Menopause and Bone Health: Ayurvedic Guide to Strength

Menopause isn't just a day on the calendar that marks the cessation of the menstrual cycle. It's a full-body transformation. Like puberty in reverse, menopause is a process that gradually (though sometimes it feels like it's happening overnight!) changes the structures and processes of our body, mind, and spirit. The intricacies of these changes are myriad, erratic, bewildering, and awe-inspiring, but on the whole we might describe their general direction as inward. Even our bones are part of this turning inward—bone health in menopause becomes a quiet but central concern, as shifting hormones reshape the very framework that holds us up.

Like a plant blossoming in the summer sun, bearing fruits and flowers and tantalizing the bees and birds with her scent and color, a woman’s life between puberty and menopause is externally oriented: toward growth, expansion, connection, and fertility (through pregnancy and/or childbirth and/or other creative pursuits). In Ayurveda, we say this season of life is dominated by the pitta doṣa, a bioenergetic force that, like summer itself, is hot, penetrating, and motivating. 

During perimenopause and afterward, the body follows the path of the earth as it transitions from summer to fall. We reap and celebrate our harvests, but the energy of our lives and attention shifts. Rather than expanding and spreading, our practices and behaviors orient around maintaining and preserving. A common misunderstanding about this season of life (and of the year), dominated by the ethereal, subtle, and mobile vāta doṣa, is that life is coming to an end. The fruits and flowers that once radiated juiciness and nutrition wither and fall, and we are left with a barren landscape. Similarly, the vāta stage of life, especially for women, has been infused with a cultural narrative of purposelessness, rejection, and shame. If a woman can’t reproduce, if she doesn’t look like she did in her “fertile” years, then we need not pay attention to her, give her value or a role in society. 

Thankfully, these narratives are being revised through increasing conversations about how to support women’s health, vitality, and social connections through the perimenopause transition and post-menopause. But well before these conversations started dominating our news and social media feeds, nature—and nature-based traditions like Ayurveda—knew the real story about the vāta stage of life. The fact that female humans’ life spans extend past the fertile years is a sign that they serve a vital purpose in our collective longevity. Namely, elder women carry the wisdom, the life-experience, and the care-taking energy to support younger generations as they bloom. The flowers of youth don’t simply die and decay; they are transformed into the roots of our ecosystems, providing a stabilizing, nourishing, and generous form of support in ways we might not see on the surface. In autumn, the flow of energy of a plant makes an about-face, from reaching up toward the sky to burrowing down into the earth, back toward its source. Though hidden from sight, our external life seems to have ended; a new, deep inner life begins. 

Reframing our narratives around menopause to align with this cycle of the earth can apply to so many aspects of the transition—to our relationship with work; our relationships with our partners, children, and parents; to the ways we feed ourselves with movement and food; and to specific physiological systems. The skeletal system, known as asthivaha srotas in Ayurveda, is a beautiful representation of both the challenges menopause poses to our sense of self and cohesion, and opportunities to make intentional changes that align with our current needs and reality. 

In a big-picture sense, our bones are at the core of who we are; our skeletons describe our uniquely human shape and way of moving in the world, as well as inform the unique shape of our individual bodies. While there are many ways we can change our external appearance through diet, exercise, surgery, and less-invasive measures like clothes and makeup, eventually we’ll hit a wall when we reach our bone layer. The length and curve of your spine, the width of your pelvis, the proportions of your leg bones—they’re formed and fixed fairly early in our development. 

Bones experience the biggest period of growth during childhood, reaching a peak between ages twenty and thirty. Then, around age thirty-five, everything changes. The body’s intelligence starts preparing us for autumn’s harvest—for menopause—and the first radical shift of our hormonal cycles and menstruation occurs. Estrogen drops off significantly, and we might notice changes in our cycles. Among other things, estrogen plays a role in preserving bone health, and so around this time of life we start losing bone faster than we replace it.

This change brings us back to examining vāta doṣa, which governs the health of bones (and associated tissues of hair, teeth, and nails) in an inverse relationship. In other words, when vāta increases, bones decrease. Preserving and attempting to build back lost bone tissue is a rather difficult endeavor for this reason. Because bone is such a deep tissue—the fifth of seven according to the Ayurvedic description of the body systems—it requires consistent digestion of nourishing foods to maintain even before menopause. And so many factors in our lives, including the hormonal changes of menopause!, can affect our digestive capacity and limit the amount of nourishment our bones receive. On average, it takes a minimum of six months to see meaningful changes in bone—and that’s when one is religiously practicing good habits and following a bone-nourishing diet.

