04/18/2026
Yes
I need to address something that has been bothering me for a long time.
There is a pervasive narrative online that menopause destroys a woman's ability to build muscle. That estrogen loss is catastrophic for lean mass. That without hormone replacement therapy, postmenopausal women are fighting a losing battle. You have seen it from influencers, from supplement companies, and unfortunately from some clinicians who should know better.
It is wrong. And we now have the data to say so with real confidence.
Isenmann et al. (2026) just published the largest systematic review and meta-analysis ever conducted on resistance training in females across the lifespan. This is not a small study. This is 126 studies and 4,019 women. What did they find? Premenopausal and postmenopausal women gained strength at virtually identical rates. The standardised mean differences were 1.50 and 1.46 respectively, with a p-value of 0.520. Functional mass increased and fat mass decreased in both groups. Menopausal status made no difference to either outcome.
Let me say that again. No difference.
Now, what about hormone therapy? If estrogen were truly essential for maintaining muscle, then replacing it should produce a measurable effect. The Javed et al. meta-analysis looked at exactly this question across 12 randomised controlled trials and 4,474 women. The result? Menopausal hormone therapy added 0.06 kg of lean mass compared to placebo. That is sixty grams. The weight of a single egg. And it was not statistically significant (p = 0.26).
So where does the idea come from that menopause causes muscle loss? It comes from observational studies showing that postmenopausal women have 2.5% to 5.7% less lean mass than premenopausal women. But when you do the arithmetic, normal age-related muscle loss runs at 0.4 to 0.7% per year, and the menopausal transition spans roughly 7 to 10 years. That gives you an expected loss from aging alone of 2.8% to 7.0%, which fully accounts for the observed difference. There is nothing left over to blame on estrogen.
I wrote an editorial on this recently. The conclusion is straightforward. Women lose muscle as they age for the same reason men do. They get older, and they stop training. Blaming estrogen is not just scientifically unsupported, it is actively harmful. It tells women that their situation is hopeless without pharmaceutical intervention. It discourages them from doing the one thing that actually works.
Resistance training is the most effective intervention for maintaining and building muscle at any age. That is not opinion. That is what 126 studies and thousands of women tell us.
If you are postmenopausal and you have been told you cannot build muscle, you were told wrong. Pick up the weights. The evidence is on your side.
References:
Isenmann et al. (2026) J Sci Med Sport: https://www.sciencedirect.com/science/article/pii/S1440244026000964
Currier et al. (2026) ACSM Position Stand, MSSE: https://doi.org/10.1249/MSS.0000000000003620
Phillips (2026) Editorial, J Cachexia Sarcopenia Muscle: https://onlinelibrary.wiley.com/doi/10.1002/jcsm.70248
Javed et al. (2019) JAMA Netw Open: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749051
