Menopause and Muscle Loss: What Women Need to Know

As estrogen levels decline during the menopause transition, physical changes may start to occur, including a loss of muscle mass and strength, known as sarcopenia. While this is part of natural aging, there are effective ways to reduce and manage muscle loss as you go through menopause.

In this article, we’re covering some things it might be helpful to know about post-menopausal muscle loss, including:-

• How muscles change with age
• The impact of estrogen loss on muscle health
• The benefits of exercise and resistance training
• The impact of hormone replacement therapy (HRT)
• The impact of weight loss treatments such as GLP-1 agonists (Ozempic, Wegovy, Mounjaro etc.)

How muscles change with age

Muscle mass peaks around age 30-35, then gradually declines, speeding up after age 65 in women. Before menopause, estrogen helps maintain muscle health by supporting repair and function, but during the menopause transition, reduced estrogen can lead to smaller, weaker muscles.

The diagram below shows a cross-section of muscle in a young, healthy 25 year-old compared to one in a typical 75 year-old.

Impact of estrogen loss on muscle health

Estrogen plays an important role in promoting the development of new, healthy muscle tissue. This is particularly important during exercise and after muscle injury. As the menopause transition occurs, falling estrogen levels start a cascade of changes that lead to muscle loss.

These changes, alongside the weight gain that often occurs during this time contribute to a condition called “sarcopenic obesity” and can have a negative impact on overall health and quality of life.

Benefits of exercise and resistance training

Activities that increase muscle strength and overall health are critical during and after the menopause transition. These include:

• Regular physical activity that increases your heart rate and gets you slightly out of breath, such as 30 minutes of brisk walking, running, cycling, dancing, etc. 4-5 times a week.
• Eating at least 1 – 1.2g/day of protein for each kg of your body weight to fuel muscle repair and growth.
• Resistance training (e.g., with resistance bands, weights or using your own body weight) at least twice a week to improve metabolism, insulin sensitivity, blood pressure, bone health, and enhance overall well-being.

Impact of hormone replacement therapy (HRT)

There is good evidence from research that estrogen can play a key role in maintaining muscle health in older women. Several studies have shown that in some women, HRT when started early in menopause, may reverse menopause-related loss of muscle. However, this is likely be due to a combination of factors, including exercise, rather than to HRT alone.

Impact of GLP-1 agonists

The new GLP-1 agonists, such as Ozempic, are extremely effective for weight loss, but as well as causing fat loss, they may also cause up to 6.9 kg (15 lb) of lean muscle loss during treatment, as well as having long term effects on muscle structure and function.

For women taking GLP-1 agonists, the strategies described in the exercise section above, in combination with a healthy diet, and HRT where appropriate, will help to protect muscles, reduce frailty, and ensure better health during and after menopause.