Menopause is an age-dependent physiological condition associated with a natural decline in estrogen levels produced by the ovaries. Menopause is marked by a 12-month period since a woman’s last menstruation. This phase in a woman’s life can cause a progressive decrease in muscle mass, strength, and bone density. We can see these losses accelerate at the beginning of menopause, and, as hormones change, many tissues and organs are affected. Estrogen is reduced to a negligible level in most women, which might mean that women spend more than one-third of their life with low levels of estrogen and progesterone. Therefore, it is imperative to plan a comprehensive strength and health program for them, including lifestyle modifications.

Through evidence, we know we can mitigate some of the adverse effects of menopause by acquiring and maintaining healthy habits. Doing exercises with resistance (like lifting weights) and eating well can slow down the degenerative aging process and losing strength. Still, unfortunately, the lack of estrogen in post-menopausal women may accelerate muscle loss.

Menopause can also lead to a disease called osteoporosis (Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society” Editorial Panel, 2021). This is a bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes. This leads to bones becoming weaker and more brittle. It is estimated that the overall effect of menopause is an annual bone loss of about 2% during the first six years and 0.5–1% after that. Therefore, the following are some considerations to formulate a comprehensive plan to support muscle growth and preservation, strength, bone density, and future function.

Periodize heavy resistance training 

Muscle and bone health is a process that must continue to develop throughout life and becomes more important among older adults. Building a strong and healthy muscle-skeletal structure can be the best defense in reducing adverse outcomes among aging populations. Physical activity, particularly strength training, is an important strategy to prevent or delay declined function as we age. Resistance training (RT) has been shown to increase muscle mass and strength, even down to a short 8-week program showing improved movements in muscle and strength in post-menopausal women (Bagheri et al., 2021). After two years, we have seen significant improvements from resistance training programs that significantly improve strength and reduce bone loss in early post-menopausal years (Kemmler et al., 2004). When resistance training is consistent, we can expect positive outcomes. 

When comparing the effects of a high-intensity (low rep) or low-intensity (high rep) program, there are similar effects in terms of BMD and strength in post-menopausal women when initially starting a program (Bemben et al., 2000). However, we will want to work up to heavy lifting and then periodize more intense training cycles. Progressing to heavier weights is well-established to provide the strength-building stimuli necessary to combat a decline in estrogen and aid bone health. In literature, heavy resistance training has been demonstrated to be safe and improve bone, function, and stature in postmenopausal women with low bone mass (Watson et al., 2015). For a sedentary person new to lifting, a feasible way to start resistance training is to perform eight to ten repetitions of eight to ten exercises for major muscle groups starting with 40% of one repetition maximum. From there, we can progress to heavier intensities, including compound movements, with the goal of 5RM, 3RM loads even 1RM loads on subsequent training blocks. 

We should avoid complete cessation of resistance training (beyond four weeks). Gains in muscle size, fiber type shifts, and strength will be more challenging to recover from. Instead, we should consider reducing frequency. Evidence demonstrates that strength can be maintained by reducing training frequency and exercise volume. Many studies indicate that reducing training frequency to 1-2 times a week at a high-intensity level can help maintain strength. 

Further, adopting a consistent, long-term strength training routine may also aid in maintaining good pelvic floor health and decrease the risk of urinary incontinence (Virtuoso et al., 2019). Traditional resistance training may also help reduce hot flashes (Berin et al., 2019). Lastly, heavy resistance training can reduce sleep quality, insomnia, and depression (Kovacevic et al., 2018; Khodadad Kashi et al., 2023). In summary, incorporating strength-focused training blocks (including above 85% of 1RM for a given exercise) may provide many benefits.

Consider power and plyometric training

We should also recommend power training cycles, as muscle power decreases faster than strength. Power training has been associated with a modest improvement in physical function compared with traditional strength training (Balachandran et al., 2022). Although more extensive trials are needed, this evidence is worth considering. In contrast to heavy, traditional resistance training, High-velocity resistance training involves moving the resistance at higher velocities during the lifting (concentric) phase, followed by a controlled lowering (2-3 second eccentric) phase. Free weights, weighted vests, and machines are some modalities that can be incorporated to move resistance as fast as possible during the concentric phase. The most studied interventions included training 1-3 times per week, 2-4 sets for 8-10 repetitions, with an intensity ranging from 40% to 70% of 1RM. 

Although less studied, we may also consider plyometric training as there can be a skeletal response to jumping exercises (Zhao et al., 2014). When jumping, hopping, and bounding, bones, and muscles can receive stimulus from pushing off against gravity and landing. These impacts may help build bone that can be lost during menopause. As with everything, a plyometric program should use the principles of progression and overload, which can be accomplished by manipulating many different variables’ volume dosages (reps, sets). Depending on conditioning level and health status, we may start with 30-60 jumps per week before progressing to two times per week. If tolerated, we can move to 3-6 sets of 10 reps twice weekly with adequate rest between sessions. When incorporated safely, plyometric training is a feasible and safe training option with the potential for improving various performance, functional, and health-related outcomes. We might also consider incorporating sprint intervals (short, 30 seconds or less) and tabatas. Short bursts of high-intensity training will be best. 

