Navigating Muscle Health in Midlife: Expert Insights for Women

As a trusted healthcare provider, I understand the challenges and changes that accompany the transition into menopause. 

One aspect that often gets overlooked but deserves attention is muscle health. 

During perimenopause, fluctuations in hormone levels, particularly estrogen, can impact metabolism, muscle mass, strength, and overall fitness. Perimenopausal women often notice weight gain around the middle, and this metabolically harmful visceral fat comes on easily and is difficult to lose. 

A useful strategy in midlife is to think about building muscle early so that it can be maintained through inevitable hormonal changes.

Here's a comprehensive guide to help you navigate muscle building, protein intake, creatine use, and the role of testosterone in menopausal hormone therapy.

Muscle Maintenance and Building

• Perimenopause may bring about a gradual loss of muscle mass, a condition known as sarcopenia. In fact, we lose 8-10% of our muscle mass every decade after the age of 30 unless we are taking active preventive measures. 

• You can combat muscle loss by incorporating resistance training exercises into your routine at least three or four times per week. Resistance training not only preserves muscle but also helps maintain bone density, reducing the risk of osteoporosis. Muscle also acts like a “sink” for glucose, since it stores glucose and utilizes it for energy, so those with more muscle mass generally have better glucose utilization and less insulin resistance.

• If you’re trying to lose weight, remember that 22-50% of any weight loss is muscle mass unless you’re actively trying to maintain your muscle with resistance training and protein intake. This is why working with a team of professionals is helpful. 

Protein Intake

• Protein is essential for muscle repair and growth. As you age, your body may become less efficient at utilizing dietary protein. 

• To counteract this, ensure that your meals contain at least 30 grams of high-quality protein sources such as lean grass-fed meats, organic poultry, wild fish, pasture-raised eggs, low-fat fermented dairy, legumes, whole organic soy (namely, tofu, tempeh and edamame), and organic protein powders (either whey protein isolate or vegan protein). We prefer unflavored organic, grass-fed whey protein isolate like that from MariGold. 

• Getting more than 30 grams of protein at each of your three meals helps you hit a critical threshold of the amino acid leucine, which maximizes protein synthesis in the body.

• If you have trouble getting enough protein, consider adding a dietary essential amino acid supplement first thing in the morning and again in the mid afternoon, at least 30 min before a meal. Our favorite is unflavored Perfect Amino capsules, which provide the equivalent of 29 grams of whey protein in 5 vegan, no-calorie capsules. Fueling up with the essential amino acids ensures that your body has the amino acids it needs to manufacture other amino acids and proteins for production of digestive enzymes, neurotransmitters, hormones and muscle.

• For more help, I also recommend collagen powder from Ancient Nutrition which supports healthy hair, skin, nails, joints and your gut. It includes 10 types of collagen and 20 grams of protein per serving with 2 billion CFU* (*at time of manufacture) Bacillus coagulans.

Creatine

• Creatine, a naturally occurring compound found in muscle cells, can enhance muscle strength and performance during resistance training due to the improvement of ATP production in the muscle cells. It also aids in recovery by reducing muscle fatigue and soreness after resistance training. 

• Research suggests that creatine supplementation may be particularly beneficial for older adults, especially when it contains taurine due to improved cognition and less mental fatigue. 

• Most people do well with 5 grams in at least 8 ounces of water near the time of their workout. Some people report weight gain with creatine, but this is likely worse in those who are under-hydrated before starting. 

• We recommend you consult with your healthcare provider before starting any new supplement regimen, especially if you have underlying medical conditions or are taking medications.

Testosterone in Menopausal Hormone Therapy

• Testosterone, primarily known as a male hormone, also plays a crucial role in women's health, including muscle strength and libido. 

• Some menopausal hormone therapy (MHT) regimens may include testosterone supplementation as a topical cream to address symptoms such as decreased energy and muscle mass. However, testosterone therapy for women is a nuanced area, and its use should be carefully considered and monitored by a qualified healthcare provider. 

• Don’t forget the impact of stress on testosterone levels. Since cortisol and testosterone both stem from the same upstream precursor, stressed people can have “cortisol steal” away from their sex hormones including testosterone. We recommend adaptogens like Ashwagandha, Passion Flower, Milky Oat Seed and combination supplements like Cortisol Manager to support your body.

• Once your cortisol is under control, using herbs like Saw Palmetto, Fenugreek, or Stinging Nettles can increase testosterone. 

In conclusion, maintaining muscle health during perimenopause is vital for overall well-being and quality of life. Incorporating strength training, optimizing protein intake, and exploring the potential benefits of supplements like creatine can help preserve muscle mass and strength as you navigate this transitional phase. 

Additionally, for women considering menopausal hormone therapy, discussing the role of testosterone with your healthcare provider is essential to tailor a treatment plan that addresses your individual needs and concerns.

Remember, staying proactive about your health and well-being is empowering. Together, we can optimize your muscle health and support you through this transformative journey.