The good news is that the nature of menopause—kicking up the winds of vāta, decreasing the stability of our bones—contains both the problem and the solution. The progression into the vāta stage of life is like a tide that comes for us all, with a force that’s hard to resist. It’s as if nature is inviting us to stop, or at least slow, the external movements in the world that our skeletons allow for. It’s as if we’re being asked to occupy our Selves, to tend to the bones of our temporary but only corporeal home, with the fullness of our attention—and prepare for that next phase of subtle life under the surface. By respecting vāta and countering the unpredictable, sometimes extreme nature of its movements, we can (studies show!) both preserve and build new bone even after the process of loss has begun. 

These three practices are opportunities to rewrite the story of your menopause journey by inviting in the qualities that nourish vāta and bone: 

• Stability 

• Rhythm 

• Warmth 

• Unctuousness

Rather than quantitative prescriptions—like how many grams of protein to eat or how much weight to lift in your workouts- the Ayurvedic approach considers both the general, human shape of the skeleton and your unique shape in determining the dose, frequency, and form of these supportive qualities. Maybe your “unctuous” is a self-massage with oil; maybe it’s adding more fat to your diet; maybe it’s a little of both and changes day-to-day, season-to-season. Be creative and let your inner compass guide you in making the changes that help you live with ease in your current, evolving shape. Decide with intention how to nourish the roots and seeds that will reveal their beauty in this new season of life, in their own time. 

If vāta is already on the rise from a life-cycle perspective during menopause, then added stress—which is mostly an expression of vāta’s erratic movements in the mind—only hastens and exaggerates the imbalances we may feel during the transition itself. Remember that the hormones affected by menopause are not just reproductive; when estrogen decreases, and later progesterone, the body loses its natural buffers against cortisol and adrenaline, our primary stress hormones. Specific to bone, this hormonal dynamic can create acidity in the blood, which then causes calcium to be leached from the bone; this is why, if you experience high stress even well before menopause, bone health can suffer.

From an Ayurvedic lens, we describe this situation as “vāta pushing pitta”—where the winds of vāta kick up the hot, fiery, stimulating stress hormones, and there isn’t enough water (the juicy reproductive hormones, like estrogen) to keep the fire at bay. Hence the prevalence of hot flashes, headaches, skin imbalances, and mood swings during menopause. 

To support a more easeful experience in this change of hormonal brigades, relaxation tools from yoga, Ayurveda, and many other modalities can prevent stress hormones from wreaking havoc on the system. 

• Slow, rhythmic breathing (prāṇayāma)—reset the breath several times a day (especially before and after meals) rather than trying to do one long breath/meditation practice per day

• Self-massage with oil (abhyaṅga)—a classical daily Ayurvedic ritual that preserves the radiance and elasticity of the skin, muscles, and connective tissues; supports immunity through the skin microbiome; and bolsters the nervous system through touch (governed by vāta), familiarizing our minds to the “landscape” of our own bodies through our senses

• Time in nature—especially in our age of technology- time in nature resets our connection to the five elements, especially that of fire in the form of light. Our various hormonal cycles are governed by our circadian rhythms, and exposing our skin and eyes to natural light, especially at dawn and dusk, can prevent unhealthy spikes in cortisol and delays/interruptions in melatonin production that can disrupt our ability to get restful sleep every night. 

No matter what or how you choose to de-stress, prioritize the spiraling of attention inward to your body and its felt sensations. Doing so naturally replenishes the system with its own life force, known as prāṇa, which is stored in the bones. It’s also important to de-stress regularly, rather than letting yourself cruise toward burnout for months (or decades!) and then expect to undo all of that on a weekend or week-long vacation. 

There’s a lot of chatter out there about how important it is to eat protein (and lots of it!) to preserve muscle mass and bone health as we age. In theory, this is good advice: the density of protein balances vāta and can support healthy blood sugar, which hormonal changes can also disrupt. But the mainstream advice is missing a key step: you have to be able to digest protein, or any food, to reap its benefits.

