Two silent risks not to be overlooked

Unlike hot flashes or vaginal dryness, osteoporosis and cardiovascular risk can't be seen or felt day to day. That's exactly what makes them dangerous: they're only taken seriously once it's too late, even though they've been building for years.

Osteoporosis: understanding the real risk

Osteoporosis is bone becoming more fragile, with no pain at all. Not to be confused with arthritis, which is painful: arthritis is extra bone forming in a joint as the cartilage that lubricates it wears down. Osteoporosis is the opposite: a lack of bone, which increases fracture risk. Hip fractures mainly affect very elderly women (average age 82), but they develop over years beforehand. In younger women (around age 60), vertebral compression fractures are more common: Odile mentions a patient who compressed a vertebra simply from landing after a wave dip on a boat. Bone mass builds up until early adulthood, declines slightly, then drops sharply at menopause, more so in women than men.

Preventing osteoporosis: calcium, vitamin D, physical activity

Three pillars of prevention. Calcium: about 1500 mg/day according to Odile, mainly from dairy products (the more compact and hard the cheese, the more calcium it contains, but watch out for the fat and calories that come with it), as well as some vegetables and almonds (in large quantities for a sufficient intake), and highly mineralized waters like Contrex (485 mg/L), a good habit is to check the label on your tap or bottled water. Vitamin D: nearly impossible to get enough from diet alone (you'd have to eat cod liver every day), skin needs sun exposure to synthesize it, which is why the entire French population is largely deficient, especially in winter, supplementation is therefore essential. Physical activity: isometric work (muscle contraction that pulls on bone to mineralize it) or repeated small impacts, like walking with poles (useful especially against wrist fractures, known as Colles' fractures), walking with a backpack, Pilates, or power plate.

Who should get a bone density scan?

Bone mineral density measurement (BMD) is only reimbursed for women at risk: early menopause, long periods without periods not linked to contraception (anorexia, significant underweight, not PCOS, which has a different mechanism), family history of osteoporotic fracture (especially maternal), long-term corticosteroid therapy (for example in asthma patients), or heavy smoking (more than 20 cigarettes/day). In these cases, get it done starting at age 45-50, at the latest at the start of menopause: the results can guide a decision on hormone therapy. Note: the French Society of Gynecology and menopause study groups recommend a BMD scan for all women entering menopause, but this exam is generally not covered in that case.

Cardiovascular risk sharply increases after menopause

Without estrogen, blood vessels become stiffer, and cholesterol rises, favoring plaque buildup (atheroma, cholesterol deposits that can obstruct a vessel). A blocked coronary vessel causes a heart attack, a blocked brain vessel causes a stroke. Primary prevention relies on lifestyle: a diet limiting saturated animal fat (without eliminating it entirely), physical activity, stress management (cortisol is a consequence of stress, not its cause), and quitting smoking.

Sedentary behavior vs. physical activity: an important nuance

Being athletic on weekends doesn't prevent you from being sedentary during the week: sedentary behavior means sitting for more than 45 minutes without moving, even for serious athletes who spend their week behind a desk. Physical activity needs to be regular, not occasional: running a marathon on the weekend doesn't make up for a motionless week. Recommended target: 30 minutes a day. The best exercise is the one you enjoy and will keep doing, alone or in a group, brisk walking in nature is a great baseline, both restorative and beneficial across the board. According to Odile, it's also the only intervention shown to have a real effect in primary cancer prevention (unlike vitamins and supplements, whose preventive effect hasn't been demonstrated by large studies).

The 6 pillars of a healthy lifestyle, in detail

Odile invites every woman to identify, among these 6 areas, the one that will be easiest and most enjoyable to work on first, not the hardest.

• Diet: a balanced fat intake (limiting saturated animal fat without eliminating it entirely), sufficient calcium and protein for bones and muscles.
• Physical activity: 30 minutes a day, regularly rather than occasionally, actively fighting sedentary behavior (sitting for more than 45 minutes without moving).
• Stress management: cortisol is a consequence of stress, not its cause; Odile likes her daughter's motto: "what can I do less of to feel better?"
• Sleep quality: going to bed at a consistent time, in a cool, dark, quiet room.
• Quality of affective and social relationships: not necessarily tied to being in a couple, it can also come from social, spiritual, or artistic life; statistics show a longer life expectancy for people in couples, but it's multifactorial, not a fatality for single people with a rich social life.
• Avoiding toxic substances: Odile calls smoking "catastrophic" without nuance. On alcohol, she shares a more personal, nuanced opinion (outside official zero-tolerance recommendations): according to her, below the equivalent of two glasses of wine a day, studies don't show a major health difference, and two glasses on the weekend in a social context wouldn't be problematic, a position she acknowledges as "not politically correct."

Heart symptoms are different in women

Unlike men (typical pain behind the sternum radiating to the left arm), women often have atypical symptoms taken less seriously: malaise, extreme fatigue, abdominal pain. In the presence of risk factors (family history of early heart attack, overweight, cholesterol, smoking), a cardiology check-up is recommended at the latest at menopause; for very athletic women, a stress test can help screen for potential issues. For stroke: speech difficulties, visual disturbances, or loss of sensation in part of the body should prompt quick action, before the signs become more serious (hemiplegia).

Weight gain: it's not (just) the hormones' fault

Contrary to a very common belief, it's not menopause itself that causes weight gain. Looking at weight trends across a large population, there's no sudden jump at menopause. The main cause is sarcopenia: the loss of muscle mass that starts as early as 35 (without being visible) and accelerates after 40. Muscles burn 85% of calories, even during sleep: with the same diet and activity level, you naturally gain weight as you age. What estrogen does affect is fat distribution (more around the waist, the silhouette becomes more "straight"), but men also gain belly fat at the same age, simply from aging, which shows it's not purely hormonal. Menopause symptoms (sleep issues, depressive mood, hot flashes) can indirectly influence eating habits, but that's not a direct hormonal effect on weight. The solution: maintain muscle mass through physical activity and adequate protein intake (without protein, you can't build muscle).

What can I do less of to feel better?