Muscle & Strength
Protect Muscle During Menopause
Lean mass can fall around menopause. Resistance training helps; supplement effects are modest, and hormone therapy is not a muscle treatment.
Many women notice their body changing shape around menopause even when the scale barely moves. That difference between weight and muscle is the question Humanic Blue takes up here. It matters for living longer and better because muscle supports strength, balance and function in the decades that follow.
In a Study of Women’s Health Across the Nation (SWAN) analysis, average lean mass (body tissue other than fat) began declining around the start of the menopause transition—about two years before the final menstrual period—while fat gain accelerated. The pattern varied among individuals. Resistance training—working muscles against weights or other resistance—has the most direct evidence for improving strength. Whey and creatine may add modest benefits in some women, especially alongside training, but the evidence does not support treating either as a substitute. Reviews combining trials that randomly assigned treatment do not show a clear muscle-strength or lean-mass benefit from hormone therapy. No trial has established that preserving muscle during menopause extends life.
The useful way through the evidence is to look first at what changes and when, then at what each option can—and cannot—do.
Key Takeaways
- In SWAN, average lean mass began declining and fat gain accelerated around the start of the menopause transition; this was a population trajectory, not a rule for every woman.
- Greater lean-mass loss during the transition was associated with more later fractures, but the study cannot show that preventing the loss prevents fractures.
- Resistance training improves strength in postmenopausal women. Whey and creatine results are smaller and conditional; hormone therapy is not an evidence-based muscle treatment.
When does muscle change around menopause?
A detailed picture comes from the Study of Women’s Health Across the Nation (SWAN), a US study following women over time. In a 2019 analysis in JCI Insight, investigators used repeated DXA scans—X-ray measurements of body composition—to track fat and lean tissue around the final menstrual period. They accounted for differences in age at that period, race, study site and hormone-therapy use.
Before the transition, both fat and lean mass were rising on average. At the estimated start of the transition—roughly two years before the final menstrual period—the rate of fat gain doubled and lean mass began to decline. Those slopes continued until about two years after the final period, then flattened. Body weight had already been rising before the transition and did not suddenly accelerate at its start. This is an average cohort pattern; it does not predict the timing or magnitude of change for an individual.
Why does muscle change matter beyond appearance?
A 2023 SWAN analysis in the Journal of Bone and Mineral Research followed about 540 women who were not using medications expected to benefit or harm bone during the transition. Women who lost more lean mass during the transition had higher rates of later fractures, mostly at sites such as the wrist, ankle or arm rather than the hip. The association remained after researchers accounted for bone density. Fat gain had a less consistent association with fractures. The detailed estimates are below.
This was an observational association. It does not establish that preserving lean mass will prevent fractures, and the relatively small number of fractures limits precision. Bone during this period is covered in Protect Bone Density as You Age.
How does measuring physical function change the discussion of menopause-related body changes?
What can each option actually do?
Resistance training. A 2024 systematic review and meta-analysis of 12 randomized trials in healthy postmenopausal women found improvements in upper- and lower-body strength, although the size of the benefit varied substantially among trials. A 2025 scoping review found that the field still lacks a well-supported, menopause-specific training prescription. Current US Physical Activity Guidelines recommend muscle-strengthening activity involving all major muscle groups on at least two days a week. That is general health guidance, not a guarantee against menopause-related muscle change. Why strength matters is covered in Why Muscle Matters for Longevity.
Protein. A 2022 systematic review included 14 whey-protein studies in postmenopausal women whose study-average ages ranged from 57 to 74. In the subgroup that also did resistance training, whey was associated with better biceps-curl strength and lower-limb lean mass. Other strength and function outcomes were not significantly improved, and trials without resistance training did not show significant benefits. The certainty was low for the biceps result and moderate for lower-limb lean mass. This does not show that everyone needs a supplement or that food protein would be ineffective.
Creatine. A 2026 meta-analysis combined seven randomized trials in postmenopausal women, average age about 62, lasting about three months to two years. Across five studies, creatine increased lean mass by 0.37 kg on average; across three smaller studies, it increased the maximum weight lifted once on a leg press by 7.5 kg. Bone density was unchanged. Favorable results appeared mainly in an exploratory subgroup using at least 5 grams daily with resistance training. Most trials had design or reporting concerns that could affect the results. The review did not register its research plan in advance, and it disclosed creatine-industry relationships and publication support. The fuller analysis is in Creatine After 50.