Per Ayurveda, muscle precedes fat, followed by bone, marrow, and reproductive tissue. If we only feed muscle with protein, there won't be anything left for the deeper tissues. If you want to try a higher-protein diet, find the forms digestible to you:

• Plant-based options — beans and legumes, nuts and seeds, and soy-based products — tend to be lighter on the body.
• These provide essential fibre and micronutrients that keep the gut microbiome healthy (which, as a side effect, supports mood and focus via the gut-brain axis).
• Diets high in animal fat and protein tend to be more acidic, which can deplete bone health over time.

As always in Ayurveda, how you eat is even more important than what you eat, so look at your mealtime routines like “macros” in terms of how they will affect the digestibility of any and all food. Is the space in which you’re cooking and/or eating generally calming, clear of clutter, and comfortable for your body? Or is it loud, chaotic, and rushed? When we set a baseline of calm — called sattva — the body absorbs and assimilates nutrients to support all tissues, not just protein into muscle. 

Complete absorption of nutrients also means that bone-building minerals like calcium and magnesium will be more readily available via food, rather than needing supplements. Of course, there is a time and a place for supplements, but check with your practitioner or health-care provider to ensure you’re taking a form that you can digest, not impeding absorption through improper or incomplete combinations (e.g., calcium needs Vitamin D, magnesium, and potassium as they support calcium absorption and eating calcium with foods that are high in oxalates or phytates, alcohol, and caffeine can prevent its absorption). Mineral-rich herbs like nettles (eaten as a vegetable or as a tea), red clover, and dandelion leaf are classical supports for bone health and hormonal health as they support the detoxification systems of the body.

The internet — and click-bait headlines — will tell you that you must "lift heavy" to build bone; others say walking or yoga does the same. What's the truth?

As far as the science goes, team weight-lifting wins. But how much weight you lift and how often will depend entirely on where you’re starting and your goals. Resistance training of any kind (bodyweight, bands, light weights, etc.) supports mood, cognitive health, and preserves muscle mass and helps maintain bone density. With this kind of program, you’ll still need to engage in progressive overload to build muscle—i.e., if you start doing bodyweight squats and you can only do five before needing a break, if you keep training eventually you’ll have to add external load to maintain a level of challenge. Working with bodyweight only, in practices like yoga or walking, won’t bring meaningful change in bone density; however, they are beneficial in terms of offering stress relief for the mind. 

If you already have bone loss (osteoporosis or osteopenia), the most effective way to generate new bone tissue is heavier resistance training, around 70% of your one-rep-max. If you're new to lifting, work with a trainer or coach who can progress you safely. Emphasize movement that promotes balance too, since fall risk is an even more significant health factor than bone density:

• One-legged (single-leg) exercises
• Core stability work
• Eye-training for balance
• Movement that opens and stretches the soles of the feet

Ayurveda lends another layer of support for resistance training and its positive effects on bone health. Remember that vāta governs bones, and vāta is generally light, mobile, and erratic. Resistance training offers the exact opposite qualities—weight, steadiness, and density—which pacifies vāta in the body and mind. Any fear (an emotion governed by vāta) or concern you may have about lifting weights will be alleviated by the activity itself! Not just because of the exposure, but because the qualities of the movement are medicinal unto themselves. By extension, classical Āyurveda ascribes a similar effect on the system to abhyaṅga, or self-massage with oil. Regular practice of abhyaṅga keeps the tissues of the body soft and strong, and oiling before any kind of workout can ensure that the system does not get too dried out from the movement.

Proper nourishment is essential to building muscle mass through movement. If you’re working on strength, you’ll want to consume protein soon after your workout (within 30-45 minutes for women). If you’re experiencing extreme soreness or fatigue after exercise, it may be a sign you’re not eating enough. Likewise, rest and sleep are essential “macros” for allowing the muscles to repair after exercise (which is when they actually get stronger!). And treat sleep like a training session — with commitment and regularity — since muscles repair and strengthen during rest.

There is an overwhelming amount of information available to help you “optimize” your menopause experience, which no doubt adds to the stress and confusion that arise during this time of life. Rather than blindly following the suggestions of influencers, your friends, even this article!, prioritize the inward direction that the vāta stage of life is leading you toward. Try things out, and stick with what makes you stand with confidence in your skin — and at home in your bones —  now.