Combating Muscle Loss During Perimenopause: A Guide for Women over 35
The transition into perimenopause brings significant changes to the body, many of which can take women by surprise. As a menopause exercise physiologist, one of the most urgent topics I address with my clients is the accelerated muscle loss that occurs during this stage of life. The natural, age-related decline in muscle mass becomes much more pronounced due to the rapid decrease in estrogen levels. This condition, known as sarcopenia, is not only a blow to strength and metabolism, it can also affect overall health, independence, and quality of life.
The Steep Decline in Muscle Mass During Perimenopause
While women generally lose 3–5% of their muscle mass per decade after age 30, this rate can skyrocket during perimenopause. Research shows that women can experience a staggering 10–20% loss of lean muscle mass during this transitional phase, with the most dramatic losses happening between the ages of 45 and 55. Muscle strength, in particular, is impacted, with reports of a 20% drop in strength between the ages of 25 and 55, especially in key muscle groups like the quadriceps (thigh muscles). This rapid decline has significant consequences, not only on physical performance but also on the ability to manage weight and maintain independence as we age.
Why Does Muscle Loss Accelerate?
The primary culprit behind this sharp decline is the drop in estrogen levels. Estrogen is a hormone that does much more than regulate reproductive health—it plays a critical role in supporting muscle repair, growth, and overall quality. Here's how estrogen deficiency impacts muscles:
Reduced Muscle Repair and Growth
Estrogen helps maintain mitochondrial function and stimulates muscle repair. Without it, muscle tissue becomes less responsive to growth signals and more prone to degeneration.
Decline in Muscle Protein Synthesis
Estrogen also plays a role in muscle protein synthesis, the process by which the body repairs and builds muscle. During perimenopause, muscle breakdown often exceeds repair, hastening atrophy.
Disrupted Hormonal Balance
The body’s anabolic (building) processes weaken, while catabolic (breaking down) processes become dominant. Lower estrogen levels also reduce the beneficial effects of other hormones, such as insulin-like growth factor-1 (IGF-1), which supports lean body mass.
Activity Decrease
Fatigue, joint pain, and other menopause-related symptoms often lead to less physical activity, further compounding muscle loss. Simply put, "use it or lose it" becomes amplified during this time.
How to Counteract Muscle Loss in Perimenopause
The good news is that muscle loss is not inevitable. With the right strategies, women can not only prevent muscle loss but also regain strength and vitality. Here are the key steps I recommend:
1. Resistance Training
Strength training is the gold standard for fighting muscle loss during perimenopause. Studies show that lifting weights 2–3 times per week can stimulate muscle protein synthesis, rebuild lean mass, and improve overall strength. Focus on major muscle groups, particularly the quadriceps, hamstrings, back, and chest, using heavy weights with proper form.
2. Protein-Rich Nutrition
Diet is just as important as exercise for maintaining muscle. Increasing protein intake to 1.4–2.0 grams per kilogram of body weight per day helps combat muscle breakdown and supports repair. High-quality protein sources, such as lean meats, fish, eggs, dairy, and plant-based options like legumes and tofu, are essential.
3. Hormone Therapy
For some women, Menopause Hormone Therapy (MHT) can be a valuable tool in preserving muscle mass when combined with regular exercise and proper nutrition. By stabilising hormone levels, MHT can reduce the rate of muscle decline and improve overall energy levels. You will need to talk to your doctor specifically about this option.
4. Prioritise Functional Movement
Beyond weights and diet, staying active through daily functional movements- such as walking, climbing stairs, and stretching—reinforces muscle use and helps maintain joint mobility. Activities that you enjoy are more likely to become long-term habits.
Ready to take charge of your health?
It’s never too early- or too late- to take action against muscle loss. Building strength, maintaining lean mass, and supporting metabolic health requires commitment, but the rewards are life-changing. In my signature program, The Perimenopause Reset, I help my clients learn how to preserve muscle, reboot their metabolism, and create sustainable health routines.
If you're ready to stop spinning your wheels and start reclaiming your strength, why wait?