Menopause is a topic that brings strong reactions and confusion, and the information online can leave people feeling more overwhelmed or worried than informed. Additionally, menopause is not a single event that occurs over a short period; it unfolds gradually over many years, so this can make it hard to separate the effects of menopause from those of aging. In short, as a topic, it’s a lot.
In this article, we’ll look at what to expect with aging in general, how menopause can add its own effects, and what this all means regarding body composition, strength, and performance. Hopefully, this will provide some guidance on how to approach this phase of your life (or better understand it for clients or a loved one).
Let’s dig in.
Stages, symptoms, and hormonal shifts
Menopause is currently defined as going 12 consecutive months without ovulation or regular follicle activity, not due to another cause like amenorrhea from illness or medical treatment. The time before and around this transition is typically referred to as perimenopause, while the period after things stabilize is called postmenopause. Age ranges vary, but the median age per the Study of Women’s Health Across the Nation (SWAN) is around 52.
| Phases of the menopause transition | ||
|---|---|---|
| Phase | Description | Symptoms |
| Premenopause | Often defined as any time during the reproductive years before noticeable signs of the menopause transition begin. Follicle stimulation and ovulation are still generally consistent. | Generally, shifts here are smaller and less distinct, making it harder to pinpoint the onset of menopause. Mostly, they are each individual’s experience. |
| Perimenopause | This phase begins when hormonal shifts and more definable symptoms start to appear. Additionally, follicle stimulation starts to decrease. A common misconception is that perimenopause ends and menopause begins, but really, perimenopause refers to the time surrounding the menopause event itself. | More notable mood shifts, irregularity in periods and level of bleeding, and perhaps the beginning of vaginal dryness, sex discomfort, and the presence of mental health symptoms. |
| Menopause | Generally defined as 12 consecutive months without ovulation with noted decreased follicle stimulation (that’s not due to other health causes). At this point, the follicle supply is no longer responsive to stimulation. It’s called a “pause,” but it’s more accurately the end of previously normal ovarian function. | Sleep disturbances, more pronounced mood fluctuations, ongoing vasomotor symptoms (hot flashes and night sweats), and joint pain. |
| Postmenopause | The period after menopause has occurred, marked by at least 12 months of no notable menstruation or ovulation. Hormone levels remain low, and symptoms may continue or stabilize over time. | Vasomotor symptoms can persist, as with sleep disturbances; vaginal atrophy and dryness, stiffening of joints, and bone density losses. |
| Inspired by Khoudary et al (2019) | ||
I think the simplest way to approach this conversation is to view menopause as a collective transition. Menopause isn’t a single event; it’s a series of gradual changes that unfold over many years. It’s also a shift in a wide range of hormones, and aging itself is part of that process.
From a testing perspective, on an ideal level, we’d see repeated blood measures over weeks, months, or even years to gain a better picture of different phases. But from a practical and cost level, you can see how that wouldn’t be very easy to execute. Therefore, you can imagine how a single blood draw in a clinical setting could give you a snapshot, but it’s more like one corner piece of a much larger puzzle. Symptom tracking helps fill in those gaps, but as you’d expect, many of the symptoms are vague or overlap with other conditions.
So, the first thing I want to emphasize here is this: If you’ve heard people say that it’s tricky or “we just don’t know” certain things about menopause, that’s not a cop-out. It’s a reflection of how complex, expensive, and varied this area of research is. That said, I’m also not a fan of using that uncertainty as a license to throw out wild takes. We do have a solid foundation in the mechanistic understanding of hormones and how they interact in the body. And from that, we can build a pretty strong framework.
| General overview of hormone shifts from perimenopause to postmenopause | ||
|---|---|---|
| Hormone | Trend During Transition | Notes |
| Estradiol (E2) | Fluctuates early, then declines significantly. | Levels may rise and fall in perimenopause before settling low in postmenopause. |
| Progesterone | Gradual decline. | Reduced production leads to luteal insufficiency and irregular cycles. |
| Testosterone | Gradual decline with aging; may shift slightly relative to estrogen. | Generally less affected by menopausal transition itself, though the drop in estrogen can increase the relative androgen balance in some individuals. |
| Follicle-Stimulating Hormone (FSH) | Increases, especially in early follicular phase. | Remains higher postmenopause. |
| Luteinizing Hormone (LH) | Increases, altered pulse pattern. | Changes in pulse frequency and response to gonadotrophin releasing hormone (GnRH). |
| Inhibin B | Declines. | Falls as follicle numbers decline. |
| Inhibin A | Declines. | Falls as ovulatory function weakens. |
| Anti-Müllerian Hormone (AMH) | Gradually decreases and often extremely low at menopause. | Possibly more telling of menopause stage. |
| Sex Hormone Binding Globulin (SHBG) | Decreases as estrogen decreases. | Reduced SHBG and increased androgens may cause shifts in body fat distribution. |
| Adiponectin | Ranges from higher and lower during peri- to postmenopause. | May contribute to central fat storage. |
| Inspired by Davis et al (2023) | ||
We could delve into the details of individual hormones, but that’s not the point of this article. For example, estrone (E1) is also an estrogen, and its levels can actually rise slightly after menopause due to conversion in body fat, though it’s much less potent than estradiol. So, it’s not quite accurate to say there’s no estrogen after menopause or that only estrogen drops. It’s more accurate to say that the ratios shift and estradiol (an estrogen) level drops more significantly.
