Calcium and vitamin D during menopause: what should I know?

Menopausia is a natural stage in a woman’s life. However, the decrease in estrogen accelerates bone loss, increasing the risk of osteoporosis and fractures, especially of the spine, hips and muñeca. Calcium and vitamin D play a fundamental role in bone health. However, this does not mean that all women should take supplements. Diet, age, sun exposure, risk of fractures and the presence of osteoporosis should guide this decision.

This article analyzes the importance of vitamin D and calcium during menopause, the recommended daily requirements, when supplementation may be indicated and how to ensure adequate intake through the diet.

What changes occur in our hearts during menopause?

Bones are constantly being renewed. Throughout life, the body removes old bone tissue and forms new tissue. Before menopause, these two processes are usually in balance. With the decline in estrogen, bone breakdown accelerates compared to the formation of new bone, leading to a gradual decrease in bone mineral density.

This loss can begin even during the transition to menopause and becomes even more pronounced in the first few years after the last menstrual period.

Since bone loss does not produce symptoms, many women are only diagnosed with osteoporosis after undergoing a bone density scan or after suffering a fracture.

While hormonal changes affect all women, this does not mean that all women will develop osteoporosis, but it does reinforce the importance of adopting measures that help preserve bone health.

Why do we need calcium?

Calcium is the main mineral that makes up bones and teeth. It also plays a role in muscle contraction, nerve impulse transmission, and normal heart function.

When the diet does not provide enough calcium, the body maintains these functions by drawing on reserves stored in the bones. If this situation persists, it can contribute to bone loss.

According to the National Consensus on Menopause, women after menopause should have about 1,200 mg of calcium per day, considering the total amount coming from food and two supplements, when these are only necessary.

It is important to note that this value does not correspond to a dose of a supplement. For many women, a balanced diet allows you to meet your daily needs without the need for supplementation.

What are the functions of vitamin D?

Vitamin D facilitates calcium absorption in the intestine and contributes to normal mineralization of the body.

It also helps preserve muscle function, an important aspect to maintain balance and reduce the risk of fractures, which can cause fractures.

Much of vitamin D is produced in the skin through sun exposure. However, this production varies from person to person. In the absence of time, the season of the year, the time spent outside, the use of sunscreen and some things or medications can reduce the production or alter the levels of this vitamin.

According to the National Consensus on Menopause, the usual needs are between 800 and 2,000 IU per day, and the dose must be adapted to the characteristics and needs of each woman.

Calcium and Vitamin D in food

The power supply must be the main source of calcium. Contrary to calcium, there are few foods naturally rich in vitamin D.

Which foods are richest in calcium?

Lactic acids, such as milk, yogurt and cheese, provide calcium in a form that is easily absorbed by the body.

Other foods that also contribute to the intake of this mineral include:

• sardine consumed with espinha;
• grão, feijão and other legumes;
• couve, broccoli and other green leafy vegetables;
• tofu prepared with calcium sauces;
• almonds;
• sesame seeds;
• vegetable drinks enriched with calcium;
• foods fortified with calcium.

That they do not contain lactic acids, you should check the labeling of the vegetable drinks, since they are not all enriched with calcium.

The European Menopause and Andropause Society recommends evaluating the usual calcium intake before taking supplementation. This endorsement is particularly important in women with lactose intolerance, strict vegetarian or vegan diets, celiac disease, inflammatory bowel disease, or history of bariatric surgery.

What foods provide vitamin D?

The main sources include:

• sardine;
• salmon;
• mackerel;
• herring;
• egg yolk;
• some fortified dairy products;
• fortified plant-based drinks;
• fortified cereals.

Although these foods contribute to daily intake, many people are unable to meet their needs through diet alone.

Therefore, the main way to obtain vitamin D naturally is through synthesis via sun exposure. However, despite Portugal having many hours of sunshine throughout the year, this does not mean that the entire population has adequate levels of vitamin D. Many people spend a large part of the day indoors, and the ability to produce vitamin D progressively decreases with age.

However, increasing sun exposure without protection solely to produce vitamin D is not recommended, as skin protection remains essential to reduce the risk of skin cancer and photoaging.

Do all women in menopause need supplements?

No.

Menopause, in itself, is not a reason to take calcium or vitamin D supplements. Before starting any supplement, it is important to assess diet, vitamin D levels, bone health, and individual risk factors.

Supplementation may be considered in situations such as:

• Insufficient calcium intake through diet;
• Vitamin D deficiency confirmed;
• Osteoporosis or osteopenia with a high risk of fracture;
• fragility fracture;
• Diseases or surgeries that reduce nutrient absorption;
• Use of medications that may interfere with calcium or vitamin D metabolism.

Whenever possible, calcium should be obtained through diet. Supplements are an option when diet does not meet daily requirements or when there is a specific clinical indication.

It is also important to remember that doses higher than recommended do not strengthen bones. On the contrary, excess calcium or vitamin D can increase the risk of adverse effects. Therefore, supplementation should be guided by a healthcare professional.

