaxation is also important. Relaxation can even help reduce menopausal symptoms (see Menopausal Symptoms And Underlying Mechanism). During the premenopause and perimenopause years, stress not only increases cortisol, but it can also suppress progesterone secretion (Stress and female reproductive function: a study of daily variations in cortisol, gonadotrophins, and gonadal steroids in a rural Mayan population. Pablo A Nepomnaschy, Kathy Welch, Dan McConnell, Beverly I Strassmann, Barry G England 2004; Stress and the menstrual cycle: relevance of cycle quality in the short- and long-term response to a 5-day endotoxin challenge during the follicular phase in the rhesus monkey. E Xiao, L Xia-Zhang, A Barth, J Zhu, M Ferin 1998; Inadequate luteal function is the initial clinical cyclic defect in a 12-day stress model that includes a psychogenic component in the Rhesus monkey. Ennian Xiao, Linna Xia-Zhang, Michel Ferin. 2002), thus amplifying the negative effects of stress. That is why it is important to loosen the grip of stress by boosting progesterone by real progesterone in cream form now and then long before menopause.
Note: A wrong hormone supplementation can raise cortisol level, not to mention unpleasant side effects, cancer, and blood clot risks as well as elevated homocysteine and suppression of bone building.
Oral estrogens and progesterone mimicking drugs increase cortisol, while ultra-low dose transdermal estradiol reduces it. Although it is well known that even the ultra-low dose transdermal estradiol is not safe if taken without real progesterone (see Safe Use of Hormones: the Hard Evidence), and oral progesterone is detrimental to calcium metabolism as I reviewed in this Bone Series articles, no researchers has examined what adding low dose transdermal real progesterone to ultralow dose transdermal estradiol will do to cortisol activities or its level, so far.

Bone series articles:

  1. Menopause and What Really Happens to your Bones
  2. False Promise of Fosamax
  3. Estrogen Paradox
  4. Role of Progesterone in Bone Health
  5. Stress Hormones Destroy Bones
  6. Menopause and How estrogen helps bone health?
  7. Sad State of Progesterone Research
  8. Bone Quality Is Just as Important as Density
  9. How to Maintain Bone Health  <<You are here


  1. I also have not felt functional on the 200 mg progesterone, Prometrium brand. Even the 100 mg felt like too much, even in the compounded dry version, although the latter was better than the Prometrium brand. I tried Dr Lee's Progesterone cream as well, and with this it is possible to use smaller amounts. I still easily feel sedated. This cream does not have a pre-measured pump, so it is hard to tell how accurate I am with each application. Is there a progesterone cream that you have found to be effective? I read somewhere on your site that you prefer a supplement/vitamin company brand over a compounded formula.
    Thank you!
    PS. Amazing amount of information on your blog. Thank you.

  2. I use Unicity's Wild Yam Cream, but Dr Lee's Progesterone cream should work the same. If you feel too sedated, just reduce the amount or apply divided into two or three times a day. It is not necessary to apply some exact amount. Your body does not secrete an exact amount every time either. Your aim it to feel good and calm, to reduce stress level.


Before you post your HRT questions, please try what I think safe and effective for at least 3 months: estradiol 0.025~0.050mg/day patch, with 20~40mg/day progesterone cream (about 1000mg progesterone in 2oz cream). You can also add DHEA 5~10mg /day.
That is the only recommendation you will get from me.