If there is one thing I want women to understand about aging, it is that preserving muscle is not simply about looking toned or fitting into a smaller size. It is about protecting your metabolism, maintaining bone strength, preserving physical independence and giving your body the resilience it needs as you get older.
We spend an enormous amount of time talking about weight loss, hormones, cholesterol and longevity, yet muscle is often overlooked in the conversation. That is a mistake, because muscle is one of the most important tissues we can actively work to preserve as we age.
Muscle allows us to lift, carry, climb stairs, recover from illness and maintain our independence. It also serves as a major site of glucose disposal, meaning that skeletal muscle plays an important role in regulating blood sugar and insulin sensitivity. When we lose muscle and accumulate more body fat, particularly around the abdomen, our metabolic health can become less favorable.
The encouraging part is that muscle is adaptable. With the right training, adequate protein, sufficient recovery and attention to hormonal and nutritional health, women can build strength and preserve muscle throughout midlife and beyond.
Muscle mass and strength change throughout adulthood, and the trajectory varies considerably depending on genetics, activity, nutrition and health. Women do not suddenly lose their muscle at menopause, but aging and the hormonal changes associated with the menopausal transition can make maintaining muscle and strength more challenging.
Estrogen influences multiple tissues, including muscle, bone and connective tissue, and declining estrogen may contribute to changes in musculoskeletal health. At the same time, many women become less physically active, consume insufficient protein or begin restricting calories more aggressively in an effort to control their weight. The combination can be problematic.
When a woman loses weight without adequately protecting her muscle, she may become smaller without necessarily becoming metabolically healthier or physically stronger. The number on the scale does not tell us how much of that weight is fat, muscle or other lean tissue.
This is particularly relevant for women using weight loss medications, because weight loss can include loss of lean mass as well as fat. Adequate nutrition and resistance training should be part of the plan rather than an afterthought.
I encourage women to think about muscle early, rather than waiting until they notice a decline in strength or find that their usual activities have become more difficult. Building and maintaining strength is a lifelong investment.
Walking is excellent for cardiovascular health, mood and general physical activity, but walking alone is not a substitute for resistance training.
Muscle responds to a stimulus. When we challenge it with resistance and progressively increase the demand as our strength improves, we encourage adaptations that help us maintain or build strength and muscle mass.
This does not mean every woman needs to lift extremely heavy weights or spend hours in a gym. It means developing a consistent, structured program that challenges the major muscle groups and progresses appropriately over time.
I encourage women to incorporate resistance training at least two to three times per week, with exercises that address the legs, hips, back, chest, shoulders and arms. Squats or appropriate alternatives, lunges, rows, presses, hip hinges and other functional movements can form the foundation of a program, with the exercises and loads adapted to each woman's experience, joint health and physical capabilities.
The key is progressive overload, which means gradually increasing resistance, repetitions or training difficulty as the body adapts. Repeating the same easy workout indefinitely may help maintain activity, but it may not provide enough stimulus to continue building strength.
Proper technique, recovery and consistency matter more than trying to lift the heaviest weight in the room.
Resistance training also places beneficial demands on bone, making it an important part of a broader strategy for musculoskeletal health. For women at risk of osteoporosis, however, the program should be individualized, particularly when there is a history of vertebral fracture or other significant bone disease.
One of the most common mistakes I see in discussions about women's health and weight management is inadequate protein intake.
Women may be eating less because they want to lose weight, skipping meals because they are busy or relying on foods that provide calories without enough protein to support their nutritional needs. If that pattern continues while they are trying to build muscle, their results may be disappointing.
Protein supplies the amino acids required for muscle protein synthesis, the process through which the body builds and repairs muscle tissue. Resistance training stimulates this process, and adequate dietary protein helps support the adaptation.
For many healthy, active women, approximately 1.2 to 1.6 grams of protein per kilogram of body weight per day can be a useful starting range, depending on training, age, energy intake and individual goals. Some women with demanding training programs may need more, while those with certain kidney conditions or other medical considerations may require individualized advice.
In my clinical discussions about muscle preservation, I often use a practical goal of approximately 100 grams of protein per day for women for whom that amount is appropriate. This is not a universal requirement, and body size, total energy intake and medical history matter.
I also encourage women to distribute protein across their meals rather than trying to consume almost all of it at dinner. Eggs, Greek yogurt, fish, poultry, lean meat, dairy products, tofu, legumes and other protein rich foods can all contribute, depending on dietary preferences.
The goal is not simply to eat more protein, but to consume enough high quality protein to support the demands being placed on the body through exercise and everyday activity.
If a woman is losing weight, particularly while taking a GLP 1 medication, I want her to pay close attention to both protein intake and resistance training so that the focus remains on reducing excess fat while preserving as much useful muscle as possible.
Creatine monohydrate is one of the most extensively studied sports nutrition supplements, yet many women still associate it exclusively with bodybuilding or assume it is something they should avoid because they do not want to look bulky.
