Menopause and Muscle Loss: Why Sarcopenia Starts Sooner Than We Thought
Share
We’ve long been told that muscle loss, also known as sarcopenia, is a natural part of aging. But new evidence shows that menopause and muscle loss are closely linked, and the process starts much earlier than we thought.
A landmark study published in The Journal of Physiology followed women ages 18 to 80, measuring muscle tissue, hormone levels, and physical performance. The results back up what many women have noticed: A sharp decline in strength begins in your 40s when hormone changes speed up muscle loss.
The bottom line: It’s not just aging. It’s menopause.
What is sarcopenia, and how is it linked to menopause?
Sarcopenia is the medical term for the gradual loss of muscle mass and strength that both men and women experience in midlife and beyond. But new research makes it clear that menopause accelerates the process for women.
Researchers discovered:
- Muscle loss in midlife women is driven by changes within the muscle itself, not just the nerves.
- Your quadriceps, the muscles in your thighs that power climbing stairs, walking, and balance, are particularly vulnerable.
- Declines in estrogen, progesterone, and testosterone are strongly associated with loss of strength and power.
- Lifestyle factors like exercise and protein intake matter, but hormones remain an important part of the picture.
The study validates what many women feel: Something shifts in perimenopause and menopause, and it changes how we move, perform, and live.
What’s happening inside your muscles?
Menopause muscle loss is not only due to less activity or aging nerves. It is also caused by changes to the muscle fibers themselves. When hormone levels change, the muscle becomes less responsive. It is less able to repair itself and less efficient at generating force.
Estrogen, progesterone, and testosterone likely all work together to maintain muscle tone and function. When those hormones drop, muscles do not rebuild as well after exercise. Simple tasks, like carrying groceries or climbing stairs, may start to feel harder. Let’s break it down:
- Estrogen supports energy use, blood flow, and muscle repair after activity.
- Progesterone contributes to tissue recovery and balance within cells.
- Testosterone, though lower in women than in men, helps preserve muscle tone and strength.
Which muscles are most affected in menopause?
The quadriceps, a group of four muscles located at the front of your thighs are among the first muscles to weaken during perimenopause, typically around age 45.
These muscles are rich in “fast-twitch” fibers, which provide power and quick reactions. They’re sensitive to hormonal shifts, and without enough estrogen, they shrink more quickly and store more fat inside the tissue.
Weak quadriceps do more than slow you down. They affect balance, bone health, and independence. In fact, strong quads are a good predictor of whether you will maintain mobility or experience falls and fractures post menopause. Beyond the quads, it’s important to preserve as much skeletal muscle throughout the body as possible since healthy overall muscle mass supports metabolism, blood sugar control and bone health.
How is sarcopenia diagnosed?
The earlier you identify muscle loss, the easier it is to reverse. Here are three tests to ask your doctor about:
- DEXA scan: Measures bone density and also estimates lean muscle mass. It’s one of the most accurate ways to track early osteoporosis and sarcopenia.
- Functional tests: Grip strength, walking speed, and chair-rise assessments can detect subtle changes long before symptoms appear.
Tracking these numbers over time provides a baseline and helps you adjust your approach as needed.
How to protect your muscles in midlife
Hormones influence muscle loss, but there are steps you can take to determine how much of that loss becomes permanent.
Move often and lift something heavy
Resistance training with heavy weights, resistance bands, or bodyweight exercises like squats and lunges helps preserve the fast-twitch fibers most affected by menopause.
If you’re new to strength training, start with simple bodyweight movements or light resistance two to three times a week. The goal is to work up to lifting weights heavy enough to exhaust your muscles after 3–6 reps. (Repeat for 4 sets, 3 times per week.)
Be sure to mix strength training with some type of moderate aerobic exercise. This can include walking, jogging, or running, and aim for at least 150 minutes each week to keep your heart healthy. The key takeaway: Exercise to be strong, not skinny.
Prioritize protein
Eating more protein helps your body maintain muscle and burn energy when you’re resting. Aim for 1.5 to 1.8 grams of protein per kilogram of your lean body mass or preferred weight. Feel free to do the math or use this protein calculator to determine your individual protein goals.
Aim to get most of your protein from healthy, whole foods, and spread your intake throughout the day. Good sources include meat, seafood, and plant-based options like nut milks, cheese, chia seeds, pumpkin seeds, chickpeas, legumes, and tofu.
Consider menopause hormone therapy (MHT)
There’s some evidence that menopause hormone therapy (MHT) could have some benefits for preserving strength and muscle mass when combined with exercise. This may be particularly true for MHT regimens that include testosterone in addition to estrogen and progesterone.
Be sure to consult your practitioner; if MHT is a good option for you, it must be carefully customized for your unique symptoms and body chemistry.
Don’t forget recovery and sleep
Muscle growth doesn’t actually happen while you’re exercising; it happens while you’re resting. During deep sleep, your body releases growth hormone, which helps repair and strengthen muscle tissue.
Chronic stress and poor sleep interfere with this process, making muscle harder to build and easier to lose. Prioritizing seven to eight hours of sleep, staying hydrated, and managing stress hormones like cortisol all help preserve muscle health through menopause.
Support your muscles with supplements
When you can’t get the nutrients you need from food, certain supplements can help support your muscles in the menopause transition.
- Creatine (5 grams/day): May increase bone and muscle mass when combined with a healthy diet and a strength training routine.* Check out this blog post on creatine supplementation to learn more.
- Protein powder: Helps meet daily protein goals when dietary intake falls short.
- Vitamin D (4,000 IU/day if deficient): Supports both muscle and bone function. Low levels are very common in midlife, so it’s critical to get yours tested and, if you are deficient, discuss supplementation with your clinician.
- Omega-3 fatty acids (2 grams/day) : Supports normal inflammation levels and may help decrease joint pain.* Great food sources of omega 3 fatty acids are fatty fish such as salmon, seeds like flax and chia and nuts, especially walnuts. You may also consider supplementing omega 3 fatty acids.
Remember to talk to your healthcare clinician before starting any supplement regimen.
Is it too late to start?
It’s never too late. Muscle responds to training at any age. Even women who begin strength training in their 50s, 60s, or beyond can gain muscle and see some improvements in function within months. The earlier you begin, the more you preserve, but starting now is always worthwhile.
Consistency matters more than intensity. A few focused sessions each week, paired with adequate protein and rest, can slow or even reverse muscle loss.
Putting it all together
Muscle loss during menopause isn’t inevitable. Hormones may shift, but the choices you make about how you exercise, what you eat, and how you care for your body shape your strength for decades ahead. To learn more, read Aging Strong: Preventing Frailty, Osteoporosis and Muscle Loss and listen to Dr. Haver’s conversation with Dr. Vonda Wright on unPAUSED.
Move often, lift something challenging, and fuel with purpose. Your future self will thank you.