Hormone therapy. An older 2009 synthesis that mixed randomized and nonrandomized evidence suggested a small strength advantage. A newer 2020 meta-analysis restricted to randomized trials included nine studies in postmenopausal women; it found no clear strength improvement, and the results varied substantially between studies. A separate 2019 meta-analysis of 12 randomized trials found no clear lean-body-mass benefit after about two years, with low-certainty evidence.
These findings do not support starting hormone therapy to preserve muscle. A clinician can discuss the recognized uses, benefits, medical reasons to avoid treatment and risks of hormone therapy, as covered in Menopause and Longevity.
Which options have evidence about strength, and which claims concern different outcomes?
What’s Interesting
The scale is only telling one part of the story. In SWAN, weight did not begin rising faster at the transition, while the balance of fat and lean tissue did shift. Strength and function therefore add information that body weight alone cannot provide.
What This Means in Practice
- Strength training: US Physical Activity Guidelines recommend muscle-strengthening work involving all major muscle groups on at least two days a week for adults. The reviews do not establish a menopause-specific program or guarantee prevention of muscle loss.
- Protein and creatine: The supplement reviews found benefits for selected outcomes, mainly alongside training. They do not establish that every woman needs either supplement.
- Hormone therapy: The randomized-trial reviews do not establish a strength or lean-mass benefit. Its recognized treatment uses raise separate questions for a clinician.
- Measurement: SWAN found changes in fat and lean tissue without faster weight gain, so weight alone did not describe the change.
A physical therapist or qualified trainer can build a program, especially with joint pain or low bone density. A clinician certified in menopause care can discuss symptoms and hormone therapy. A registered dietitian can help set a protein target.
Bottom Line
On average, lean mass begins to decline around the start of the menopause transition, but individual change varies. Resistance training has the clearest direct evidence for strength; whey and creatine may provide modest, conditional additions rather than replacements. Randomized-trial evidence does not support hormone therapy as a muscle-preservation treatment. Whether any of these strategies adds years to life has not been established, and the evidence here concerns strength and function rather than demonstrated extra years of life. Those outcomes are one part of what living longer and better means after menopause.
A NOTE FROM LONGEVITY365
We read research, consult expert perspectives and work to make complicated health information easier to understand. What you’re reading here reflects how we’ve interpreted and organized that information. It is educational content—not personal medical advice, diagnosis or treatment guidance.
We’re not perfect, and neither is the available research. Evidence changes, new studies emerge and what’s appropriate for one person may not be appropriate for another.
Use this article as a starting point for your own research and conversations with qualified professionals. Always talk with your doctor or another trusted healthcare professional before making decisions that could affect your health, particularly if you take medications, are receiving treatment, have existing health conditions, are pregnant or have other circumstances that could affect what’s appropriate for you.
Reader Questions
A few questions to carry into the comments or your next conversation. Please leave out identifying or personal medical details.
- 01Which measurement or milestone would feel useful to track without letting it take over the whole point of moving?
- 02Which real-world barrier did the article address most usefully: time, confidence, access, recovery, or knowing where to start?
- 03What question would you bring to a clinician, physical therapist, trainer, or exercise professional after reading about Protect Muscle During Menopause?
Extra Insights & Sources
Options compared
| Option | What the evidence shows | Label |
|---|---|---|
| Resistance training | Improves strength; reviews also report favorable muscle-mass outcomes, although the best menopause-specific prescription is uncertain | Supported |
| Protein (whey) supplements | A 2022 review found favorable biceps-strength and lower-limb lean-mass subgroup results with training, but not broad benefits across outcomes | Limited/conditional |
| Creatine | A 2026 review found small average lean-mass and leg-press gains; favorable results clustered in training trials, while bone density was unchanged | Limited/conditional |
| Hormone therapy | Randomized-trial meta-analyses found no significant improvement in strength or lean mass | Not supported for this purpose |
The evidence summaries and linked sources behind this article. Lean mass includes muscle and other nonfat tissue; it is not a direct measurement of muscle alone. A meta-analysis combines results from studies. Heterogeneity means those results vary, while a nonsignificant result does not clearly establish a treatment difference.
Fracture analysis details
A 2023 SWAN analysis in the Journal of Bone and Mineral Research followed 539 women who were not using medications expected to benefit or harm bone during the transition. Average age at the start of the measured transition was 50.7. Mean lean-mass loss was only 0.7%, but individual change varied widely; one quarter lost at least 4.7%.
During an average 14.6 years after the transition, 64 women had an appendicular fracture, mostly at sites such as the wrist, ankle or arm rather than the hip. Each standard-deviation greater lean-mass loss—6.9 percentage points—was associated with a 63% higher fracture hazard before bone-density adjustment and a similar hazard after adjustment. The fat-gain estimate in the base model was borderline rather than conventionally significant. That model already accounted for other measured differences between women; it had not yet included bone density. The estimate became significant in models that added bone density.
