For women, one of the largest factors in overall bone health is estrogen. Anything that significantly cuts down on estrogen can have a negative effect on women’s bones, since estrogen is so important to maintaining bone density. You can’t always control the amount of estrogen your body produces (menopause comes whether or not it gets an engraved invitation from you), but there are several ways to make up for low levels of the hormone. Sometimes you do have some control: if you’ve exercised yourself to the point of stopping menstruation, for example, you can back off enough to restore your normal cycles (and therefore your estrogen). Or you can make sure you’ve exhausted other treatment options before having a hysterectomy.The most obvious case of getting less estrogen than is optimal for your skeleton is menopause, when estrogen levels drop dramatically. Without so much estrogen, bone loss picks up dramatically for the first five years or so after the last period, and you might lose as much as 5 percent of your total bone mass each year.Early menopause, or “surgical menopause” like a hysterectomy or removal of the ovaries, increases your risk further still, since your body faces the same challenges as with menopause, but years earlier. Women who have their ovaries removed lose bone faster than do older women at menopause. Women who have had a hysterectomy but have both ovaries (which actually make estrogen) still show an increased risk. Even just experiencing menopause at a relatively young age (but still within the normal range) ratchets up the stakes for you, since every drop of estrogen you can come by naturally (without having to tally up potential risks and side effects from hormone replacement) is crucial.This is why HRT is such an important consideration whenever you enter menopause. Another way to protect yourself is with natural progesterone, which is particularly worth learning about if you are wary of or unable to take estrogen.Some women experience low levels of estrogen well before menopause (upping the ante still more, especially if it occurs in girls and young women who should be in their peak bone-building years). Amenorrhea (loss of periods) or very infrequent and irregular periods are the most common ways this occurs. It happens to intensely active athletes, especially in sports where low body weight and extremely low body fat are advantageous and common (e.g., marathon runners, ballerinas, and gymnasts). Delayed onset of menstruation and interrupted periods have similar effects. For every year with few or no periods, you may lose about 2 percent of your bone mass.Before menopause, normal menstrual cycles are best for you for many reasons, bone health among them. Stress, poor nutrition, excessive exercise, and lack of exposure to natural light can all disrupt your menstrual cycle, interfering with hormonal reactions and so contributing to bone loss. Irregular periods and irregular ovulation put you at higher risk for osteoporosis. If your periods are irregular, consider using birth control pills, or natural progesterone to restore them, as well as addressing the underlying causes so your body can get back to properly regulating itself. In fact, the pill can prevent bone loss—and perhaps even increase density—in any premenopausal woman, which you should factor into your decision about what contraceptive to use (on balance with the other attendant risks and side effects, of course). Your goals should be to maintain your physiology as close to Mother Nature’s recipe as possible.*42\228\2*