9th Feb 2026

Newsletter Monday

Hello Reader,

Buried among the cancer headlines this week was a genuinely positive piece of research.

The sort you’d miss if you blinked.

It didn’t come with a scary percentage, a lifestyle villain, or a call to panic, which is probably why it slipped under the radar.

A study was published which focused on a specific group of women: those whose periods stop because of low energy availability.

That might be due to intense exercise, under-fueling, significant weight loss, or eating disorders.

It’s often labelled functional hypothalamic amenorrhoea, but the label matters less than the consequence.

These women are at real risk of bone loss at a time in life when bone mass should be rising to its peak or most certainly not in decline.

It may not be a huge group numerically.

But it's the sort of scenario in clinical practice where you struggle because you can see the problem over the hill and want to help DO SOMETHING.

What’s genuinely encouraging here is the quality of the data.

This wasn’t a vague observational suggestion or a hand-waving association of a couple of variables.

It was a systematic review and meta-analysis comparing different hormonal approaches, and it gave us something clinicians rarely get: a clear steer.

The finding was simple and consistent:

Oestrogen delivered through the skin (patch, gel, spray) improves bone density more reliably than oral preparations in this group of women.

That matters.

Because while we’ve known for years that oestrogen deficiency harms bone, we’ve been far less clear on the best way to replace it outside of menopause.

This study moves us out of uncertainty and into evidence.

It also fits with what we already know from menopause research.

We already have robust trial data showing that HRT reduces bone loss and fracture risk.

What’s missing is not the evidence, but the translation of that evidence into clear preventative guidance.

Current guidelines acknowledge the benefit, but stop short of recommending HRT primarily for bone protection — in menopause and in younger at-risk women alike.

Part of that is process.

Trials take years.

Peer review takes time.

Guideline updates move slowly.

But bones don’t wait.

In the time it takes for evidence to work its way through committees and consensus statements, real people keep living their lives.

People fall.

People fracture.

People recover — sometimes incompletely — and then fall again.

A woman can fracture, rehabilitate, and fracture again while we’re still “waiting for the guidance”.

Another important point this study quietly reinforces is how HRT is given.

Oestrogen delivered through the skin does not increase clot risk in the same way oral oestrogen does, which means many more women may be eligible.

If you’ve previously assumed HRT wasn’t an option because of certain medical conditions — migraine with aura being a common example — transdermal oestrogen is not automatically excluded.

One final reality check: the bone-protective effects of HRT are present while you’re taking it.

This isn’t something you “bank” permanently and walk away from.

That’s true in menopause, and it’s true here too.

Which is why it’s worth ending on something reassuring.

There are no contraindications to lifting weights.

Progressive strength training remains some of the best medicine we have for bone — accessible, evidence-based, and doing a lot more than just propping up a DEXA scan.

Quiet paper.

Clear data.

Still far too little urgency.

But a step in the right direction — and one worth noticing when it finally appears.

See you next week.

Lynette