Menopause care

Bone & Heart Health

DEXA, lipids and the risk window after 45

In short

Bone loss accelerates around the last menstrual period, and cardiovascular risk changes after menopause as lipids, blood pressure and body composition shift. Both are largely silent until an event occurs, which is why structured assessment in the years around menopause is the most valuable preventive work available in women's midlife health.

Menopause was early or surgically induced
You have fracture, osteoporosis or heart-risk factors
You want a structured long-term health review
You are unsure which screening is useful

A woman doing weight-bearing exercise for bone strength

01Understand

What happens to bone

Oestrogen restrains the cells that break down bone. When it falls, resorption outpaces formation and bone density declines fastest in the years immediately surrounding the last period. That loss is silent. There is no symptom until a fracture occurs, often at the wrist, spine or hip, and vertebral fractures can happen without any recognised injury, presenting instead as height loss or back pain.

Indian data on vitamin D deficiency and dietary calcium intake are relevant here, as both are frequently inadequate. Add low body weight, smoking, a family history of hip fracture, long-term steroid use, thyroid disease, or menopause before 45, and the risk profile changes considerably. Identifying that profile early is the point of the assessment.

02Recognise

What happens to the heart

Cardiovascular disease is the leading cause of death in women, and much of the risk emerges after menopause. Total and LDL cholesterol tend to rise, HDL may fall, blood pressure often increases, insulin resistance and central fat gain become more common, and the protective effect associated with premenopausal oestrogen levels is lost. In South Asian women, cardiovascular risk tends to present at a younger age and at lower body mass index than in European populations, which makes earlier assessment more important, not less.

Women are also less likely than men to be screened, less likely to recognise atypical symptoms, and more likely to attribute breathlessness or fatigue to stress or ageing. A menopause consultation is a natural opportunity to review cardiovascular risk properly, because the woman is already in the room at exactly the age when it matters.

One transition, many signals

Symptoms rarely arrive in isolation.

A useful assessment connects the pattern across sleep, temperature, mood, cycles, bone and heart health rather than treating each symptom as a separate problem.

Hormonal transitionread as one pattern

Temperature

Sleep

Heart & bone

Mood & focus

03Assess

The assessment

A structured review typically includes blood pressure, weight and waist measurement, a lipid profile, fasting glucose or HbA1c, thyroid function, vitamin D and calcium where indicated, and a fracture risk assessment. DEXA bone densitometry is arranged where risk factors justify it, including early or surgical menopause, previous fragility fracture, long-term steroid use, or a strong family history. In India, DEXA is widely available in larger cities and results can be reviewed online.

The result of that work is a written risk picture rather than a list of numbers: what is currently increasing your risk, what can be modified, what needs treatment now, and what should be repeated and when. Where a specific medical treatment for bone or lipids is indicated, it is discussed and, where appropriate, coordinated with a physician or endocrinologist.

04Treat

What actually protects

Resistance training is the single most under-used intervention in Indian midlife women's health. Loading bone and building muscle protects bone density, improves glucose handling, supports balance and reduces fall risk. Two to three sessions weekly of progressive resistance work, alongside regular brisk walking, changes long-term outcomes more than any supplement.

Protein intake is often low in Indian vegetarian diets relative to what is needed to maintain muscle after 45, and calcium and vitamin D frequently need attention. Stopping smoking and moderating alcohol matter. Where hormone therapy is being used for symptoms, it also helps preserve bone density, and that benefit forms part of the overall discussion. Bone-specific medicines are considered where density or fracture risk warrants them.

05Review

Reviewing over time

Prevention is not a one-off appointment. Blood pressure and lipids are rechecked at intervals appropriate to the risk level, DEXA is repeated at intervals guided by the initial result and any treatment started, and the plan is revised as circumstances change.

Most of this can be managed online: results are reviewed together, changes explained, and further tests requested where indicated. In-person referral is arranged when examination or specialist input is needed.

What is involved

Assessment before prescription.

Listen

Your symptoms, cycle, medical history and priorities, with a structured symptom score for a baseline.

Assess

Relevant risk factors, blood pressure and investigations where they change management.

Plan

A written, individual plan with safety-net advice and a clear review point.

Preparing

Useful for a bone and heart review

Any previous fracture, and how it happened
Family history of hip fracture, osteoporosis or early heart disease
Recent lipid, glucose, thyroid and vitamin D results
Blood pressure readings if you monitor at home
Smoking, alcohol and current exercise pattern
Age at menopause, or date of ovary removal

Common questions

Bone & Heart Health: answers

When should a DEXA scan be done?+

It is arranged when risk factors justify it, such as early or surgical menopause, previous fragility fracture, long-term steroid use, low body weight or a strong family history, rather than routinely for everyone.

Does hormone therapy protect bone?+

Yes, hormone therapy helps preserve bone density and reduces fracture risk while it is being taken. Whether that is a reason to use it depends on the whole clinical picture.

Are calcium supplements enough?+

Usually not on their own. Adequate calcium and vitamin D matter, but resistance training, protein intake and, where indicated, specific bone medicines have a greater effect on fracture risk.

Why is cardiovascular risk assessed at menopause?+

Because lipids, blood pressure and body composition change around this time, and South Asian women tend to develop cardiovascular disease earlier. Assessment at this stage allows modifiable risk to be treated before an event.

This page is general information about menopause care and is not a diagnosis, prescription or treatment recommendation for any individual. Medicines, doses and suitability are decided only in consultation.

Related menopause care

Discuss bone & heart health with Dr. Sana.

Book an online consultation → Menopause overview

Online consultation

Select a date and time that suits you.

Difficulty booking? Contact us on WhatsApp

Book an online consultation →

Explore the practice

Bone & Heart Health

What happens to bone

What happens to the heart

Symptoms rarely arrive in isolation.

The assessment

What actually protects

Reviewing over time

Assessment before prescription.

Listen

Assess

Plan

Useful for a bone and heart review

Bone & Heart Health: answers

Perimenopause Care

Menopause Hormone Therapy

Premature Ovarian Insufficiency

Discuss bone & heart health with Dr. Sana.

Select a date and time that suits you.

Everything on this site, in one place.

About Dr. Sana

Fertility & IVF

Menopause

Consultations

Journal

Patient stories

Questions & answers

Consultation fees

Contact