Consider creatine supplementation

When combined with resistance training, we already know that creatine can further augment positive body composition changes, function, and bone mineral density, but this is even more significant among post-menopausal females (Smith-Ryan et al., 2021). Evidence supports high doses of creatine (0.3 g/kg/d) with favorable effects on bone, function, and muscle size when combined with resistance training. Studies have also concluded that creatine enhances muscle preservation, strength, and function among aging populations, and we know that retention of muscle mass and strength is integral to healthy aging (Devries & Phillips, 2014). Post-menopause, it appears that creatine supplementation becomes even more valuable.

Protein, nutrition and additional supplementation

Evidence suggests that post-menopausal women need an adequate protein intake with exercise to enhance muscle preservation. A high protein diet is recommended, which may need to increase to 2.2-2.4g/day, especially if this is an older individual. Next, we will want to focus on sources, as plant-based protein sources typically have less leucine (~6–8%) compared to animal-based proteins (>10%). We know that leucine appears to be a primary trigger of MPS, so if this individual eats more plant proteins, we should take extra caution to match the leucine content, meaning that plant-based proteins must be consumed in higher dosages. We should also monitor calcium, magnesium, and vitamin D levels, as deficiencies could interfere with anabolism for both muscle and bone (Vázquez-Lorente et al., 2020). Supplementation may be warranted.

There is a menopause supplement that I can confidently recommend from momentous. One of the research and development team leads is in my cohort, and we have discussed this topic in detail. This formulation is safe and has shown to be effective for post-menopause support. Active ingredients include creatine, turmeric, collagen, and vitamin D.

 

 

References

 

Bagheri, R., Forbes, S. C., Candow, D. G., & Wong, A. (2021). Effects of branched-chain amino acid supplementation and resistance training in postmenopausal women. Experimental Gerontology, 144(111185), 111185. https://doi.org/10.1016/j.exger.2020.111185

 

Balachandran, A. T., Steele, J., Angielczyk, D., Belio, M., Schoenfeld, B. J., Quiles, N., Askin, N., & Abou-Setta, A. M. (2022). Comparison of power training vs traditional strength training on physical function in older adults: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Network Open, 5(5), e2211623. https://doi.org/10.1001/jamanetworkopen.2022.11623

 

Bemben, D. A., Fetters, N. L., Bemben, M. G., Nabavi, N., & Koh, E. T. (2000). Musculoskeletal responses to high- and low-intensity resistance training in early postmenopausal women. Medicine and Science in Sports and Exercise, 32(11), 1949–1957. https://doi.org/10.1097/00005768-200011000-00020

 

Berin, E., Hammar, M., Lindblom, H., Lindh-Åstrand, L., Rubér, M., & Spetz Holm, A.-C. (2019). Resistance training for hot flushes in postmenopausal women: A randomised controlled trial. Maturitas, 126, 55–60. https://doi.org/10.1016/j.maturitas.2019.05.005

 

Devries, M. C., & Phillips, S. M. (2014). Creatine supplementation during resistance training in older adults-a meta-analysis. Medicine and Science in Sports and Exercise, 46(6), 1194–1203. https://doi.org/10.1249/MSS.0000000000000220

 

Khodadad Kashi, S., Mirzazadeh, Z. S., & Saatchian, V. (2023). A systematic review and meta-analysis of resistance training on quality of life, depression, muscle strength, and functional exercise capacity in older adults aged 60 years or more. Biological Research for Nursing, 25(1), 88–106. https://doi.org/10.1177/10998004221120945

 

Kemmler, W., Lauber, D., Weineck, J., Hensen, J., Kalender, W., & Engelke, K. (2004). Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS): Results of the Erlangen fitness osteoporosis prevention study (EFOPS). Archives of Internal Medicine, 164(10), 1084–1091. https://doi.org/10.1001/archinte.164.10.1084

 

Kovacevic, A., Mavros, Y., Heisz, J. J., & Fiatarone Singh, M. A. (2018). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep Medicine Reviews, 39, 52–68. https://doi.org/10.1016/j.smrv.2017.07.002

 

Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society’’ Editorial Panel. (2021). Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause (New York, N.Y.), 28(9), 973–997. https://doi.org/10.1097/GME.0000000000001831

 

Smith-Ryan, A. E., Cabre, H. E., Eckerson, J. M., & Candow, D. G. (2021). Creatine supplementation in women’s health: A lifespan perspective. Nutrients, 13(3), 877. https://doi.org/10.3390/nu13030877

 

Vázquez-Lorente, H., Herrera-Quintana, L., Molina-López, J., Gamarra-Morales, Y., López-González, B., Miralles-Adell, C., & Planells, E. (2020). Response of vitamin D after magnesium intervention in a postmenopausal population from the province of Granada, Spain. Nutrients, 12(8), 2283. https://doi.org/10.3390/nu12082283

 

Virtuoso, J. F., Menezes, E. C., & Mazo, G. Z. (2019). Effect of weight training with pelvic floor muscle training in elderly women with urinary incontinence. Research Quarterly for Exercise and Sport, 90(2), 141–150. https://doi.org/10.1080/02701367.2019.1571674

 

Watson, S. L., Weeks, B. K., Weis, L. J., Horan, S. A., & Beck, B. R. (2015). Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial. Osteoporosis International: A Journal Established as Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 26(12), 2889–2894. https://doi.org/10.1007/s00198-015-3263-2

 

Zhao, R., Zhao, M., & Zhang, L. (2014). Efficiency of jumping exercise in improving bone mineral density among premenopausal women: a meta-analysis. Sports Medicine (Auckland, N.Z.), 44(10), 1393–1402. https://doi.org/10.1007/s40279-014-0220-8