Managing Menopause
“Does menopause affect my body fat, muscle mass, and ability to progress with exercise?”
Menopause is defined as a 12 month period of an absence of ovulation. The menstrual cycle section in this article, should explain why a 12 month absence of a period does not define menopause as it historically used too and why defining the true start of menopause is difficult. Menopause is often experienced as a confusing and life-changing 5-15 year period of many physical and mental symptoms. On average menopause is first experienced by the age of 51 in women, but symptoms of peri-menopause (when your ovaries are still producing normal amounts of oestrogen) can occur much earlier than this age (Menopause | Nature Reviews Disease Primers + Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years - PubMed + Navigating Menopause: Expert Insights and Solutions (Part 1) | Dr S.Davis and Part 2 + Information About Menopause - YouTube + Position Papers and Consensus Statements - International Menopause Society + Bothersome vasomotor symptoms: a potential early clinical marker of perimenopause?). To emphasise, the confusing life changing symptoms of menopause are still occurring when oestrogen levels are normal. Other complex changes are causing these symptoms (Lecture | Cardiometabolic Health: Do Sex Steroids Matter?- YouTube). Unfortunately, marketing of medication, supplementation and health advice can take advantage, targeting women at this vulnerable stage who often have a strong and reasonable desire to solve the confusing symptoms of menopause by promising a quick fix. Many experience these unproven medical promises through social media. Many of these marketing companies use the belief that oestrogen reduction is the cause of all your symptoms, and only what they are selling can resolve what you wish to change (Marketing empowerment: how corporations co-opt feminist narratives to promote non-evidence based health interventions | The BMJ + “Menopause is not a dirty word.” Australian women's opinions about increased public attention to menopause + Wild West or Gold Rush: How Long-Neglected Menopause Care Has Spawned a Booming Marketplace).
Like anything that is complex, misinformation is common despite being often well-intended. Menopause misinformation within our scope at Method Health that is harmful and worth discussing includes the myth around “inevitability” of weight gain and muscle loss during menopause. Like anyone through any context of life, if a woman believes weight gain and muscle loss are inevitable, they will not take daily actions to prevent weight gain and muscle loss, making peri- and post-menopause unnecessarily difficult (Gains in Body Fat and Vasomotor Symptom Reporting Over the Menopausal Transition).
Is muscle loss and fat gain inevitable in menopause?
Despite common cultural beliefs, muscle loss and weight/fat gain during menopause is more related to lifestyle changes contributing to less physical activity, worse daily nutrition habits and unhealthy aging rather than the direct effect of oestrogen changes (Changes in body composition and weight during the menopause transition - PMC + Changes in physical activity and body composition in postmenopausal women over time - PubMed + Metabolic health, menopause, and physical activity-a 4-year follow-up study + Menopause 101 | Docs Who Lift Podcast + Changes in Regional Fat Distribution and Anthropometric Measures Across the Menopause Transition + Is Weight Loss Resistance Real? - Dr Bill Campbell + Body composition and cardiometabolic health across the menopause transition + Weight Regulation in Menopause).
Muscle and fat changes occur at the same rate for males and females who are the same ages, disputing any unique influence of menopause on body composition (Influence of age and gender on fat mass, fat-free mass and skeletal muscle mass among Australian adults + Assessment of Age-Induced Changes in Body Fat Percentage + Changes in body composition and weight during the menopause transition). Any other change in fat, muscle mass, or metabolism unaccounted for by lifestyle changes coincidentally common during menopause, such as increased attention on child-raising, increased work commitments/responsibilities, caring for less independent parents (all resulting in changes to nutrition, sleep and exercise habits) can be explained by the effects of healthy aging. Also, changes in metabolism with healthy aging are so small as to be unnoticeable. Studies with thousands of participants have undramatically shown that metabolism is stable on average until 60 years old on average in either sex. This is 10 years after average menopause changes begin for females, and again is so small it takes laboratory based measurement to detect this small change. Also, some of these small changes we think can be attributed to changes in oestrogen, only occur during the first years of peri-menopause and do not progress or worsen with time as many still fear-monger (Daily energy expenditure through the human life course + Age But Not Menopausal Status Is Linked to Lower Resting Energy Expenditure). Finally, the research from which this menopause belief that a reduction in metabolism occurs dramatically due to changes in oestrogen, occurred from studying laboratory female rats after their ovaries were surgically removed. This is not comparable to the changes occurring in a woman throughout menopause. We have other glands in our body that still produce oestrogen after menopause, whereas rats do not. This also points to another misconception that oestrogen production completely stops in women post-menopause. If this were true, women would have little risk of developing breast and uterine cancer.