When is it useful to determine vitamin D levels?

The blood test evaluates a form of vitamin D called 25-hydroxyvitamin D, considered the best indicator of the body’s vitamin D reserves.

However, this analysis is not systematically recommended for all women after menopause.

This can be useful in situations such as:

• Osteoporosis or osteopenia with a high risk of fracture;
• fragility fracture;
• little sun exposure over prolonged periods;
• kidney, liver, or intestinal diseases that may reduce the absorption or metabolism of vitamin D;
• prolonged use of medications that interfere with vitamin D levels;
• suspected vitamin D deficiency, based on medical history and medical evaluation;
• the need to monitor the response to supplementation in specific situations.

The results should be interpreted by a healthcare professional, taking into account the clinical history, risk factors, and context of each woman. There is no single value or appropriate supplementation dose for everyone.

How to choose a calcium supplement?

When diet alone is insufficient to meet daily calcium requirements, calcium supplementation may be recommended.

There are different types of calcium salts, the most commonly used being calcium carbonate and calcium citrate.

Calcium carbonate

Calcium carbonate contains a high amount of elemental calcium and should be taken with meals. The presence of food promotes its absorption.

Calcium citrate

Calcium citrate is absorbed more independently of stomach acidity. Therefore, it may be a more suitable option for people taking medications that reduce gastric acidity, such as proton pump inhibitors, for example omeprazole.

When higher doses are needed, the daily amount can be divided into two or more doses. Generally, the body absorbs doses of about 500 mg of elemental calcium more efficiently at a time.

The choice of supplement should take into account diet, usual medications, other illnesses, and the possible use of additional supplements.

Can calcium and vitamin D supplements interfere with medications?

Yes.

Calcium can decrease the absorption of some medications, including certain antibiotics, levothyroxine, and some medications used to treat osteoporosis. In most cases, this interaction can be avoided by leaving an adequate interval between doses. The necessary time depends on the medication, so you should follow the instructions of your doctor or pharmacist.

Vitamin D may also require caution in people with kidney disease, hypercalcemia, or other specific clinical conditions.

Before starting any supplement, inform your doctor or pharmacist about all medications and supplements you use, including multivitamins and products intended for bone health, hair health, etc. Many of these products already contain calcium or vitamin D. Without this verification, unnecessary doubling of doses may occur.

Is it harmful to consume too much calcium and vitamin D?

Yes.

Calcium supplements can cause undesirable side effects such as constipation, abdominal discomfort, bloating, or nausea. In some people, especially those with a predisposition, they can also increase the risk of kidney stones, among other complications. For this reason, whenever possible, calcium should be obtained through diet, resorting to supplements only when there is a clinical indication.

Excess vitamin D can also be harmful. High doses over prolonged periods can cause hypercalcemia, a condition in which blood calcium levels become too high and can cause nausea, vomiting, weakness, impaired kidney function, and other health problems.

Therefore, calcium and vitamin D supplements should be used in doses recommended by a healthcare professional and not on one’s own initiative.

Are calcium and vitamin D sufficient to protect bones?

No.

Bone health depends on several factors. Calcium and vitamin D are important, but on their own they do not prevent bone loss or replace other preventive measures.

Physical exercise is one of the cornerstones of bone health. Moderate-impact activities, such as walking, climbing stairs, or dancing, along with strength training, help preserve bone mass, maintain muscle strength, and reduce the risk of falls.

It is also important:

• to ensure adequate protein intake;
• maintain a healthy weight;
• do not smoke;
• moderate your alcohol consumption;
• perform balance exercises;
• to correct vision problems;
• use stable and appropriate footwear;
• reduce the risk of falls at home.

When osteoporosis is present, these measures remain essential, but they do not replace prescribed treatment. Calcium and vitamin D may be part of the treatment plan, but they do not replace the medications prescribed for the prevention and treatment of osteoporosis.

When should you seek medical advice?

Talk to your doctor if:

• he has already suffered a fracture after a low-energy fall;
• it has lost height over the last few years;
• feels persistent back pain;
• she went through menopause before the age of 40;
• has close relatives with a history of hip fracture;
• he has been taking corticosteroids for several months;
• has kidney, liver, or bowel disease;
• she underwent bariatric surgery.

In addition to medical evaluation, at Farmácia Correia Rosa you can get advice on the supplements you already use, check for unnecessary duplications, and find out the most appropriate way to administer them.

In short, menopause is a crucial time to take care of bone health and reduce the risk of osteoporosis and fractures.

For most women, a balanced diet, adequate calcium intake, sufficient vitamin D levels, and regular physical exercise form the basis for maintaining stronger bones over the years.

When supplementation is necessary, it should address an identified need and be used at the appropriate dose. Taking more calcium or vitamin D does not necessarily mean greater protection.

The most important thing is to adopt a holistic approach to bone health and, whenever there are doubts or risk factors, seek advice from a healthcare professional.