Let's Not Bring This 90s Trend Back

PLUS: a promising (but early) bone discovery + more evidence for starting MHT early

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👋 Hi Friends,

Welcome to the October 13th edition of Menopaussible—bringing you the news you can use and the ⚡energy⚡ you need to support your menopause journey. I'm Maria Caracci Ciccolella—mindset coach and menopause advocate. (Connect with me on IG or LinkedIn!)

There's nothing like the re-emergence of a good trend, right? And who on this newsletter did not love the 1990s? The simplicity, the fashion, the entertainment—all now embraced by a much younger generation thrusting some of our favorite things right back into the cultural zeitgeist. It's fun to be hip again (though I'm sure "hip" is NOT the word I'd want to use in front of said younger generation!).

Riding on the coattails of 90s trends, however, is one many of us had hoped we’d put to bed—the thin ideal. It's not only back, it's bigger than ever—and easier to attain. And here's where it gets tricky: wanting to reach a healthy weight in midlife is smart, even necessary. But "thin" and "healthy" aren't always the same target—and for some of us, the pursuit of the former may be quietly costing us something we can't see happening: our bone density.

The Skinny on Low Body Weight and Bone Loss

After years of body acceptance and all-shapes, all-sizes messaging, the pendulum has swung back. Thin is back in, thanks in large part to GLP-1 medications, which—a recent New York Times article found—are being used by a far larger swath of the population than they were originally intended. And, while there's real, legitimate value in pursuing a healthier weight in midlife—visceral fat gain carries genuine metabolic and cardiovascular risk—an overriding need to be "small" and "thin" is what can lead to frailty sooner than you'd expect.

Low body weight is a recognized risk factor for osteoporosis—less body mass means less mechanical load on bones, which means less stimulus for bone formation. That hardly seems like menopause's problem, given that body composition changes tend to drive an accumulation of pounds in unwanted places. But it's what follows—the drive to shed those pounds, colliding with an already-accelerated rate of bone loss due to declining estrogen—where the real damage gets done.

Thin ≠ Healthy
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​It’s important to be clear that looking smaller is not the same as being healthier. For women in midlife, that distinction matters more than ever—because the bone loss that comes with chasing "small" doesn't show up on a scale. It shows up on a DEXA scan when it's harder to reverse. According to the CDC, half (51.4%) of all women age 50+ already have osteopenia—a weakening of the bones that can lead to osteoporosis and an increased risk of broken bones—while roughly 1 in 5 have osteoporosis. Given a quarter of all hip fractures end in death within a year, a growing number of physicians are now advocating for earlier baseline scans around perimenopause, well before the screening age of 65—because that’s when the bone loss actually begins accelerating.

What You Can Do

Here's the empowering part: you get to choose a different goal. The culture is selling smaller. Your bones are asking for stronger. Not less of you, but a more capable version of you—and that's a body composition question, not a scale question.

I'll be honest with you: I've strength trained for most of my adult life. But I eased off in my 40s—not stopped, just didn't push as hard as I should have—right around the years it mattered most. Add 25+ years behind a computer, and you get the full picture. When I got my own DEXA scan this year, I learned I have osteopenia in my hip—mild, a T-score of -1.2, just past the line into "needs attention." Not alarming. Just the nudge I'm glad I got early.

If you're reading this and thinking "why bother," that's not the takeaway. The takeaway is that consistency matters, but so does progressively increasing what you ask of your body—especially in your 40s and beyond. And, if you're now thinking "time to go hard," pump the brakes there, too: the fix isn't suddenly lifting like you're 25. It's lifting with real intention, good form, and progression—ideally with some guidance if you're new to heavier loads. Bones respond to increasing demand over time. They don't respond well to a shock to the system.

Know Your Numbers

Two tools exist to tell you where you actually stand, instead of guessing:

• FRAX Tool → A free calculator from the International Osteoporosis Foundation and WHO, estimating your 10-year fracture risk from basics like age, height, weight, and lifestyle factors. Start here—it takes less than five minutes. Bring your results to your next appointment and ask whether a DEXA scan makes sense for you. That's how you go from waiting to advocating.
• DEXA Scan → A low-radiation scan producing a T-score that compares your bone density to a healthy young adult's peak bone density—the gold standard for actually knowing where you stand.

The scale can tell you how much you weigh. It can't tell you how strong your bones are. These two can, and the earlier you know, the more you can do about it.

All The Paussibilities

This issue has been about bones, but it's really been about something bigger: the quiet pull toward smaller. Smaller body, smaller ask, smaller risk. Somewhere along the way, "small" started getting mistaken for safe—even healthy. But a body built for less isn't stronger. And, a life built for less isn't either. If there's one thing worth retiring, it's not the extra pounds. It's the habit of playing small.

You named where you've been playing small. A free clarity conversation can help you figure out what it looks like to claim your space instead. Book a free clarity consult here.​

PLUS: NEWS ITEMS

A Bone-Building Breakthrough (Still Early, But Promising)
​Researchers at Leipzig University have identified a receptor called GPR133 that, when activated by an experimental compound, appears to do something most bone treatments can't—build new bone and slow bone loss at the same time, according to the study. So far, this has only been tested in mice, so there's real work left before it could mean anything for humans. But it's a genuinely hopeful signal: the more we understand about how bone remodeling actually works, the more targeted (and less blunt) our future treatment options could become.

Early HRT, Fewer Fractures
​A real-world study presented at this year's American Academy of Orthopaedic Surgeons meeting found that women who started hormone replacement therapy early after a menopause diagnosis had a 13% lower risk of fracture over the long term, compared to those who didn't. It's not the first research to connect estrogen and bone health, but it adds real-world weight to a conversation worth having with your provider—especially if bone health already has you thinking about your options.