So, I won’t break down every hormone here; I might reference how a few values shift to illustrate key points. Just know that there’s a lot of interaction going on behind the scenes, and what I’m covering barely scratches the surface. In a real-world setting, things often go back to symptoms versus frequent blood tests.
Separating aging from menopause
I don’t want to assume too much in this article, so let’s briefly touch on the topic of aging.
All individuals undergo different phases of hormonal changes throughout their lives. To be honest, regardless of sex, we’re never really in one stable state. From infancy to adulthood to midlife, there is a range of changes, from subtle to significant swings. From one person to another, it’s also hard to lock down what counts as ideal. That said, this article focuses specifically on body composition, performance, and strength. And when that’s the focus, the traits that help most people maintain or improve those things do tend to decline after midlife.
In Janssen et al, researchers used full-body MRI scans to measure skeletal muscle in 468 adults aged 18 to 88. They found that there is a gradual shift in muscle loss that starts earlier than most people expect. And while relative muscle mass (percentage of body weight) can start to decline at earlier ages, absolute muscle mass does not tend to drop noticeably until our mid-40s or later, with this pattern observed in both men and women.
With performance, velocity and power drop a lot more sharply as we age. Your late 20s are typically when you’ll start to see significant shifts begin. Strength tends to hold out a bit longer, but even with consistent training and good nutrition, it gets harder to maintain as we move past our 60s. It’s important to note, there can be differences in severity and where those changes show up. But to be clear, across the board, we tend to get weaker, slower, and a little fatter as we age.
So, with that said, is menopause any different? More specifically, are there things that distinguish simply getting older from aging while also undergoing the transition of menopause? That’s the point of this article, because aging itself brings valid challenges, and I don’t think it’s easy for any of us. But where is that line between aging and menopause?
Body composition and menopause
With body composition, we are looking at changes in the ratio of muscle mass to fat mass. In this instance, researchers will watch for these changes in individuals going through the stages of menopause, as well as the general transition to midlife.
| Body composition indicators in menopause | ||
|---|---|---|
| Indicator | Definition | Relevance to Menopause |
| Body Fat Mass (BFM) | Total fat mass in the body. | Often associated with increases during menopause, particularly in the abdominal region. |
| Fat-Free Mass (FFM) | All mass excluding fat, including muscle and water. | Can decrease due to muscle loss or changes in hydration; may be influenced by age and dietary patterns. |
| Waist Circumference (WC) | A measurement of abdominal fat. | Tends to increase in some individuals during menopause due to shifts in fat distribution and hormonal changes. |
Let’s start with fat mass, specifically. Does body fat increase during menopause, and does waist circumference go up?
The short answer is: Often, yes. But it’s more nuanced than saying, “You just start gaining fat during menopause.”
A common knee-jerk explanation for body changes during menopause is that metabolism just slows down. But that’s not quite right. Greg wrote a great article on how basal metabolic rate changes with age, and the gist is: BMR declines gradually over the decades, not suddenly at menopause. So while there is a slow drop with age, we don’t typically see a sharp cliff during the transition from pre- to postmenopause.
Now this isn’t to say we don’t gain actual fat mass as we age. Generally speaking, most people gain weight across adulthood, which can add up over time, though it often levels off or even reverses slightly after the 70s. We also decrease activity as we age and create an overall condition that lends itself to easier weight gain.
With that said, fat gain often feels different during menopause, especially in the midsection. It is common to hear things like, “I’ve been doing the same things for years, and now I’m gaining belly fat when I never used to.” And while fat gain still requires a Calorie surplus relative to your personal energy expenditure, people still seem to notice a shift. What is it that’s taking place?
Alterations of fat distribution during menopause
As discussed earlier, hormone levels shift during menopause, most notably, estradiol drops. This drop can have a meaningful impact on fat storage patterns and distribution. Before menopause, fat tends to be stored more in the hips and thighs, and this is often described as being more “pear” shaped in appearance. As estradiol declines, the pattern shifts toward more central storage, particularly visceral fat in the abdominal region. The result is a more pronounced stomach and a rounder midsection. And because most of us are accustomed to seeing our bodies gain or lose fat in familiar areas, this kind of change can feel more noticeable. You might not notice small fluctuations in your hips or thighs, but if you’ve never really carried weight around your middle before, it’s going to stand out when you all of a sudden gain in that region.
