By Kelly Tull
Women’s Health Nurse Practitioner & Sex Counselor, Venus Collective Women’s
Health and Intimacy
In my first year of college, before starting my nursing career, I watched my grandmother decline over the last two to three years of her life. What had been a vibrant, independent, healthy woman became frail and easily broken. She had significant osteoporosis and little muscle left to protect her fragile bones.
You probably have a story like this too. A parent, an aunt, a neighbor who went from independent to dependent, seemingly overnight. I see women fighting for their longevity every day in my practice, and here’s what I want every one of them to know: the biggest problem isn’t what happens at 80. It’s the window we miss decades earlier.
The critical bone years
Here’s what most women don’t realize. The most rapid bone loss doesn’t happen after menopause, it happens during perimenopause, the years leading up to your last period. Women lose an average of 10% of their bone density in this window alone. Muscle follows a similar path, with an average 2.5% drop during perimenopause and a steeper 5.7% drop after, compared to your premenopausal baseline.
The cause is largely hormonal. Estrogen levels fluctuate and then drop sharply during the menopause transition, and since estrogen helps your body build and maintain both bone and muscle, that drop accelerates the loss of both. Testosterone declines more gradually with age and plays a supporting role in muscle strength as well.
Avoiding the decline
Here’s why that matters. Muscle and bone are what let you climb stairs, carry groceries, and get out of a chair without thinking about it. As both decline, fall risk rises, and it rises faster for women than men, especially after 65. When bones are already fragile, a fall is far more likely to become a fracture. About one in five women who break a hip will die within a year. Another one in five will need long-term nursing facility care. This is how so many women end up in a nursing home: not from one single event, but from years of quiet loss that set the stage for a fall that changes everything.
A plan to stay independent
My goal with patients is always a nursing home prevention plan, and it starts decades before that fall.
Three things work, and I want you doing all three.
Strength train at least three days a week. Focus on movements that mimic real life: squats, lunges, step-ups, rows. New to this? Start with body weight or resistance bands and build from there. Ask for help. A single session with a trainer to learn proper form is worth it.
Train your balance. Just five to 10 minutes, a few times a week. Stand on one foot while brushing your teeth. Practice heel-to-toe walking. Try a beginner tai chi or chair yoga class. Small and consistent simple movements can meaningfully lower your fall risk over time.
Eat enough protein, calcium, and vitamin D. Strength training without enough protein is like building a house without materials, the effort goes nowhere.
Consider hormones
Ask your provider about hormone therapy. Estrogen replacement during peri- and post-menopause can help slow bone loss and support muscle maintenance. It isn’t right for everyone, but it deserves a real conversation with a provider who’s comfortable managing it, not a quick dismissal. If you need help finding the right provider, I recommend looking at The Menopause Society’s website and searching for “Find a menopause practitioner.”
Know where your bones stand
And get a bone density screening. If you’re menopausal and haven’t had one, ask for it directly. Cash price is often more affordable than people expect, even without insurance coverage. Don’t wait until 65 if you have a family history of osteoporosis, went through early or surgical menopause, smoke, drink heavily, have had a prior fracture, or have taken long-term steroids. One risk factor is reason enough to ask now.
Getting stronger isn’t about fighting aging or chasing youth. It’s about building the strength to live exactly how you want at 80: climbing stairs without a second thought, carrying your own groceries, getting on the floor with your grandkids, staying in your own home on your own terms.
Start now, wherever you are. The choices you make in the next few years, not the ones you make at 79, decide which version of 80 you get. I think about my grandmother often, how much of her decline had already been set in motion years before that first fall, and how no one had ever told her that.
Now you know, so take that first step.
Kelly Tull is a Women’s Health Nurse Practitioner and AASECT Certified Sex Counselor at Venus Collective Women’s Health and Intimacy in East Longmeadow, MA. She is a member of the Menopause Society and the International Society for the Study of Women’s Sexual Health (ISSWSH). Kelly specializes in menopause management, women’s pelvic health, and sexual wellness. For more information, visit www.myvenuscollective.com or follow her on Instagram at @myvenus_collective.