Menopause and Muscle Mass

Menopause is not only hot flashes and changes in the cycle. During this period women lose muscle mass and strength noticeably faster, and fat is redistributed toward the abdomen. Metabolism, bone strength, the risk of falls, and independence in older age all depend on preserving muscle. Our editorial team breaks down what happens to muscles during menopause and which measures have the best evidence base.

What happens to muscles after menopause

With age muscle mass gradually declines in everyone. However, in women this process accelerates precisely around menopause. A review by Maltais, Desroches, and Dionne (2009) describes how the menopausal transition is accompanied by a noticeable decline in muscle mass and strength that is not explained by chronological age alone.

The SWAN study, which observed women through the menopausal transition over many years (Greendale et al., 2019), showed a characteristic picture: in the years around the final menstruation the gain in fat mass accelerates, while lean mass begins to decline. Total weight may change little in the process, but body composition becomes less favorable.

Lost first and foremost are the fast type II muscle fibers, which are responsible for strength and speed. That is why women often notice that it has become harder to climb stairs, get up from a low chair, and react quickly to a stumble. Strength falls even faster than muscle mass.

In parallel with muscles, bones weaken. This tandem is called «osteosarcopenia» and sharply increases the risk of falls and fractures. That is precisely why the approach to muscles and bones in menopause should be a joint one.

The role of estrogens in muscle tissue

Muscle cells have estrogen receptors. Estradiol takes part in regulating the sensitivity of muscles to anabolic stimuli, protects muscle fibers from damage, and supports the function of satellite cells — the «stem» cells of muscle that ensure repair and growth.

As estrogens decline, muscles recover worse after exertion and respond more slowly to protein and training. This phenomenon is often described as «anabolic resistance», characteristic of older age in general. Menopause seems to add yet another factor to age-related changes.

Estrogens also affect metabolism in muscles: insulin sensitivity, the use of fat as fuel, and mitochondrial function. Muscle loss and the deterioration of their metabolic quality contribute to the accumulation of visceral fat and the risk of type 2 diabetes.

Finally, menopause is often accompanied by sleep disturbances, fatigue, and reduced physical activity. Less movement means fewer stimuli for muscles. Thus a vicious cycle forms, which it is important to consciously break.

Sarcopenia: when loss becomes a disease

Sarcopenia is a progressive skeletal muscle disease with loss of strength, mass, and function. The European working group EWGSOP2 (Cruz-Jentoft et al., 2019) made low strength the key criterion, since it best predicts adverse outcomes.

For women EWGSOP2 proposes thresholds of low hand strength below 16 kg and slow rising — more than 15 seconds for five chair stands. These tests are simple and can be performed at a doctor’s appointment in a few minutes.

For most women aged 50–60 it is not yet about sarcopenia but about its prevention. Yet it is precisely this period that determines the reserve of muscle a person will bring into older age. The more muscle and strength at the start, the later the critical threshold is reached.

Strength training — the foundation of muscle protection

The most powerful proven way to preserve and build muscle at any age is progressive strength training. A meta-analysis by Peterson and colleagues (2010) showed that in older people strength training substantially increases strength, with higher intensity giving a greater effect.

Postmenopausal women respond well to training: both strength and muscle mass increase, and insulin sensitivity improves. The LIFTMOR study (Watson et al., 2018) demonstrated that women with low bone density tolerated even intense supervised loads safely, gaining benefits for bones and function.

• 2–3 strength sessions per week covering the main muscle groups of the legs, back, chest, and arms.
• A gradual increase in load: weight, number of repetitions, or sets.
• Working close to fatigue in each set — this is precisely what provides the stimulus for growth.
• Power exercises (fast lifting of a moderate weight) and balance work to prevent falls.
• Aerobic activity as a supplement for the heart, not a replacement for strength work.

If you have no experience, it is worth starting with a few sessions with a qualified trainer to establish technique. The presence of osteoporosis, joint pain, or cardiovascular disease is not an automatic prohibition, but it does require an individual approach and coordination with a doctor.

Results are usually noticeable within 8–12 weeks: strength increases and everyday movements come more easily. But the effect is maintained only with regularity, so training should become part of one’s lifestyle.

Nutrition and hormone therapy

Muscles need building material. The PROT-AGE group (Bauer et al., 2013) recommends that older people consume at least 1.0–1.2 g of protein per kilogram of body weight per day, and physically active people more. It is useful to distribute protein evenly across meals, getting a sufficient serving at each.

If it is hard to get enough protein from food, protein supplements are appropriate, for example whey protein, which is rich in leucine. Creatine monohydrate is one of the most studied supplements, also studied in postmenopausal women in combination with strength training; it does not replace training but can enhance its effect.

Vitamin D is important for both bones and muscles. It is advisable to check its level and correct a deficiency with a doctor. Adequate calcium and energy intake and quality sleep also affect recovery.

Menopausal hormone therapy (MHT) is prescribed primarily to treat vasomotor symptoms and prevent bone loss. The 2022 position of the North American Menopause Society recognizes its effectiveness for bones, but MHT is not considered a way to build muscle. The decision on MHT is made with a doctor, taking individual risks into account.

Editorial conclusions

Menopause accelerates the loss of muscle mass and strength through declining estrogens, lifestyle changes, and the age-related background. This process is not an inevitable sentence — it responds well to correction.

Strength training remains the main tool: it preserves muscle, strengthens bones, improves metabolism, and reduces the risk of falls. Protein and vitamin D enhance its effect.

The best time to start is before menopause or at its onset, but women of any age benefit from training, even if they have never exercised before.

We also recommend reading «Osteoporosis in Women and Strength Training», «Female Myths About Getting Too Bulky», and «Weight Loss in Women: Hormonal Particulars».

References

1. Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186–197.
2. Greendale GA, Sternfeld B, Huang M, et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4(5):e124865.
3. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31.
4. Peterson MD, Rhea MR, Sen A, Gordon PM. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev. 2010;9(3):226–237.
5. Watson SL, Weeks BK, Weis LJ, et al. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211–220.
6. Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542–559.
7. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794.