So to summarise, negative muscle, fat and metabolic changes during menopause match what we would expect in males of the same age and are so small, you won’t notice them compared to the effects of lifestyle changes at this time. However, it is much easier to blame menopause, than change difficult lifestyle situations, so this common misconception remains “common knowledge.”
As we have said, maintaining healthy lifestyle habits is very important during this time. Those who maintain consistent strength exercise during peri-menopause and post-menopause years do not see small amounts of weight gain, bone density reduction or muscle loss many still unfortunately believe as “inevitable.” These measures only improve with progressive strength training (Preventing muscle and bone loss in peri-menopausal and early post-menopausal females with heavy strength and impact training + Resistance training predicts 6-yr body composition change in postmenopausal women). Your metabolism hasn’t slowed down. You have. So spread the word that menopause does not affect your potential to gain strength, muscle or reduce body fat from a strength training program. However, an unhealthy lifestyle at any stage of life, sometimes due to unpredictable life events with a lack of time management skills and/or social support around you to maintain healthy lifestyle habits to cope with, definitely can (Evaluation of sex-based differences in resistance exercise training-induced changes in muscle mass, strength, and physical performance in healthy older (≥60 y) adults + Sex Differences in Adaptations in Muscle Strength and Size Following Resistance Training in Older Adults + It's never too late: The impact of resistance training on strength and body composition in females across the lifespan + Resistance training alters body composition in middle-aged women depending on menopause). So seek out coaching at Method Health if you need more support.
Women mistakenly perceive fat redistribution towards the belly away from other body areas due to menopausal changes as fat gain, even though no fat gain has occurred (Are hormones the key to weight loss?).
Symptoms of menopause, and associated life stress common in this time of life for most families, greatly contribute to behaviour contributing to weight gain (Menopausal symptoms: do life events predict severity of symptoms in peri- and post-menopause? + Sleep and sleep disorders in the menopausal transition), and can make weight loss or maintaining your body weight difficult for some women. Still, many women going through menopause do not experience weight gain (Effects of the menopausal transition on dietary intake and appetite) again pointing to the fact that while menopausal changes might make weight loss or weight maintenance more difficult, fat gain is not inevitable.
Again, as addressed in the “Is it harder for women to lose weight than men?” section above, be careful of beliefs that “losing weight will be harder for me than others” as we know this makes general weight loss more difficult than it needs to be (Mind over milkshakes: mindsets, not just nutrients, determine ghrelin response). Do the social messages of “inevitable weight gain” during and after menopause reduce your belief that fat loss habits will be helpful. The belief of “inevitable” changes can be a strong barrier to weight loss attempts and maintenance due to how it reduces your confidence in healthy daily behaviour. Again, mindset matters much more than the direct effects of oestrogen changes during menopause, and thankfully is more modifiable.
Some might be thinking about the effects of hormone therapy and how this influences body composition, including fat mass, bone and muscle. While being very helpful for many women (when accessible and not always in a “more is better” way) to reduce some symptoms of menopause when negatively affecting quality of life (Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline + What We Should Know About Perimenopause + Low use of effective and safe therapies for moderate to severe menopausal symptoms: a cross-sectional community study of Australian women + Your Brain On... Menopause Hormones - Apple Podcasts + Your Brain On...Testosterone Apple Podcasts + NAMS 2022 Hormone Therapy Position Statement + Addressing the “Women Have More Testosterone Than Estrogen” Claim), hormone therapy aiming to increase oestrogen and/or testosterone does not prevent the small amounts of muscle loss associated with the normal healthy aging during this time. Again, strength training is your best option here for improving your body composition during this time (Association Between Hormone Therapy and Muscle Mass in Postmenopausal Women + Is Testosterone Just for Men? The Science of Women’s Hormones & Health | Susan Davis + Women’s sexual health, menopause, and hormone replacement therapy (HRT) + The Truth About Hormone Replacement Therapy). We wish it would be as simple as just raising hormones with medication to have the body composition goals you are aspiring to, but multiple lines of evidence suggest this is not helpful to depend on. Focus on lifestyle factors, exercise and for some the assistance of hormone therapy, to help manage the symptoms of menopause to positively influence your body composition during this time, rather than being concerned about “inevitable hormone effects.”
