Effects of Perimenopause on Muscle Mass

The loss of muscle mass, known as sarcopenia, is a critical concern during perimenopause, as it impacts physical performance, metabolic health, and overall quality of life.

Hormonal Changes and Muscle Mass

Oestrogen plays a pivotal role in maintaining muscle mass and function. It influences muscle protein synthesis, mitochondrial function, and the regulation of inflammation, all of which contribute to muscle health (Collins et al., 2019). During perimenopause, the decline in oestrogen levels disrupts these processes, leading to a reduction in muscle mass and strength. Oestrogen also enhances muscle repair mechanisms following exercise or injury, and its absence can delay recovery and exacerbate muscle loss.

Muscle Loss and Metabolism

Perimenopause is often accompanied by an increase in fat mass and a decrease in lean body mass, driven by both hormonal changes and age-related metabolic shifts. This body composition change has significant implications for metabolism. Muscle is a metabolically active tissue that contributes to resting energy expenditure. Loss of muscle mass reduces metabolic rate, increasing the risk of weight gain and associated metabolic disorders such as insulin resistance and type 2 diabetes (Greising et al., 2015).

Functional Impairments

The loss of muscle mass during perimenopause affects physical strength, endurance, and overall functionality. Many women report reduced ability to perform daily activities, decreased stamina, and an increased risk of falls due to weakened muscles and compromised balance (Sipilä et al., 2020). Loss of muscle mass also correlates with decreased bone density, further elevating the risk of fractures in postmenopausal years.

Exercise and Resistance Training

Physical activity, particularly resistance training, is a critical intervention to mitigate muscle loss during perimenopause. Resistance training promotes muscle protein synthesis and increases muscle strength, counteracting the effects of oestrogen deficiency (Dos Santos et al., 2017). Additionally, combining resistance training with aerobic exercise improves cardiovascular health and helps maintain a healthy body composition. A diet rich in protein further supports muscle repair and growth, complementing exercise interventions.

Potential Role of Hormone Therapy

Menopause hormone therapy (MHT) may help attenuate muscle loss by supplementing oestrogen levels. Research suggests that MHT can improve muscle mass and strength, particularly when combined with physical activity (Taaffe et al., 2005). Individualised approaches to MHT are essential, considering personal health history and preferences.

Psychological and Quality of Life Impact

The decline in muscle mass during perimenopause also has psychological effects. Reduced physical capability can lead to feelings of frustration and diminished self-confidence. Addressing these changes with supportive interventions can help women maintain independence and improve their quality of life.

In conclusion, the hormonal changes of perimenopause significantly impact muscle mass, leading to functional and metabolic consequences. Targeted interventions, including exercise, dietary strategies, and potential use of hormone therapy, can help mitigate these effects and support overall health during this transitional period.

References

• Collins, B. C., Laakkonen, E. K., & Lowe, D. A. (2019). Aging and exercise: Molecular mechanisms underpinning skeletal muscle adaptation. Journal of Applied Physiology, 127(5), 1403–1412.
• Dos Santos, R., Rogero, M. M., & Tirapegui, J. (2017). Nutrition and physical activity in preventing sarcopenia. Nutrition Research Reviews, 30(1), 91–103.
• Greising, S. M., Baltgalvis, K. A., Lowe, D. A., & Warren, G. L. (2015). Hormone therapy and skeletal muscle strength: A review of the literature. Journal of Applied Physiology, 119(8), 795–802.
• Sipilä, S., Narici, M., Barabasz, M., et al. (2020). Exercise restores aging-related loss of skeletal muscle mass and function. Scandinavian Journal of Medicine & Science in Sports, 30(1), 3–15.
• Taaffe, D. R., Sipilä, S., Cheng, S., Puolakka, J., Toivanen, J., & Suominen, H. (2005). The effect of hormone replacement therapy and/or exercise on skeletal muscle attenuation in postmenopausal women: A year-long intervention. Clinical Physiology and Functional Imaging, 25(5), 297–304.