Creatine helps replenish phosphocreatine, which supports the rapid production of ATP, the energy currency used during short, high intensity efforts such as lifting weights. Supplementation can increase muscle creatine stores and may help improve training performance, allowing some people to complete more work during resistance exercise.
Over time, better training capacity can support improvements in strength and muscle mass. Creatine is not a steroid, and it does not work by directly increasing testosterone. It is also not a substitute for exercise, adequate protein or sufficient recovery.
For most healthy adults who choose to supplement, creatine monohydrate at three to five grams daily is a commonly used regimen. Some studies in postmenopausal women suggest that creatine may provide additional benefits when combined with resistance training, although findings are not uniform and the evidence in women remains less extensive than the broader creatine literature. It should not be presented as a proven treatment for preventing osteoporosis or as a guarantee of improved physical function.
Creatine can cause a modest increase in body weight because it increases water stored within muscle, which is not the same as gaining body fat. It can also affect the interpretation of serum creatinine, a laboratory marker used in assessing kidney function, so women should tell their clinicians if they take it.
For the right patient, creatine can be a useful addition to a strength and nutrition program, but the foundation remains training, food and consistency.
As an OB/GYN, I believe hormonal health deserves thoughtful attention throughout a woman's life, particularly as she approaches and moves through the menopausal transition.
Estrogen has effects beyond reproduction, including effects on bone and other musculoskeletal tissues. Changes in estrogen during menopause may contribute to declining musculoskeletal health, although muscle loss is influenced by many factors, including age, physical activity, nutrition, illness and genetics.
When a woman experiences changes in strength, body composition, sleep or energy, I want to understand the full clinical picture rather than automatically attributing everything to menopause.
Hormone therapy may be appropriate for women experiencing menopausal symptoms or for certain other indications after an individualized discussion of benefits and risks. It can help protect against bone loss in appropriate patients, but it should not be prescribed solely as a muscle building treatment. Current evidence does not establish menopausal hormone therapy as a reliable stand alone strategy for increasing muscle mass or strength.
This distinction is important because women sometimes assume that correcting their hormones will solve the problem of declining muscle. Hormonal health can be one component of the picture, but it does not replace the mechanical stimulus of resistance training or the nutritional support required to build muscle.
Testosterone has an important role in female physiology, but its use in women requires a particularly careful discussion.
Testosterone levels decline gradually across much of adult life, although the relationship between an individual woman's testosterone level and her symptoms is not straightforward. A laboratory result alone cannot reliably establish whether a woman has an androgen deficiency that requires treatment.
The strongest evidence supporting testosterone therapy in women is for the treatment of appropriately assessed postmenopausal women with hypoactive sexual desire disorder, after a biopsychosocial evaluation. Evidence does not currently support prescribing testosterone routinely to women simply to improve muscle mass, strength, energy or longevity.
Physiological doses of testosterone have not demonstrated consistent, clinically significant improvements in muscle strength or lean mass in the available evidence. Higher doses can cause unwanted effects, including acne, increased facial or body hair, scalp hair loss and voice changes, some of which may not fully reverse.
For women who are prescribed testosterone for an appropriate indication, treatment should involve informed consent, appropriate dosing and monitoring, with the goal of keeping concentrations within the physiological range for women.
I am interested in optimizing hormonal health, but optimization should be grounded in evidence rather than the assumption that higher hormone levels automatically produce better outcomes.
Muscle is not simply a structural tissue that allows us to move. It plays an important role in how the body handles glucose and responds to insulin.When we contract our muscles during exercise, they increase their uptake of glucose, and regular physical activity improves insulin sensitivity. Maintaining muscle and engaging in resistance training can therefore support metabolic health, particularly when combined with aerobic activity, appropriate nutrition and adequate sleep.
This is one reason I am concerned when women focus exclusively on reducing body weight without paying attention to strength or body composition. A smaller number on the scale does not necessarily mean improved muscle function, and losing muscle while dieting can work against long term health goals.
For women with insulin resistance, PMOS or other metabolic concerns, preserving muscle is an important part of a broader treatment plan, although it does not replace appropriate medical assessment or medication when indicated.
I want women to stop thinking of strength training as something they do only to change their appearance and start recognizing it as a fundamental part of preventive health.
I encourage women to build a consistent resistance training routine, consume sufficient protein, consider creatine when appropriate, prioritize sleep and recovery, and evaluate hormonal or metabolic concerns when symptoms or risk factors warrant further investigation.
For women losing weight, particularly during midlife or while using medication for obesity, preserving muscle should be a deliberate part of the plan. We should be paying attention to strength, physical function and body composition, rather than celebrating weight loss without asking what tissue has been lost.
Muscle is not just about how we look at forty or fifty. It is about how easily we can get up from the floor at seventy, carry our groceries at eighty, recover from an illness and maintain independence for as long as possible.
Longevity is not simply about adding years to life. It is about preserving the strength, function and resilience that allow us to live those years well.
I consider muscle one of the most important investments a woman can make in her long term health.