While just as beneficial for any age group, exercise is particularly beneficial during and after this time period for women, especially if you are concerned about changes in bone health, body fat, muscle mass, strength, aerobic fitness and menopausal symptoms like hot flashes and fatigue (Optimizing Female Health: The Crucial Role of Exercise Initiation before and during the Menopausal Transition). Low-intensity exercises like walking, house work, occupational movement and light intensity strength training like yoga, stretching, and pilates have fewer benefits for menopausal symptoms than running, sport and heavy strength exercise - so seeking support to begin these each week is recommended.
The effects of aerobic exercise on cardiometabolic health in postmenopausal females
Resistance training predicts 6-yr body composition change in postmenopausal women - PubMed
Resistance training for postmenopausal women: systematic review and meta-analysis
The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review
Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms
The effect of resistance training in reducing hot flushes in post-menopausal women: A meta-analysis
Talking About Older Female... - The NAF Physio Podcast - Apple Podcasts
Knowing all this should hopefully challenge any belief that fat gain or muscle loss is “inevitable” during menopause and that lifestyle rather than age often explains what is blamed on menopause. Also the section above on the myth or women's perceived exercise fragility should challenge any belief that intense exercise is harmful after your mid-life as a woman.
More menopause support:
Menopause, Part 1: What It Actually Is and the 24-Year WHI Correction - YouTube + Menopause, Part 2: The 2,000-Year-Old Lie About Women and Exercise + Body Composition, Bone, Brain, & the Fitness Changes (Data vs the Influencers) I Menopause Part 3 + Women’s Health Consultation with Dr. Loraine Baraki | Barbell Medicine + Menopause & Strength Training: What Actually Works (The Evidence) I Part IV
Dr. Jen Gunter
Lauren Colenso-Semple
Susan Davis
Susan Davis Archives - The Proof (We apologise in advance for the sponsors of this show which are unfortunately sometimes outdated. Hopefully this is not a barrier for trusting who is being interviewed)
Why didn't anyone tell me this? Prof Susan Davis: Making sense of the menopause - YouTube
Menopause Information & Support | Australasian Menopause Society
Trustworthy Women’s Health Resources/Leaders.
Lauren Colenso-Semple, PhD (@drlaurencs1) • Instagram photos and videos + Women's Fitness Myths, Cycle Syncing, & Fasted Cardio DEBUNKED with Dr. Lauren Colenso-Semple + Episode 379: Menopause Myths, Cortisol Belly, & The Truth About IUDs + Female-Specific Training & What the Science Really Says | Dr. Lauren Colenso-Semple
Dr.Gabrielle Fundaro, CHC (@trust_and_nourish) • Instagram photos and videos + Gabrielle Fundaro, PhD, CHC (@no_bs_guthealth) • Instagram photos and videos
Andrea C. Love, PhD (@dr.andrealove) • Instagram photos and videos
Nick Hannah | Physio + Coach | (@hannahmoves) • Instagram photos and videos
Movement Logic Tutorials (@movementlogictutorials) • Instagram photos and videos
Women’s health misinformation | Dr Jen Gunter, OB, GYN - The Proof (We apologise in advance for the sponsors of this show which are unfortunately sometimes outdated. Hopefully this is not a barrier for trusting who is being interviewed). Here is more from the guest- A Five-Step Guide to Combating Misinformation on Social Media + The Truth About Women’s Hormone Therapy | Dr. Jen Gunter + Dr. Jen Gunter | Substack
Women's Health Consultation with Dr. Loraine Baraki - Barbell Medicine
Kelly McNulty, PhD (@periodoftheperiod) • Instagram photos and videos
Dr. Christina Prevett PT, PhD (@dr.christina_prevett) • Instagram photos and videos
Nicole Surdyka DPT, CSCS, CPSS (@dr.nicolept) • Instagram photos and videos
Dr Claire Minshull - Get Back To Sport + 074 Talking About Strength and... - The NAF Physio Podcast - Apple Podcasts
Elisabetta Brigo🔹Physiotherapist (@the.physio.formula) • Instagram photos and videos




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