A meta-analysis from Ambikairajah et al took a look at this and lent some interesting inferences to the conversation. It analyzed data from over 1 million women across 201 cross-sectional studies and 11 longitudinal studies and found that while fat mass increases with age, it’s not necessarily tied to menopause. The study also noted that while there can be an increase in fat centrally located in the stomach, there can be a decrease in fat in the legs — essentially a shift away from a pear-shaped distribution toward a more apple-shaped one.
Now, this study rests a lot on cross-sectional data, but we do see similar findings popping up suggesting that during or after menopause, fat distribution tends to shift even without big bounces in overall fat or BMI during that same period of time.
Another factor to consider is the gradual loss of lean mass that often happens alongside fat gain. In Greendale et al, researchers observed a small but measurable decrease in lean mass (about −0.06 kg per year) across the menopausal transition. On its own, it’s not a huge shift. But when you mix a little lean mass loss with a little increase in fat gain (even if it’s just a distribution change), those subtle changes contribute to changes in body composition.
This aligns with findings from other research on lean mass loss. One longitudinal study of middle-aged Finnish women saw lean and muscle mass drop across the menopausal transition, even after accounting for aging. Another showed lean mass losses were closely tied to vasomotor symptoms and stage of menopause. With this said, menopause doesn’t have to stop one’s ability to gain lean mass, but it might lead to a need for a tad more resistance training volume or intensity than is typical for certain populations and their training styles.
Quick recap
None of this changes the basics: Calories and daily energy expenditure still matter. However, menopause alters the hormonal landscape in ways that favor fat gain and changes the pattern of fat distribution while making it more challenging to maintain lean mass. In short, there is reason to believe that body composition can become harder to manage, even if your habits haven’t changed. That said, training and hormone replacement therapy (HRT) are viable mitigators.
Strength and performance during menopause
As discussed earlier, aging itself presents challenges and affects both performance and strength in men and women. The lingering question might be: Is there a factor beyond aging that affects menopause and leads to performance or strength decreases?
From a mechanistic standpoint, we can examine several factors that occur when estrogen levels drop. For instance, we can see decreases in neuromuscular function and estrogen plays a role in protecting from muscle damage. Together, these changes can lead to less power and strength and slower recovery during and after menopause.
One study that examines this angle is from Bondarev et al. They examined women between the ages of 47 and 55 and compared their physical performance, which included measures such as handgrip strength and lower body muscle power. They categorized women based on hormone levels and menstrual history, with the mean age difference between premenopausal and postmenopausal women being approximately 2 years, so age differences were relatively modest. The postmenopausal women had lower grip strength and less body muscle power than their premenopausal counterparts.
The study also notes that women with higher physical activity levels generally performed better than those with low activity, regardless of menopause stage. This suggests that menopause may contribute to reduced strength and power beyond the effects of aging; however, staying active can help counteract some of these effects.
A more recent 2025 study included pre-, peri-, and postmenopausal women randomly assigned to either a control group or a relatively light resistance training program (meaning this wasn’t pushing anyone’s 1RM). Even with the lighter loads, menopause status didn’t affect the adaptations to training, including women with the lowest estradiol levels. Something else to note is this study excluded HRT users (which I will get into in a moment). These studies show that even light resistance and maintaining physical activity can still produce a positive training response across different hormonal states.
Now, much of the training research on the topic of menopause tends to focus less on what specifically happens to strength and power during the transition from the start of perimenopause to the postmenopause transition and more on how implementing exercise can help offset negative and common menopausal symptoms. Overall, it seems like there are small effects that can take place with menopause, but I think a fair question to examine is how much menopause has to throw you off your game. I think a big tell would be if we saw a lot of big shifts that happened with the introduction of hormone therapy.
Quick recap
There appear to be small effects (outside of aging) that can impact individuals during the menopause transition. With that said, training alone seems to have a pretty meaningful and positive impact to counteract a lot of these effects.
Does hormone replacement therapy help?
Now, the reason behind these changes during menopause from a mechanistic standpoint seems to be quite complicated. We learned that estrogen drops more sharply and dramatically during the transition through menopause. Estrogen seems to help maintain the pool of satellite cells in muscle and support receptor signaling that aids recovery and limits muscle damage. And while debated, there could be effects of estrogen loss on joint stiffness or osteoarthritis, which can all play a role relevant to strength and power. On the body comp side, estrogen could help reduce visceral fat gain.
There are other hormone-related factors in the mix, too. For example, adiponectin levels tend to increase on average; however, in women who gain visceral fat during menopause, those levels sometimes decrease. Higher FSH levels have also been associated with increased fat mass and changes in body composition, although the mechanisms underlying these associations are not yet fully understood.