Appendicular fractures affect the limbs. A standard deviation measures variation among participants; here it corresponds to 6.9 percentage points of lean-mass change. Fracture hazard compares fracture rates over time. A 63% higher hazard is a relative comparison, not 63 additional fractures per 100 women. Accounting for bone density statistically does not establish causation.
What We Know
- Average lean mass declined and fat gain accelerated around the menopause transition in SWAN, then both trends flattened about two years after the final menstrual period.
- Greater lean-mass loss during the transition was associated with more later appendicular fractures. Supported (observational; not proof of prevention).
- Resistance training improves strength in healthy postmenopausal women. Supported, with substantial variation among studies.
- Whey and creatine may add small or outcome-specific benefits, especially with resistance training. Limited/conditional.
- Randomized-trial meta-analyses did not find significant hormone-therapy benefits for strength or lean mass. Supported null finding, with heterogeneity and low certainty for lean mass.
What We Don’t Know
- Whether preventing lean-mass loss during the transition reduces later fractures. Unknown; the fracture evidence is observational.
- The best training dose for women going through menopause specifically. Uncertain.
- Who, if anyone, receives a clinically meaningful added benefit from whey or creatine. Uncertain.
- Whether protecting muscle during menopause affects lifespan. Unknown.
Source Materials
- Greendale et al., JCI Insight (2019), PMID 30843880 — Longitudinal SWAN analysis using repeated DXA measurements aligned to the final menstrual period and adjusted for age at that period, race, site and hormone-therapy use. Supports the average timing of fat gain and lean-mass decline. It describes population trajectories and cannot predict an individual’s change. NIH funded; the article reported no conflicts.
- Shieh et al., Journal of Bone and Mineral Research (2023), PMID 36542065 — Observational SWAN analysis of 539 women, mean age 50.7 at the start of the transition, with mean 14.6-year follow-up afterward and 64 appendicular fractures. Supports the lean-loss hazard estimate and its bone-density-adjusted persistence. It cannot establish that preserving lean mass prevents fracture, and the event count limits precision.
- Zuo et al., BMC Women’s Health (2024), PMID 38353251 — Systematic review and meta-analysis of 12 randomized trials in healthy postmenopausal women. Supports improved upper- and lower-body strength with resistance training. The pooled estimates were highly heterogeneous and do not define an optimal menopause-specific prescription.
- Systematic scoping review of resistance training after menopause (2025), PMID 40440557 — Maps intervention designs and concludes that evidence remains insufficient for a distinct, evidence-based training prescription specific to postmenopausal women. Supports the dosing-uncertainty statement.
- Kuo et al., Nutrients (2022), PMID 36235862 — Systematic review of 14 studies and meta-analysis of ten, covering 776 postmenopausal women with mean ages 57–74. Supports subgroup benefits for biceps-curl strength and lower-limb lean mass when whey accompanied resistance training, along with null findings for other outcomes and without training. Certainty was low to moderate; populations and trial designs varied. The authors declared no conflicts.
- Naddafha et al., Journal of the International Society of Sports Nutrition (2026), PMID 42141930 — Systematic review and meta-analysis of seven randomized trials (608 postmenopausal women; mean age about 62; 12–104 weeks). Supports the pooled 0.37-kg lean-mass and 7.5-kg leg-press estimates and unchanged bone density. The dose/training pattern came from exploratory subgroups; most trials had some risk-of-bias concerns, the review was not prospectively registered, and disclosures included creatine-industry relationships and publication support.
- Greising et al., Journal of Gerontology: Medical Sciences (2009), PMID 19561145 — Older synthesis of 23 studies suggesting a small strength effect from estrogen-based therapy. It included nonrandomized evidence and is presented only as historical context, not the current conclusion.
- Javed et al., Menopause (2020), PMID 32187131 — Meta-analysis of nine randomized studies and 2,476 postmenopausal women. Found no statistically significant strength improvement with hormone therapy; heterogeneity was very high. Supports the conclusion that randomized evidence does not establish a strength benefit.
- Javed et al., JAMA Network Open (2019), PMID 31461147 — Meta-analysis of 12 randomized trials and 4,474 women, with median two-year follow-up. The 0.06-kg lean-mass difference was not statistically significant, and evidence certainty was rated low.
- US Office of Disease Prevention and Health Promotion, current Physical Activity Guidelines — Current federal recommendation for muscle-strengthening work involving all major muscle groups on at least two days per week. This is broad population guidance, not a menopause-treatment protocol.
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