Muscle Mass and Perimenopause

Debunking the viral claim

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There are viral claims that women lose a lot of muscle mass, even up to 10%, during the menopause transition, a.k.a perimenopause. I've seen several iterations of this, but here is one of the rather alarming quotes that I was sent and that prompted this piece:

Starting with perimenopause, we begin to lose muscle at an incredibly fast rate. We lose twice as much muscle during perimenopause and menopause as during any other time of life- up to 10% between early and late perimenopause.

There are also claims that the clear answer to this dramatic loss of muscle is menopause hormone therapy, which means that without MHT, women are destined to become feeble.

How accurate is this?

I was naturally skeptical for two reasons. One is that it is fear-based messaging, which gets far more attention on social media. The second is that studies tell us that metabolism doesn’t change during the menopause transition. As muscle contributes significantly to metabolism, if a lot of women were really losing 10% of their muscle mass or close to that percentage during the menopause transition, I would think that we should expect to see a change in metabolism.

But thinking isn’t knowing. And as a woman of science I am always open to quality data. Admittedly, I had not taken a deep dive into the literature on muscle mass and menopause in a while, so, I thought now would be a good time to do just that.

Let’s get into it!

Muscle and Aging

Both men and women lose muscle mass with age, but do the hormone changes of the menopause transition add to this equation for women?

Muscle mass is relatively stable from age 18 to 30, and around age 30, age-related muscle loss begins; it is about 0.37% per year for women and 0.47% per year for men.^1,2 (There is some controversy about the age at which this loss of muscle starts, and while that isn’t the point of this piece and doesn’t really factor in here, I just wanted to add it for completeness). Once we are over 75, muscle loss accelerates to 0.64-0.7% per year for women and 0.8-0.98% per year for men.¹

I asked Dr. Lauren Colenso-Semple, a PhD scientist in female physiology, exercise, and nutrition, about age-related muscle loss (she is a great evidence-based follow on Instagram). She said, “Depending on the measurement technique, the rate of muscle loss is ~0.05% to ~1% per year. Aging and reduced physical activity often go hand in hand, so muscle loss in individuals over 75 tends to be greater than muscle loss in individuals in their early 60s.”

Menopause, Aging, and Muscle

We’ve established that loss of muscle mass will occur over time for women in their 30s and above, but does menopause affect that trajectory? Some cross-sectional studies