So, the obvious question is: Does HRT help with any of that? And to be clear, I’m not talking about relief from hot flashes or other vasomotor symptoms, just muscle, performance, and body comp for now.
One review from Javed et al looked at 12 randomized controlled trials and found no statistically significant difference in lean mass between hormone users and non-users. Another review from Xu et al, which looked at 20 studies on strength outcomes like handgrip and knee extension, also found that HRT didn’t lead to notable improvements. A systematic review and meta-analysis by Nolan et al looked at eight studies comparing oral contraceptive pill users with naturally menstruating women. Hypertrophy, power, and strength were not statistically significantly different between groups. And while these findings are specific to oral contraceptives, they illustrate how adding exogenous sex hormones did not meaningfully change training adaptations.
An earlier meta-analysis and systematic review found more positive outcomes but rested a little heavily on animal models. And it’s also important to recognize that hormone therapy protocols and dosages have changed a lot through the years, so heterogeneity across these studies is high. But we aren’t seeing that the hormone changes themselves are making big swings in strength and performance.
What this all does suggest is while there are biological mechanistic possibilities, hormone therapy alone isn’t likely to be enough. And in general, that tracks pretty well with what we see about resistance training and aging across sexes. If you want to maintain muscle, strength, and performance, you have to keep training for it, and that’s going to be a bigger factor in this situation until we hit the next aging level.
Let’s go one step further though and see if utilizing HRT with training gives a better advantage.
Interestingly, there aren’t a ton of these studies, and some of the older ones tend to use more outdated HRT methods, but I think it’s enough to have a conversation. An older study by Sipila and Poutamo compared a one-year program of strength and performance training with and without the use of HRT and found that while trainees in both groups improved, there were slightly larger increases in strength and muscle cross-sectional area in those who utilized HRT. This could suggest the possibility of a synergistic effect.
A more recent study from Vrist Dam et al found that training with HRT led to larger gains in muscle cross-sectional area and fat-free mass compared to a placebo group. This research group seems to be examining this area and released another study finding the advantage of HRT use with training. So, all of this points to a possibility that estrogen could help preserve muscle better alongside resistance training but, on its own, is probably not going to make any noted difference.
And as discussed earlier, hormone therapy does appear to slow or even shift fat distribution. Studies comparing women using HRT to those who aren’t show that users tend to carry less abdominal fat. However, once therapy stops, that fat distribution usually returns to the typical postmenopausal pattern.
I haven’t touched much on how common menopause symptoms can also affect performance, strength, and body composition. Poor sleep is one of the most obvious examples, as it’s extremely common during menopause. As discussed in a recent article, consistent and quality sleep are important for easier weight management. On top of that, hot flashes or erratic body temperature could certainly tank motivation and focus. Hormone therapy could help these things in many individuals.
That said, hormone therapy is a personal decision and full of complex nuances. For example, while estrogen could support better fat distribution, too much without progesterone can cause uterine thickening and increase cancer and stroke risks. That’s why most treatments pair estrogen with progesterone. So, if you’re considering HRT, it’s worth working closely with someone who knows your health history and can help you balance the benefits with the risks.
Quick recap
Hormone therapy appears to be most effective in slowing the fat distribution patterns that occur during menopause. With strength and performance, there could be a slight advantage in using hormone therapy alongside training, but the use of hormone therapy alone isn’t likely to do much. Lastly, though not the main topic of this article, if someone is affected negatively in their weight management and training by some of the more common side effects of menopause, hormone therapy might be an aid but should be individualized and discussed in detail with an expert physician.
Final thoughts
What we’ve covered so far is that aging is a very real factor in decreasing performance and strength and in changing body composition; however, menopause also plays its role. With that said, I think that role tends to be viewed as more intensive regarding sharp losses of strength or huge swings in fat gain, and as you can see, I don’t think it has to be that severe. I find myself struggling to find the balance between motivation and the sometimes harsh reality of aging. Sure, top-tier performance peaks years before menopause, but that doesn’t mean you stop striving to do your best. You can certainly lose fat during menopause and even maintain or build some strength. Overall, you probably don’t need to adjust your expectations much beyond what you’d already do for aging in general.
The biggest positive takeaway here should be that training is significantly important for having a better experience during menopause, from body composition to strength to performance. And there’s even evidence to suggest that it could be a little helpful for some associated symptoms. However, when it comes to the more intensive vasomotor symptoms of menopause, it seems like many need more than just exercise.
While I don’t want to come across as overly optimistic, embracing basic self-care habits (like regular exercise) puts you in a much better position to manage the transition to menopause. It won’t erase the realities of menopause, but it can help you navigate this stage with more confidence and, hopefully, a little less fear.
